Margaret AWinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
To the Editor: Sildenafil is being used extensively
for erectile dysfunction (ED) of all causes, due to its inhibitory effect
on cyclic guanosine monophosphate (GMP) phosphodiesterase in the corpus cavernosum
of the penis.1 Most patients with diabetes
have ED due to either vascular abnormalities or neuropathy. Impaired nitric
oxide synthesis may be an important factor in these patients and, therefore,
conservation of cyclic GMP by sildenafil is an effective mechanism to enhance
nitric oxide bioavailability and thereby improve erections. Dr Rendell and
colleagues2 do not explain their finding
that men with diabetes had a lower response rate to sildenafil than that previously
reported in mixed, largely nondiabetic populations. Diabetic men may have
sex hormone abnormalities that could interfere with their response to sildenafil,
but Rendell et al did not report the sex hormone levels in their patients.
Garg R, Khaishgi A, Dandona P. Sildenafil for Diabetic Men With Erectile Dysfunction. JAMA. 1999;282(10):939–941. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-10-jbk0908
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