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Meeting report risk of developing retinopathy and potential vision loss. He explained that good glycaemic control is critical and regular screening is important to enable appropriate timing of treatment. He showed that if these are achieved, most diabetes-related blindness is preventable. Mitchell also presented alarming data showing that 37% of adult indigenous Australians have diabetes and that 13% have already lost some vision. He pointed out that although timely laser surgery can prevent 98% of diabetesrelated blindness, almost two-thirds of indigenous Australians requiring this treatment have not received it. However, the new availability of funded retinography through Medicare provides hope that appropriate screening through optometrists, ophthalmologists or retinography will be accessible by all Australians. The role of pharmacists in diabetes detection and management, new government initiatives Kirstie-Jane Grenfell, Community Pharmacist and Diabetes Educator, Melbourne, Vic Kirstie-Jane Grenfell discussed the Australian Government’s Sixth Community Pharmacy Agreement (6CPA) $50m Pharmacy Trial Program. The program, which commenced in 2016, involves a comparison of three different pharmacy-based diabetes screening interventions to determine their clinical and cost effectiveness in improving the identification of previously undiagnosed diabetes in the community. Dental practitioners – important players in the diabetes multidisciplinary care team Associate Professor Werner Bischof, Periodontist in Practice, Geelong, Vic Delegate Dr Mandy Mossop enjoying looking around the exhibitions hall. Werner Bischof presented a strong case for periodontal disease to be seen as the sixth complication of diabetes along with retinopathy, neuropathy, nephropathy, cardiovascular disease and peripheral vascular disease. He highlighted the bidirectional nature of the relationship of periodontal disease and diabetes in terms of risk and control, and asked that we consider the oral health of our patients, particularly those with diabetes, and collaborate with dentists as part of optimal multidisciplinary care of our patients. He also outlined other oral health conditions associated with diabetes, including dry mouth, dental caries, candida, poor wound healing and burning mouth syndrome. A note of thanks We would like to thank all of our speakers, sponsors, exhibitors and organisers for their support of the PCDSA. Feedback from conference delegates was very positive and initial planning for the 2018 national conference is already underway. The PCDSA is your society, so do email us at info@pcdsa.com.au with your suggestions for what, or who, you would like to see at next year’s conference. You can also contact us at the above address if you would like an education seminar in your area, or wish to contribute to Diabetes & Primary Care Australia. We look forward to seeing you at our national conference next year! n Citation Kennedy M (2017) 2 nd National Conference of the Primary Care Diabetes Society of Australia. Diabetes & Primary Care Australia 2: 88–90 90 Diabetes & Primary Care Australia Vol 2 No 3 2017
Article Sexual health and dysfunction in men and women with diabetes David Edwards and Nicholas Forgione Sexual dysfunction is common in people with diabetes and, although much research has focused on erectile dysfunction, there is a paucity of knowledge regarding sexual dysfunction in women. Despite the evidence, sexual dysfunction is poorly evaluated and managed in patients with diabetes. Taking a basic sexual history is therefore an important skill for a primary care clinician, as an individual’s sexual background will help to provide the appropriate treatment, be it pharmacological or psychological. This article discusses the identification and treatment of male and female sexual dysfunction in people with diabetes and explores how to take a sexual history. Sexual dysfunction is common in people with diabetes. Much medical research has focused on male sexual dysfunction, particularly erectile dysfunction (ED). In general, male sexual dysfunction is more obvious and measurable than female sexual dysfunction. There is also more research into ED because effective treatments have been developed. This gender imbalance is being addressed as more research on female sexual dysfunction is published. This article looks first at the identification and treatment of male and female sexual dysfunction and then at how best to conduct a consultation about sexual dysfunction. Sexual health in men with diabetes Erectile dysfunction An Australian survey showed that at least one in five men over the age of 40 years has erectile problems and about one in 10 men is completely unable to have an erection (Andrology Australia, 2014). About 50% of men with diabetes will suffer from ED within 10 years of the diagnosis and this may be a manifestation of more generalised vascular disease. ED can be defined as the persistent inability to attain or maintain an erection that lasts long enough for satisfactory sexual activity (Hatzimouratidis et al, 2010). ED affects over half of men with diabetes, (Diabetes UK, 2013) and around 5% of men with ED have undiagnosed diabetes (Nieschlag et al, 2006). It is three times more common and occurs 10–15 years earlier in life in men with diabetes than those without (Feldman et al, 1994). An erection is initiated by sexual stimulation and is a vascular process controlled by the autonomic nervous system. The blood vessels in the corpora cavernosa dilate, leading to increased arterial inflow and reduced venous outflow. Smooth muscle relaxation is crucial, and nitric oxide (NO) has been identified as the agent largely responsible for smooth muscle relaxation in the corpora cavernosum. NO stimulates guanylate cyclase, which leads to increased production of cyclic guanosine monophosphate, and it is thought that this induces smooth muscle relaxation through the opening of calcium channels (Price, 2010). In men with diabetes, evidence suggests that autonomic neuropathy and endothelial dysfunction contribute to the failure of NO-induced smooth muscle relaxation, resulting in ED (Sáenz de Tejada et al, 1989; 2004). The pathophysiology in diabetes is complex, however, and knowledge has been gradually increasing since the 1990s (Cellek et al, 2013). Citation: Edwards D, Forgione N (2017) Sexual health and dysfunction in men and women with diabetes. Diabetes & Primary Care Australia 2: 91–8 Article points 1. Men with diabetes are more likely to develop erectile dysfunction, have androgen deficiency, premature ejaculation, balanitis, phimosis, Peyronie’s disease and penile fibrosis than men without diabetes. 2. Women with diabetes may present with sexual dysfunction, fungal and bacterial infections, polycystic ovarian syndrome and fertility problems. 3. Clinicians can encourage patients to provide a full sexual history by listening, looking interested, maintaining eye contact and providing encouraging verbal and non-verbal cues. Key words – Androgen deficiency – Contraception – Sexual dysfunction Authors David Edwards is a GP at Claridges Barn, Chipping Norton, Oxfordshire, UK, and Past President of the British Society for Sexual Medicine; Nicholas Forgione is a GP in Perth, Western Australia with a special interest in diabetes. Diabetes & Primary Care Australia Vol 2 No 3 2017 91
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