Prof. Dr. Filip Kumanov graduated in medicine in Sofia in 1975. From 1979 he worked at USBALE “Acad. Iv. Penchev”. He has a recognized specialty in internal medicine and in endocrinology and metabolic diseases. Specializes in Munich and Rome. He is the author of more than 200 articles, reviews, textbook chapters on endocrinology, including the monograph “Climacterium in men?”. He has research interests in reproductive endocrinology, andrology and neuroendocrinology. Prof. Dr. Filip Kumanov is a specialist in testicular diseases, impotence, premature ejaculation and erectile dysfunction, thyroid gland diseases, excessive hair growth, puberty disorders in boys and girls, pituitary and adrenal gland diseases, diabetes mellitus, obesity, metabolic syndrome. He is a member of the European Academy of Andrology, the European Neuroendocrine Association (ENEA), the European Society of Endocrinology (ESE), the American Association of Clinical Endocrinologists. How do endocrine disorders affect men’s sexual health? Any serious organic disease undermines and collapses sexuality. The same applies to endocrine diseases – diabetes mellitus, thyrotoxicosis, hypothyroidism, Cushing’s syndrome. With these diseases, there are serious disturbances in the sexual possibilities, both in the desire to lead a sexual life and in the fertility capacity. What complications are observed in diabetic patients and at what stage of the disease do they appear? Especially in the case of diabetes mellitus, the complications are mainly related to erection difficulties, decreased libido, and a decrease in the main male sex hormone – testosterone. No one knows when diabetes begins, but many times specialists diagnose type 2 diabetes based on these symptoms. There are quite a few cases where sexual relations become the reason for the discovery of diabetes. On the other hand – if a person has impaired function of the testicles, this can lead to diabetes mellitus, obesity. What proportion of diabetics also have erectile dysfunction? A very large number are affected by the problem. It is believed that between 50-75% of diabetics also have erectile dysfunction. The tendency is to rejuvenate the problem. What do you think it is due to? It is due to stress, some chronic diseases that start at an earlier age. The bad psychological attitude, the lack of time for a good fit and cooperation with the partner also have an influence. Sexual relationships, communication in general with the beloved, should bring relief, not tension. Both men and women nowadays are too busy, worried about busy work schedule, tired at the end of the day and cannot fully enjoy their beloved. Going back 1, 2 centuries, things are completely different. Then there are no cell phones and such daily stress. The woman is not working, she is relaxed, she is looking forward to the evening when she will be with her partner, she has time to prepare for her,which predisposes her even more to experiencing sexual moments with her husband. The 20th century liberated women, but on the other hand it burdened her. And when she is busy and nervous, the man cannot relax. A woman plays a very big role in a man’s success. Of course, the opposite also applies, so that the woman can experience the pleasure to the full. This situation is typical of the time in which we live. The hectic lifestyle does not allow partners to pay enough attention to each other in an intimate plan and affects the harmony of relationships. What are the signs of erectile dysfunction by which a man can understand that he has a serious health problem and should seek a specialist? Erectile dysfunction itself is a symptom. In most cases at certain ages, especially after the age of 40, it signals that something is wrong in the man’s body, most often the cardiovascular and nervous systems. It should be well known that disorders of sexual life, in particular erectile dysfunction, are not always a manifestation of a medical condition. They can be due to interpersonal relationships, fatigue, worry. But still, an organic cause must be ruled out, which in most cases is at the “bottom” of the events – for weight loss, a decrease in libido or the appearance of erectile dysfunction. I appeal to Bulgarian men to take it seriously and seek medical help in the event of erectile dysfunction. Ignoring it can lead not only to problems in the relationship with the partner. Erectile dysfunction signals underlying serious disorders. The general practitioner is the one who must initially judge and guide the patient whether it is a psychogenic, personality-related, sexual impotence or a more serious problem. Especially if the man is over 40 years old, a possible organic cause must first be ruled out by carrying out the relevant tests and consultation with a specialist. According to statistics, about 5 million men in the US have testicular insufficiency with reduced testosterone function and secretion, and only 5% of them are treated. How is the matter in Bulgaria? The fact that only 5% of these 5 million men are treated means that health care is not sought there, and this issue remains obscured for one reason or another. In this regard, Bulgarian men are becoming more and more active and are looking for help with the problem. Unfortunately, testicular failure is a widespread health problem in our country as well. The condition is insidious because it may not be congenital, but acquired at an early age, in the prime of a man’s strength. It is important that people are informed about where they should go, what specialist they should contact. What are the effective methods for solving these sexual problems in endocrine diseases? The underlying disease that led to the sexual problems must be treated first. If a man suffers from diabetes, the disease must be put under strict control,not to progress and not to allow large “swings” in the levels of blood sugar, respectively insulin. This undermines the body. Once the underlying disease has been brought under control or eliminated, then if testicular insufficiency is still present, replace it with testosterone. If erectile dysfunction cannot be overcome, phosphodiesterase inhibitors can help. And in a condition in which testosterone is normalized, but erectile dysfunction is not overcome, a phosphodiesterase inhibitor should be taken – Viagra, Levitra or Cialis. In other words, we move step by step according to analysis and metrics until we overcome the breach. Regular intake of what groups of medications can cause erectile dysfunction? The so-called medication-induced erectile dysfunction can be reached by frequent and long-term taking of certain types of sedative medications; psychogenic drugs; some of the medicines, especially from the older groups, to treat blood pressure; with some medicinal products for gastrointestinal problems. Does the practice of sex in certain cases hide dangers for the condition of diabetic patients? It is forbidden to practice sex in the case of a recent heart attack or stroke, in conditions where a large emotional load is not desirable. Because the physical load during sex is not great. To one degree or another, the patient thinks about his illness, feels ostracized from society, believes that human joys are forbidden to him. This further aggravates his illness. Therefore, in most cases, when there is no acute disorder such as a recent heart attack, for example, sexual life should not only not be prohibited for diabetics, but should even be recommended, because a good quality of life normalizes the life of this person.in conditions where a high emotional load is not desirable. Because the physical load during sex is not great. To one degree or another, the patient thinks about his illness, feels ostracized from society, believes that human joys are forbidden to him. This further aggravates his illness. Therefore, in most cases, when there is no acute disorder such as a recent heart attack, for example, sexual life should not only not be prohibited for diabetics, but should even be recommended, because a good quality of life normalizes the life of this person.in conditions where a high emotional load is not desirable. Because the physical load during sex is not great. To one degree or another, the patient thinks about his illness, feels ostracized from society, believes that human joys are forbidden to him. This further aggravates his illness. Therefore, in most cases, when there is no acute disorder such as a recent heart attack, for example, sexual life should not only not be prohibited for diabetics, but should even be recommended, because a good quality of life normalizes the life of this person.