Erectile dysfunction: does insulin resistance play a part?

• Published in: Fertility and sterility Vol. 88; no. 4; pp. 771 - 778
• Main Authors: Trussell, J.C., M.D, Legro, Richard S., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2007; Elsevier Science
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Animals; Biological and medical sciences; Erectile dysfunction; Erectile Dysfunction - drug therapy; Erectile Dysfunction - etiology; Gonadal Steroid Hormones - physiology; Gynecology. Andrology. Obstetrics; Humans; Insulin - physiology; insulin resistance; Insulin Resistance - physiology; Internal Medicine; Male; Medical sciences; metformin; Middle Aged; nitric oxide; Nitric Oxide - physiology; Nitric Oxide Synthase - antagonists & inhibitors; Nitric Oxide Synthase - physiology; Obstetrics and Gynecology; Phosphatidylinositol 3-Kinases - metabolism; Proto-Oncogene Proteins c-akt - physiology; metformin; nitric oxide; Erectile dysfunction; insulin resistance; Endocrinopathy; Target tissue resistance; Hypoglycemic agent; Biguanides; Erection disorders; Nitric oxide; Sexual dysfunction; Insulin resistance; Metformin; Male genital diseases; Insulin
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2007.01.116

Objective To review MEDLINE literature for correlations between insulin resistance and erectile dysfunction (ED). Design MEDLINE literature review (1966 to present). Setting Academic medical center. Patient(s) None. Intervention(s) None. Main Outcome Measure(s) None. Result(s) Erectile dysfunction affects more than half of men over the age of 40. Fortunately, most men with ED can be successfully treated with phosphodiesterase 5A (PDE-5) inhibitors, which up-regulate the vasodilatory effects of nitric oxide (NO). Insulin resistance affects 25% of U.S. adults and increases to a 60% occurrence in individuals who are overweight. Endothelial dysfunction, which is associated with insulin resistance states, can cause disturbances in the subcellular signaling pathways required for NO production. Because endothelial production of NO and insulin sensitivity are positively related in healthy humans, the relationships among insulin resistance, NO, and ED are the target of this review of MEDLINE literature. Conclusion(s) Insulin resistance states are characterized by defective vascular NO production and impaired insulin-induced vasodilation, both of which are likely to cause ED. Diagnosing and treating insulin resistance should be part of the initial management plan for ED. Future studies concerning the cause and effect relationship of insulin resistance and ED should be implemented.