The effect of cholesterol (normal: 0–200 mg/dL; high: 200–400 mg/dL), triglyceride (normal: 0–150 mg/dL; high: >150 mg/dL), HDL (low: 0–40 mg/dL; normal: 40–60 mg/dL), and LDL (normal: 0–100 mg/dL; high: 100–220 mg/dL) on sexual dysfunction in subjects was measured based on reported IIEF scores.

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p < 0.05 was considered statistically significant and indicated with a horizontal bracket The effects of lipid profile parameters of the subjects on sexual dysfunction were evaluated. [Figure 2] depicts that there was no significant difference in IIEF parameters when compared at normal (0–200 mg/dL) or high (200–400 mg/dL) cholesterol levels. In terms of elevated triglyceride levels (>150 mg/dL), SD score was reported to be significantly reduced as compared to the subjects with triglyceride levels in the normal range (0–150 mg/dL). The subjects with low levels of HDL (0–40 mg/dL) compared to normal as well as high levels of LDL (100–220 mg/dL) compared to normal reported a significant reduction in SD and OS scores. Lipid profile parameters and their effect on IIEF scores. p < 0.05 was considered statistically significant and indicated with a horizontal bracket The subjects, who were on Tadalafil or the combination of Tadalafil + Dapoxetine, were counselled with the validated IIEF questionnaire for ED at baseline and at follow-up.

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It was seen that the individuals on Tadalafil reported significant improvement in all the IIEF parameters at the follow-up with respect to the baseline [Figure 3]A. In addition, individuals on Tadalafil + Dapoxetine reported significant improvement in all domains of IIEF except SD [Figure 3]B. Thus, if we compare the effects of both, Tadalafil versus Tadalafil + Dapoxetine drug combination on change in IIEF scores at the follow-up, both groups had similar effect on ED and there was no significant difference in the IIEF parameters when compared at follow-up [Figure 3]C. Efficacy of (A) Tadalafil or (B) the combination of Tadalafil + Dapoxetine in the treated individuals based on IIEF scores at baseline and at follow-up. (C) A comparison of change in IIEF scores at follow-up with either Tadalafil or Tadalafil + Dapoxetine drug combination. p < 0.05 was considered statistically significant and indicated with a horizontal bracket Role of BMI on the treatment efficacy BMI has a significant effect on the IIEF parameters as seen from this study [Figure 1] as well as previous reports.

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The effect of these parameters was assessed by means of five domains of the IIEF questionnaire namely EF, OF, SD, IS, and OS. The significant differences (p < 0.05) are shown by horizontal brackets. Analysis of the participant responses to the IIEF questionnaire, as shown in [Figure 1], indicates that SD and OS scores were significantly low in subjects with BMI higher than cut-off (>23 kg/m2) with respect to subjects with BMI less than or equal to cut-off (≤23 kg/m2). A cut-off BMI of 23 kg/m2 cheap cialis 80mg was considered according to the Asian standards. [20] Subjects having high (>7.5%) compared to normal HbA1c reported reduced SD and OS scores.

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Subjects with low (<400 ng/dL) compared to normal testosterone levels reported reduced OF and SD scores. Subjects having low (<300 pg/mL) compared to normal VitB12 reported a significant reduction in SD scores. These findings suggest a direct correlation between an unbalanced glycometabolic profile and sexual dysfunction in individuals with T2DM. Glycometabolic parameters and their effect on IIEF scores. The effect of BMI (cut-off: 23 kg/m2, above cut-off: >23 kg/m2), HbA1c (normal: <7.5%, high: >7.5%), testosterone (low: 0–400 ng/dL; normal: 400–1000 ng/dL), and VitB12 (low: 0–300 pg/mL; normal: 300–2000 pg/mL) on sexual dysfunction in the subjects was measured based on IIEF scores. [21] Therefore, the effect of BMI at cut-off and above cut-off was evaluated for treated individuals at the baseline and at follow-up. Figure 4 shows that Tadalafil-treated individuals having cut-off or below cut-off BMI showed significant improvement only in OS score.

Dapoxetine's primary benefit is delaying ejaculation.
Cialis helps in achieving and maintaining erections.
Dapoxetine starts working within 1 hour, duration 1 to 3 hours.
Cialis provides longer-lasting effects, up to 36 hours.
Dapoxetine’s effect is dose-dependent; lower doses may reduce side effects.
Cialis requires a prescription in most countries.
Combining medications may enhance sexual performance but increases risks.
Consult a doctor before combining dapoxetine and Cialis.

Individuals treated with Tadalafil + Dapoxetine who were also having cut-off or below cut-off BMI showed no significant improvement in any of the IIEF scores. Tadalafil and Tadalafil + Dapoxetine combination treatment improved all the IIEF scores for individuals with above cut-off BMI except for SD values.

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The drugs were prescribed based on participant’s discretion. At baseline, the medical history of subjects including any previous medical conditions and other concomitant medication was recorded in a case record form followed by a general and systemic examination. Participants on either medication were followed up after 1 month of medication. The individual domain scores of IIEF were represented as boxplots to evaluate the effect of measured parameter such as BMI, HbA1c, testosterone, VitB12, cholesterol, triglyceride, HDL, and LDL. Similarly, the effect of treatments on IIEF scores was also represented.

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The statistical analysis was carried out using Microsoft Excel (Microsoft 365). For comparison of categorical variables, the χ2 test was used. For comparison of two groups, 2 tailed t-test with unequal variance was carried out. A significance level of 5% was used for considering the differences to be significant. Out of the 240 male T2DM subjects screened, 216 satisfied the inclusion criteria and were enrolled in the study.

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Subjects with age more than 40 years experienced ED almost two times as compared to those in the age groups of 30–39 years. In general, the prevalence of ED increased with age among subjects having T2DM. Among the selected group, 53 individuals were prescribed either Tadalafil or Tadalafil + Dapoxetine drug combination as per their demand. The following effects were studied: (I) relationship between ED and BMI, HbA1c, testosterone, and VitB12; (II) effect of lipid profile parameters on ED; (III) effect of treatment on IIEF; (IV) role of BMI on the treatment efficacy; and (V) effect of co-morbidities on treatment outcome. Relationship between ED and BMI, HbA1c, testosterone, and VitB12 The effect of imbalance in parameters such as BMI, HbA1c, testosterone, and VitB12 caused by T2DM on ED was evaluated. Effect of BMI and price cialis super active treatment on IIEF scores at baseline and follow-up of treated subjects. At normal BMI (cut-off or below cut-off), the effect of (A) Tadalafil, and (B) Tadalafil + Dapoxetine on IIEF scores. At high BMI (above cut-off), the effect of (C) Tadalafil, and (D) Tadalafil + Dapoxetine on IIEF scores.

Neither medication is intended for use by women.
Cialis is not safe for pregnant women.
Dapoxetine can pass into breast milk.
Nursing mothers should avoid taking dapoxetine.
If pregnant, contact a doctor immediately.
Both drugs are contraindicated during pregnancy.
Consult a healthcare provider before any treatment.
Safety profiles for pregnant women are unknown.
These are strictly male sexual health medications.

p < 0.05 was considered statistically significant and indicated with a horizontal bracket Effect of co-morbidities on treatment outcome The effect of comorbidities on ED is not well understood because co-morbidities such as hypertension, dyslipidemia, and coronary artery disease can lead to other health problems that can also impact erectile function. [22] Therefore, the effect of comorbidities at baseline was compared with the follow-up values of IIEF parameters of all the treated subjects. [Figure 5] depicts that except for the SD values in individuals without co-morbidities (C–), all other IIEF values significantly improved after the treatment (Tadalafil or Tadalafil + Dapoxetine).

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The efficacy of Tadalafil alone and in combination with Dapoxetine in managing ED was evaluated and discussed. And the effect of comorbidities in individuals suffering from T2DM and ED was evaluated separately based on their BMI and the treatment groups. This was a bicentric, prospective, open-labelled, cross-sectional, observational study. Study centers were RIMS Super Specialty Hospital, Ahmedabad, and Rudraksha Multi-specialty Hospital, Bareja, situated in the state of Gujarat, India. Ethical approval for this study was provided by the Rudraksha Hospital Ethical Committee, on 16 December 2021.

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All willing males with age between 30 and 65 years, having any duration of T2DM, with or without hypertension, and having a complaint relevant to sexual desire as diagnosed by the IIEF questionnaire were included in the study. IIEF questionnaire is used by physicians to diagnose the presence and severity of ED. [19] The five items are based on ability to identify the presence or absence of ED and on adherence to the National Institute of Health’s definition of ED. The following five items are included: erectile function (EF); orgasmic function (OF); sexual desire (SD); intercourse satisfaction (IS); and overall satisfaction (OS). Individuals with type-1 diabetes, chronic kidney disease, and those taking PDE-5 inhibitors were excluded from the study.

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Participants in the study were recruited from December 1, 2021 until March 31, 2022. Examination, history taking, anthropometric data, laboratory parameters, and questionnaire surveys were undertaken as a part of routine protocol. At the end of the demographic questionnaire, participants were requested to provide informed consent. Prospective data collection for metabolic disorders was done at tertiary care centers. The Tadalafil drug belongs to 20mg cialis pill the class of PDE-5 inhibitors and Dapoxetine is a selective serotonin reuptake inhibitor. On the other hand, in individuals with comorbidities (C+), the effect of both the medications was positive on treatment of ED as seen by the significant improvement of all the IIEF scores. Evaluation of changes in IIEF scores at baseline versus at follow-up in individuals with (C+) and without (C–) comorbidities, who were treated with either Tadalafil or Tadalafil + Dapoxetine drug combination. p < 0.05 was considered statistically significant and indicated with a horizontal bracket DM is considered a possibly life-threatening metabolic disorder with mortalities reported to be associated with complications such as cardiovascular diseases, kidney failure, retinopathy, nephropathy, and neuropathy. [3] Additionally, ED, reduced sexual desire, orgasmic disorder, and retrograde ejaculation are also a sub-set of complications of variable incidence in men suffering from DM. [1] The objective of the present study was to characterize the major sexual dysfunctions in a single diabetic population, and their inter-associations with other clinical variables and comorbidities.