Die erektile Dysfunktion (ED) zählt zu den häufigsten und belastendsten Folgeerkrankungen
des Diabetes mellitus. Die diabetische ED erfordert eine frühzeitige Erkennung und
ein multimodales Vorgehen. Nur durch eine Kombination aus Stoffwechselkontrolle, endokriner
Wiederherstellung und individualisierter Therapie lässt sich die sexuelle Funktion
verbessern, das kardiovaskuläre Risiko senken und die Lebensqualität nachhaltig steigern.
Abstract
Erectile dysfunction (ED) is a common and distressing complication of diabetes mellitus
(DM), affecting up to 75% of men and often appearing a decade earlier than in non-diabetic
individuals. Beyond intimacy issues, ED can signal undiagnosed DM and predicts cardiovascular
risk. The pathogenesis is multifactorial: chronic hyperglycemia damages endothelium
via oxidative stress and glycation, reducing nitric oxide and impairing smooth muscle
relaxation. Vascular and neural complications, including diabetic neuropathy, further
contribute. In type 2 DM, obesity-related hypogonadism worsens sexual dysfunction.
Assessment includes: detailed sexual history, questionnaires, physical exam, hormone
and metabolic labs, and cardiovascular evaluation. Treatment is stepwise: lifestyle
changes and glycemic control are foundational. PDE5 inhibitors are first-line but
less effective in hypogonadal men, where testosterone replacement may help. If needed,
alprostadil, vacuum devices, or penile implants are options. Emerging data suggest
GLP-1 receptor agonists may improve erectile function. In summary, diabetic ED requires
early recognition and a comprehensive approach combining metabolic, hormonal, and
individualized therapies to improve sexual health and reduce cardiovascular risk.
Schlüsselwörter
SKAT - Alprostadil - funktioneller Hypogonadismus - Penisprothese - PDE-5-Hemmer -
erektile Dysfunktion - Diabetes mellitus - Schwellkörper-Autoinjektionstherapie
Keywords
erectile dysfunction - GLP-1 receptor agonists - hypogonadism - PDE5 inhibitors -
alprostadil - testosterone replacement - vacuum device - penile implant - Diabetes
mellitus
