The diabetes physician and an assessment and treatment programme for male erectile impotence

The feasibility has been investigated of a physician in a district general hospital implementing an assessment and treatment service for male erectile impotence. Over an 8-month period a questionnaire was given to 200 men attending a diabetes review clinic. There were 50 replies declaring a problem of impotence, 34 of whom expressed interest in discussing treatment. These men and 17 others who spontaneously mentioned an impotence problem were further assessed with a view to treatment. After a full assessment and discussion the following treatments were agreed and successfully implemented: no treatment 30 (59%), self-injection of papaverine 12 (24%), urology referral 4 (8%), psychosexual clinic referral 2 (4%), vacuum devices 2 (4%), adjustment of drug therapy 1 (2%). Only 18% of questionnaire respondents ultimately opted for active treatment compared with 88% of the spontaneous complaints. A successful impotence assessment and treatment service, including self-injection of vasoactive drugs, can be provided by a physician as part of the diabetes care service. Active treatment is gratefully accepted. The numbers involved are manageable if resources are concentrated on those spontaneously mentioning the problem. Our experience suggested self-injection of vasoactive drugs to be the most successful treatment option.