The Role of Diabetes Mellitus in Sexual and Reproductive Health: An Overview of Pathogenesis, Evaluation, and Management.

BACKGROUND: Uncontrolled or long-term diabetes mellitus is conducive to vascular and oxidative stress disturbances that impede several physiological systems, which may in turn elicit psychological symptoms. OBJECTIVE: We assess the sexual and hormonal complications of diabetes mellitus that impair reproductive function in males and females. METHODS: A comprehensive MEDLINE® search was guided using key words relevant to diabetes mellitus and reproductive health. RESULTS: We reviewed the pathogenesis, clinical manifestations, imaging modalities, pharmacological treatment, and intervention options for each diabetic reproductive complication in males and females. Erectile dysfunction secondary to angiopathic, neuropathic, and myopathic damage is a leading complication of diabetes in males. Other reproductive complications include ejaculatory dysfunction, hypogonadism, modified semen parameters, and delayed puberty. Specifics of reproductive dysfunction in diabetic women are less definite than in men due to the lack of standardized evaluation of sexual function in women as well as the increased role of psychological morbidity. Despite this, it is known to manifest as hypogonadism, hypoactive sexual desire disorder, dyspareunia, menstrual dysfunction, and polycystic ovarian syndrome. CONCLUSION: Longitudinal studies with larger sample sizes are necessary to better comprehend the connection between diabetes and sexual dysfunction, chiefly in females. Understanding and dividing the role of fertility and sexual issues in reproductive dysfunction can help guide evaluation and management.

The impact and management of sexual dysfunction secondary to pharmacological therapy of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is one of the most common genitourinary complications in men over 50 years of age and typically presents with lower urinary tract symptoms (LUTS). Classes of medications include α1-adrenoceptor blockers, 5α-reductase inhibitors, and phosphodiesterase 5 inhibitors. Today, α1-adrenoceptor blockers and 5α-reductase inhibitors are often combined to give a synergistic effect. A review of the current literature identified several adverse sexual side effects, including erectile dysfunction (ED), decreased libido, orgasmic disorders, and ejaculatory disorders. We believe it is important to know the extent of these side effects, as the clinician and patient will need to decide the cost of improved voiding symptoms. The chief adverse effect is ejaculatory disorders, including the absence of ejaculation. Clinical consideration for BPH should include the elements of male sexual function, patients' age, and the characteristics and comprehensive effects of each group of drugs. Methodological bias in clinical studies, such as the subjective evaluation of the sexual side effect, makes it difficult to determine the ideal drug for treatment.