How are diabetes and erectile dysfunction related?
For men, type 1 and type 2 diabetes can lead to an increased risk of erectile dysfunction, or ED for short. Based on data from a survey study, the risk is 50% higher for men with diabetes compared to men without diabetes, regardless of what type of diabetes they have. While many men may develop ED as they age, those who have diabetes may develop ED 5 – 10 years earlier than most.
It is important to note that ED can be related to insufficient blood flowing to penis (vascular), emotional issues such as depression (psychological), or problems with the nerves to the penis (neurological). Diabetes can cause or make these issues worse. As such, patients with diabetes who experience ED tend to notice that the problem gradually gets worse.
Current medical knowledge has identified several likely causes in patients specifically with diabetes.
- Damage to blood vessels – Diabetes means there’s more sugar (glucose) in the bloodstream, and this can damage small blood vessels (called microvascular disease). This is what leads to kidney damage, loss of vision, and nerve pain. But, damage to small blood vessels in the penis also makes it harder to have and maintain an erection. That’s why ED is worse in men with long-standing, uncontrolled diabetes. Men with diabetes and high blood pressure may also see an increased risk of ED due to further damage to the vessels in the penis.
- Low testosterone levels – It’s estimated that 25% of men with diabetes have low testosterone levels. As testosterone has a large impact on sexual function in men, low testosterone can lead to ED.
- Depression – Many men with diabetes may become depressed or have anxiety due to the stress of having to manage a difficult disease. Depression can lead to various issues with having an erection. One example is a lack of sleep that causes a loss of morning erections (“morning wood”), which is natural in healthy men. Anxiety can cause men to suddenly have a loss of an erection during sex or have difficulty making an erection.
- Medication side effects – Many men who have diabetes are treated with multiple medications to reduce their risk of heart problems or complications from diabetes. Some of these medications may also lead to ED by lowering blood pressure or causing other side effects that make an erection difficult.
How can I manage erectile dysfunction if I have diabetes?
Since patients with diabetes often have many other health issues to think about, it is impossible to offer a “one-size-fits-all” recommendation for addressing ED. Nonetheless, there are multiple options you can consider.
Lifestyle Changes
Treatment of diabetes relies on lifestyle changes, many of which not only help to reduce blood glucose, but by doing so can strengthen the body and reduce the risk of ED. In clinical studies, better glucose control was shown to improve erections and reduce the risk of developing ED.
- Quitting smoking – Smoking increases your risk for ED by raising your blood pressure, which over time, can damage small blood vessels in your penis. It’s even worse if you have diabetes, which itself can cause blood vessel damage.
- Reducing fat and cholesterol in your diet – Research has shown that men with high cholesterol have a higher risk of ED, and that making dietary changes to lower fat and cholesterol levels can help reduce this risk.
- Exercising and losing weight – Losing weight is important for men with diabetes who are obese or overweight, as it can help lower blood glucose levels and increase blood circulation. These improvements can also help with ED. In clinical studies, weight loss has been a great means of restoring sexual function for many men.
- Reducing stress – Diabetes can lead to mental health problems, such as depression or anxiety, which can cause or worsen ED through psychological stress. Overcoming stress can be accomplished in multiple ways, such as through meditation or counseling.
Drug options
If a doctor or medical provider determines that you have ED and it isn’t the result of another health issue, they may prescribe one or more medications to help. Most of these work by helping to increase blood flow to the penis.
- Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) – These drugs help with erections by increasing blood flow into the penis. Each of these drugs has pros and cons. For a detailed comparison of Viagra, Cialis, and Levitra, see here.
- Caverject (alprostadil) – This drug is directly injected into the penis to cause an erection. It works more than 70% of the time, though based on the fact that a needle needs to be injected into your penis, most men prefer trying an oral medication before using this. Unlike the medications above, Caverject does not require you to be sexually stimulated to cause an erection and will generally work right away.
- Muse (alprostadil) – Instead of an injection, Muse is inserted up the urethra 5 – 10 minutes before sex and will cause an erection that can last about an hour.
- Testosterone therapy – For men who have low testosterone levels, testosterone replacement therapy may be used to help increase sex drive and treat ED. However, since testosterone therapy is known to potentially cause heart problems, and diabetes also increases the risk of heart problems, this is something that should be carefully considered with your doctor and closely monitored.
Mechanical treatments
If diabetes is leading to difficulties with blood flowing into the penis, several devices can help to increase blood flow, especially for those who may not respond to medications. These include vacuum-assisted erection devices that basically draw blood into the penis to induce an erection, which have been shown to work for 2 out of every 3 men. Another more invasive treatment is prosthetic surgery. Here, a prosthesis is inserted into the penis that can be inflated whenever sex is desired. Unlike medications, these devices are a one-time expense, though the decision ultimately depends on personal preference.
Other considerations
Since diabetes can cause ED in many ways, be sure to talk with your doctor about your treatment plan. Many online resources may recommend alternative therapies or stopping certain medications you may be on. While you can consider these options, you should speak with your doctor before making any abrupt changes to avoid dangerous health effects or actually making your ED worse. Lastly, sex is often an intimate interaction with a partner, and even though struggling with ED may be frustrating, it is important that both you and your partner feel supported. Consider couples counseling or support groups if you feel that it may be beneficial.
For more information, the American Diabetes Association has some helpful webpages focused on sexual health and diabetes here, covering everything from ED to diet and exercise recommendations. They also have a book called “Sex and Diabetes: For Him and For Her” that may be helpful to read, though it costs about $10.
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