Erectile Dysfunction and Diabetes

Understanding and treating erectile dysfunction in men with diabetes:

Erectile dysfunction (ED) is a common problem for men, especially as they age. It is estimated that about 25% of men in the general population experience ED at some point in their lives. It is even more common in men with diabetes. Nearly half of men with diabetes will struggle with erectile dysfunction at some point. The good news is that diabetes and the presence of erectile problems do not mean the end of sexual engagement. There are effective ways to treat ED, and we are learning more all the time. Here are some of the most frequently asked questions about ED and diabetes.

What is ED?

Erectile dysfunction typically refers to a man’s physical inability to develop or maintain an adequate erection for sex. Though the term "impotence" is often interchangeably used with ED, the two terms do not always describe the same condition.

Impotence is a broader term that can include the physical inability to maintain an erection, but it can also include other sexual-related issues, such as a lack of sexual desire, an inability to ejaculate, premature ejaculation or issues surrounding orgasm.

What causes an erection?

To understand how ED happens, we first need to explore how an erection should typically occur. In a normal response to arousal, the brain sends a signal through the nervous system to the penis. Contrary to what most men think, this initial nerve response actually relaxes the penis. This short-lived relaxation helps create space around the penis for blood to flow into. A membrane in the walls of the penis then traps the blood that has flowed in to help maintain the erection. Once the penile muscles contract, the blood in the penis is forced back into the rest of the body and the penis no longer maintains an erection.

This is how your body is supposed to respond. But there are any number of things that can disrupt the process along the way. We will focus on those specific to diabetes.

What causes ED in men with diabetes?

Among the several complications that can develop with diabetes, the two most responsible for possible ED-related problems involve your nerves and blood vessels.

It has been shown that nerve damage from diabetes (neuropathy) is the greatest risk factor for developing ED. Neuropathy is most often associated with the peripheral parts of the body, such as the legs and feet, which is very common in those who have had diabetes for years. But neuropathy can affect virtually any part of the body. When the pelvic nerves that are connected to the penis muscles are damaged or impaired they may not properly send the initial nerve signal for the penis to relax so that blood can flow into it.

In addition, blood vessel damage, which is another complication from diabetes, may inhibit the blood flow to the penis even if the nerves correctly send the signal to the pelvic area.

A third cause of ED in some men with diabetes is low amounts of testosterone. This condition is called hypogonadism and is most often association with men who have type 2 diabetes. One study found that one-third of men with type 2 had low testosterone levels. Being overweight or obese is also a risk factor for hypogonadism.

What can be done to prevent ED?

Your best means of preventing ED is to manage your glucose well. Even though this is no guarantee of avoiding ED, studies have shown that men with type 1 diabetes who practiced tight glucose control lowered their risk of ED.
Practicing several lifestyle habits can also reduce your risk of ED. These include:

• keeping your blood pressure under 130/80 mm/Hg
• achieving and maintaining an optimal weight
• not smoking
• regular physical activity
• eating a balanced diet