Erectile dysfunction, also called impotence, is not being able to get and maintain an erection for long enough to have sexual intercourse.
Studies suggest that 35-75 percent of men with diabetes will go on to develop ED. They will also tend to develop ED some 10-15 years earlier than men without diabetes.
Diabetes can cause ED because it can damage the blood supply to the penis and the nerves that control an erection.
When a man becomes sexually aroused, a chemical called nitric oxide is released into his bloodstream. This nitric oxide tells the arteries and the muscles in the penis to relax, which allows more blood to flow into the penis. This gives the man an erection.
Men with diabetes struggle with blood sugar level swings, especially if their condition isn’t managed poorly.
When their blood sugar levels get too high, less nitric oxide is produced. This can mean that there is not enough blood flowing into the penis to get or keep an erection. Low levels of nitric oxide are often found in those with diabetes.
Other causes of erectile dysfunction
Listed below are some other reasons for ED:
- obesity, high blood pressure, and high cholesterol
- hormonal problems such as low testosterone
- psychological problems including stress, anxiety, and depression
- nervous system problems including damage to spinal cord or brain
- smoking, drinking too much alcohol, and using some illegal drugs
- some medications such as those taken for high blood pressure and depression
Pelvic injury or surgery on the prostate, bowel or bladder may cause damage to nerves connected to the penis. This nerve damage can also lead to ED.
Tests and diagnosis
A doctor will often perform some of the following tests to diagnose ED:
- Blood tests to check for a raised blood sugar level, which may indicate diabetes.
- Hormone tests to measure the levels of testosterone and other hormones.
- Nervous system tests, such as blood pressure and sweat tests, which can rule out nerve damage to the heart, blood vessels, and sweat glands.
- Urinalysis to test for sugar in urine, which might indicate diabetes.
- Physical examination to assess the genitals and nerve reflexes in the legs and penis.
- Patient history to help determine why someone is having problems with erections and under what circumstances.
- Sexual health (SHIM) questionnaire to help diagnose the presence and severity of ED.
- Injection of a drug into the penis to check that the blood supply to the penis is normal.
Erectile dysfunction due to diabetes is much better understood now. Good control of diabetes can reduce the risk of ED.
Other preventive measures such as stopping smoking and reducing alcohol intake will help lower the risk of developing ED.
Other lifestyle changes that may help include:
- Eating a healthy diet and taking exercise: Studies suggest that men who changed their diet to one low in saturated fat and high in fiber and did moderate physical activity each week were able to improve ED without prescription drugs.
- Weight loss: Some studies show that even a small weight loss can improve erectile function and sexual desire in men with diabetes. Those who lost weight had increased testosterone levels and blood flow resulting in better erections.
- Stress reduction: ED can cause stress and tension in a relationship. Counseling can be helpful even if the origins of sexual dysfunction are physical. People with ED should try to find time for relaxation and get enough sleep every night.
A new study also suggests that supplementation with amino acids called l-arginine and l-citrulline may also help to improve erectile function. These acids are known to increase the body’s production of nitric oxide, which can increase blood flow to the penis. As stated previously, low levels of nitric oxide are often found in men with diabetes.
Treatment of ED will depend on the cause and there is a range of good treatment options. These are the same for men with diabetes and men who have ED from other causes.
Doctors can switch any prescription medications that may contribute to ED.
The most common treatment is with oral tablets. These have been shown to work well in many men with diabetes, restoring sexual function. Certain drugs called PDE-5 inhibitors are used to treat ED.
The four most commonly prescribed are:
- sildenafil (Viagra)
- vardenafil (Levitra)
- tadalafil (Cialis)
- avanafil (Spedra)
These drugs cause an erection by increasing blood flow to the penis. They require sexual stimulation to be effective. They should be taken 30-60 minutes before sexual intercourse.
There are several other forms of treatment for ED. These include:
- Hormone therapy: Testosterone replacement therapy is recommended for men with ED who show low levels of testosterone.
- Penile injection therapy: Injection of alprostadil (Caverject) directly into the penis before intercourse has been approved for men who do not respond to oral drug therapy. This hormone injection increases the blood supply to the penis to produce an erection.
- Vacuum pump therapy: A plastic tube connected to a pump is placed over the penis. The pump empties the air out of the tube and this causes blood to be drawn into the penis. A ring is then placed on the base of the penis to maintain the erection during intercourse.
- Penile prosthesis: This is only considered when all other treatment options have failed as it requires major surgery. An inflatable rod is implanted into the penis to make it erect for intercourse.
- Psychological support: If erectile dysfunction is caused by psychological conditions, such as anxiety or depression, the patient may benefit from counseling.
A well-balanced diet, exercise, and good stress management have been shown to be equally important in treating diabetes.