In Response to Sexual Dysfunction in Men with Type II Diabetes Mellitus: Prevalence and Severity—An Observational Study

Abstract

Respected Sir, At the outset, I must appreciate the original article titled “Sexual Dysfunction in Men with Type II Diabetes Mellitus: Prevalence and Severity—An Observational Study” published in the last edition of your esteemed journal. Diabetes mellitus (DM) is one of the commonest chronic noncommunicable diseases encountered globally. Epidemiological studies have clearly documented that sexual dysfunction (SD) particularly erectile dysfunction (ED) is one of the major complications of DM among males. In fact, ED can serve as a potential coronary artery disease (CAD) risk equivalent. However, in comparison with the other microvascular and macrovascular complications of DM, SD is often neglected and studies evaluating SD in males is very rare not only worldwide but also in eastern India. Hence, such a research article addressing this area of complication of DM is highly praiseworthy and pertinent. The authors conducted a single-center, hospital-based, cross-sectional study over a period of 12 months and included 109 type II diabetic men who were married and aged between 18 and 65 years irrespective of the duration of the disease. However, as the legal minimum age for marriage is 21 years for men in India, approved by the amendment of the Child Marriage Restraint Act, 1929, in 1978 and recommended by the Special Marriage Act, 1954, and the Prohibition of Child Marriage Act, 2006, it would have been ideal to include males aged above 21 years in the study. ED is detected by having male patients’ complete standardized questionnaires investigating their sexual function. Though various pretested and predesigned standardized questionnaires are available to assess ED, one of the most practical questionnaires that are administered is the International Index of Erectile Function (IIEF)-5, which the authors have used as a study tool in their study. It consists of items 5, 15, 4, 2, and 7 from the full-scale IIEF-15; a sum score of 21 or less indicates the presence of ED. Advancing age, presence of overweight or obesity, and addiction like alcohol and smoking are strong accessory determinants of ED. Despite including young and middle-aged subjects in the study (only 4.6% of diabetic males were aged greater than 60 years), the authors obtained the prevalence of ED 89.9% comprising 62.4% severe ED which is a huge number, thereby implying a public health pressing problem. When ED occurs in younger males, it is associated with a greater increase in the risk of future cardiac events as compared to its first