Exploration of Cardiology

Table 3. Neural mechanisms linking SD and PAD in diabetes.

Neural pathway	Defect in diabetes	Clinical consequence	References
Autonomic neuropathy	Sympathetic predominance, reduced vagal activity, impaired baroreflex	Erectile failure, impaired genital engorgement, and abnormal vasomotor tone in limbs	[11, 31–33]
Nitrergic signaling (nNOS)	Reduced nNOS activity, axonal degeneration	Impaired erection and vaginal engorgement, reduced neurogenic vasodilation	[10, 34, 35]
Somatic small-fiber neuropathy	Sensory loss, impaired neurogenic inflammation, defective peptidergic signaling	Decreased arousal, reduced genital sensation, delayed PAD recognition, ulcer risk	[36–38]

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SD: sexual dysfunction; PAD: peripheral artery disease; nNOS: neuronal nitric oxide synthase.

Declarations

Author contributions

AB: Conceptualization, Investigation, Writing—original draft. MCÇ: Conceptualization, Investigation, Writing—original draft. MK: Conceptualization, Writing—review & editing. MY: Writing—review & editing. LB: Supervision, Validation. YK: Supervision, Validation. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

No financial funding was received for this study.

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