Erectile dysfunction (ED) is a common problem amongst men who have diabetes affecting 35-75% of male diabetics. Diabetes mellitus, commonly known as diabetes, is a metabolic disease that causes high blood sugar. The hormone insulin moves sugar from the blood into your cells to be stored or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it does make.
Untreated high blood sugar from diabetes can damage your nerves, eyes, kidneys, and other organs.
Up to 75% of men suffering from diabetes will experience some degree of erectile dysfunction (erection problems) over the course of their lifetime.
Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from the disease.
Over the age of 70, there is a 95% likelihood of facing difficulties with erectile function.
The Connection Between ED And Diabetes
According to the National Institutes of Health, men with diabetes are 2 to 3 times more likely to have ED than those who do not have diabetes. Men with diabetes experience ED 10 to 15 years earlier on average than others.
ED below the age of 45 can actually be an early sign of type 2 diabetes. The percentage of ED in male diabetics ranges from 20 to 75 percent.
There are factors that increase a man’s risk of developing sexual and urological problems, including:
- Poor blood glucose control
- High blood pressure
- Being older than 40
The Boston University Medical Center studied the link between type 2 diabetes and erectile dysfunction and found that about half of men who receive type 2 diabetes diagnoses will develop ED within five to 10 years.
Type 2 diabetes with heart disease increases the risk of ED even more. Blood circulation and the nervous system affect sexual stimulation and response. When diabetes damages these systems, it can impact a man’s ability to achieve erection.
You may be most at risk of developing ED and other diabetes complications if you’re:
- Maintaining a poor diet
- A smoker
- Not physically active
What causes erectile dysfunction amongst diabetics?
Causes of ED are extremely complex, and are based around changes that occur to the body over time affecting nerve, muscle and blood vessel functions.
In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex
Without blood vessels and nerves that control erection, ED can still occur despite a desire to have sex and normal male hormones.
Factors amongst men
Many other factors bear on erectile dysfunction amongst diabetic men.
- Being overweight
- Taking too little exercise and other lifestyle factors.
Surgery can damage nerves and arteries linked to the penis, as can some injuries.
Many common medications (including antidepressants and blood pressure drugs) can produce ED.
Psychological factors also have an enormous influence.
Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of ED cases.
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 is ED diagnosed?
Erectile dysfunction is diagnosed using several different methods. Patient history often informs the degree and nature of the ED.
Medical and sexual past often has an influence, as does prescription or illegal drug use. ED patients may be physically examined, and bodily features can give clues to the cause. Laboratory tests can also be key for diagnosing ED.
Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to cancel some causes out.
Furthermore, psychological examination can reveal psychological factors.
Why Does Diabetes Pose a Challenge in Treating ED?
The first step in treating ED is to visit your doctor. You will need a sexual history and physical exam to understand and treat your dual conditions. Blood glucose, blood pressure, and cholesterol can all affect the development of ED.
As a diabetic with ED, adopting a healthier lifestyle may be all you need to reverse or ease the symptoms of erectile dysfunction.
Getting your blood sugar, weight, cholesterol and blood pressure under control by eating healthfully and exercising can reduce diabetes symptoms. These steps would all improve your sexual health as well. You may also want to consider certain medications to control symptoms.
Some drugs that diabetics use to treat high blood pressure, depression and other symptoms may contribute to erectile problems. Men with diabetes often have chronic conditions that make ED worse.
Unfortunately, diabetic patients won’t always see the results that non-diabetic patients see with just an oral ED medication like Viagra. Instead, they will have to use alternate methods or more than one medication in combination.
To get to the bottom of ED with diabetes, you must work with a doctor to make sure you address all related health problems, not just one. Stress can worsen ED, so you may also want to speak to a psychiatrist to learn ways to control stress and anxiety levels.
As a diabetic with ED, your case is unique. You will need a physician who understands both conditions and their connection. Luckily, there are effective treatments for ED in patients with diabetes.
How to Fix Erectile Dysfunction in Diabetics ?
The best way to fix erectile dysfunction in diabetics is through a tailored treatment plan with help from a doctor. Patients should work closely with specialists to find an ED treatment that also takes the diabetes into consideration.
Personalized medical treatment can result in methods such as hormone therapy, or compounded medications. Compounded medications are custom drugs that can include treatments for ED and diabetes in the same pill.
Compounded medications can potentially solve ED issues in diabetes such as retrograde ejaculation – which is caused by poor blood sugar control and related nerve damage. This occurs when semen goes into the bladder instead of out of the tip of the penis during ejaculation, due to the muscles not functioning properly.
If you have diabetes and retrograde ejaculation, there are medications that can strengthen the internal muscles, or sphincters, in the bladder to prevent retrograde ejaculation. Compounded oral medications with sildenafil, tadalafil, vardenafil or other ingredients can increase blood flow to the penis, helping to solve ED and maintain an erection that’s hard enough for penetration.
At the same time, men with diabetes need to take medications that control symptoms of this condition as well, without taking those that could exacerbate the symptoms of erectile dysfunction. A conversation with a primary doctor can elicit the best medications for each particular case, as well as a referral to the right compounding pharmacy.
Are there treatments for men with diabetes and erectile dysfunction?
Men who have diabetes and are having trouble achieving or maintaining an erection can take oral medicine The NHS can provide the following medications on prescription for men with diabetes:
Brand names include:
However, these medicines can all affect the heart rate, and detailed consultation with your doctor is necessary to determine the best course of action.
If pills aren’t a good option for you, your doctor might recommend a tiny suppository you insert into the tip of your penis before sex. Another possibility is medication you inject into the base or side of your penis. Like oral medications, these drugs increase blood flow that helps you get and maintain an erection.
vacuum constriction devices –
This device, also called a penis pump or a vacuum pump, is a hollow tube you put over your penis. It uses a pump to draw blood into your penis to create an erection.
A band placed at the base of the penis maintains the erection after the tube is removed. This hand- or battery-powered device is simple to operate and has a low risk of problems.
If a vacuum-constriction device is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
Intraurethral therapy – Intraurethral agents, sometimes called transurethral agents, are medications that treat ED by increasing blood flow to the penis to achieve and maintain erection. Medicated urethral suppository for erection (MUSE®) is the only intraurethral agent approved by the U.S. Food and Drug Administration (FDA).
Penile implants. In cases where medications or a penis pump won’t work, a surgical penis implant might be an option. Semirigid or inflatable penile implants are a safe and effective option for many men with erectile dysfunction.
Psychotherapy can have an enormous influence on erectile dysfunction.
Further treatment such as surgery and vacuum devices may also have a role to play in some specific cases.
Non-oral treatments for erectile dysfunction
Additional treatments include vacuum constriction devices, intraurethral alprostadil suppository or intracavernous injection therapy and sex therapy.
Vacuum pumps consist of a plastic tube, in which you place your penis. The pump, which may be battery or hand pump operated, creates a vacuum that will draw blood into the penis making it erect. A rubber ring will need to placed around the bottom of the penis to keep it erect. A vacuum pump is not for use if you have a bleeding disorder or take anticoagulants.
Alprostadil is a form of hormone medication that stimulates blood flow to penis, and may be given by two different methods:
- Intracavernosal injection – whereby alprostadil is given by injection into the penis
- Intraurethral application – whereby a pellet (1.6mm diameter and 6mm length) of alprostadil is inserted into the urethra via a urethral stick
Alprostadil may be prescribed if you do not respond to other treatments, or you are unwilling to try oral medications or vacuum pump therapy. Your health team may provide training on how to inject or insert alprostadil.
Which treatment is the best for diabetes and ED?
The most suitable treatment will depend on the health of the patient and their own ability to tolerate the treatment. Specialists such as urologists can work with individual cases and determine the best treatment.
What is the future of diabetes and erectile dysfunction?
There are frequent advances in this field. Better medications, implants, vacuum devices and suppositories have all increased options for diabetic men with ED.
Gene therapy is not being tested, and at some point may offer a permanent therapeutic approach to tackling diabetes and erectile dysfunction.
How can I get rid of ED when I have diabets ?
Don’t underestimate the difference a few changes can make. Try these approaches to improve erectile dysfunction and your overall health:
- Stop smoking. Tobacco use, including smoking, narrows your blood vessels, which can lead to or worsen erectile dysfunction. Smoking can also decrease levels of the chemical nitric oxide, which signals your body to allow blood flow to your penis.If you’ve tried to quit on your own but couldn’t, don’t give up — ask for help. There are a number of strategies to help you quit, including medications.
- Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
- Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
- Limit or cut out alcohol. Excess alcohol can contribute to erectile dysfunction. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for men older than age 65, and up to two drinks a day for men age 65 and younger.