Erectile Dysfunction and Diabetes

Sexual dysfunction (SD) is a problem experienced by a significant number of men with diabetes. One of the most common forms of sexual dysfunction is erectile dysfunction or ED. Research has indicated the incidence of erectile dysfunction among diabetic males ranges from 30% to 35%, a figure that climbs to as high as 50% after a 10 year interval of diabetes.[1]

What is Erectile Dysfunction?

ED is defined as a consistent inability to reach and maintain an erection for the purpose of sexual intercourse.[2] For it to be erectile dysfunction, the inability to maintain an erection must be long term or sustained and not a temporary or occasional occurrence.  Everyone has times when sexual arousal is difficult due to stress, fatigue, anxiety or other factors. Sexual dysfunction is an ongoing condition.

Erectile dysfunction is also called impotence. Though many men develop ED after the age of 50, diabetic men often develop this complication much earlier. Studies have indicated male diabetics may develop ED as much as 15 years earlier than non-diabetic men.

The diabetic men most likely to develop erectile dysfunction include:

  • Older men
  • Obese men
  • Those with poor glucose control
  • Men who have had diabetes for a long period of time
  • Those with an increased risk of cardiovascular disease (CV)
  • Men who have had metabolic syndrome

An erection depends on a man having healthy blood vessels and nerves. Diabetes damages both.

What are the Symptoms of ED?

If your levels of free testosterone and the sex hormone–binding globulin (SHBG) are low, erectile dysfunction is probable. [3] A doctor can detect these levels by administering tests. In general, the most common noticable symptoms are:

  • Less rigidity of the penis
  • An erection of short duration
  • Premature ejaculation
  • Retrograde ejaculation

Retrograde ejaculation refers to the sperm being shot into the bladder rather than through the urethra.

What are the Causes of ED?

It is possible that erectile dysfunction may be a symptom or early warning sign of diabetes. Since a sustained erection relies on properly functioning nerves and blood flow, it should not be surprising that diabetes and ED are linked. However, ED has been associated with many factors. Among the other causes are the following:

  • Testosterone deficiency
  • Medications (e.g., serotonin reuptake inhibitors, antiandrogens),
  • Insulin resistance which may partly influence testosterone deficiency[4]
  • Poor metabolic control
  • Smoking
  • Alcohol
  • Depression
  • Antidepressants
  • Antihypertensives
  • CVD medications
  • Histamine 2 receptor antagonists
  • Recreational drugs
  • Fatigue
  • Systemic illness

From the list, it’s clear the causes of ED include hormone imbalances, medications and mental disorders like depression. Of course, emotional problems may also contribute to ED. These may be relationship problems or problems dealing with diabetes as a disease. In other words, the causes of ED among diabetics include neurological, vascular, endocrine, and psychological factors. There is not one single factor, excluding perhaps the use of certain medications, that cause ED. It is, rather a combined effect of several factors

What is the Treatment of ED?

There are a number of methods for treating ED. The best treatment depends upon your health, the medication you are taking and other related factors. Glucose control remains important in preventing ED from progressing further, but often cannot reverse damage that has already occured. The most common treatments are oral medication, injection therapy, urethral suppositories, vacuum devices (VED), hormone therapy and surgery[5].

  • Oral Medication – This is the better known of the treatments. The pills used are members of the phosphodiesterase type 5 (PDE5) drugs first introduced in 1998 to address ED.[6] They include several well known brands e.g. Viagra, Cialis, Levitra. These drugs all require sexual stimulation and may result in certain side effects such as headaches, facial flushing, back pain, nasal congestion and muscle pain. These medications should be used with caution and consultation with your doctor if you have cardiovascular problems.
  • Injection Therapy – This form of treatment does not require sexual stimulation. An injection is given just prior to sexual intercourse. It is recommended for those with vascular or anatomic disease. Side effects include aching of the penis, a prolonged erection and potential scarring of the penis.
  • Urethral suppositories – These are small tablets. Like injection therapy, no sexual stimulation is required and the medication can be used even if the person is on nitroglycerine. The time frame is crucial as erections occur from 10 to 15 minutes after the injection and will continue until 45 to 60 minutes have passed.
  • Vacuum – These devices are constructed to fit over the penis. They are a type of pump that uses inflation and requires sustainment of an erection with a hard ring. It may be uncomfortable and it does inhibit the process of normal ejaculation.
  • Hormone therapy – In diabetic men, the testosterone level is low. In order to correct this, a doctor may prescribe testosterone in the form of gel or patches, injections.
  • Surgery – This can involve the application of a penile prosthesis. Since the mid 1970s, surgeons have been able to employ this method. An inflatable prosthesis is effective, has few side effects and does not affect either sensation of ejaculation. These implants are a viable alternative.

The treatment chosen by the doctor depends on what is determined to be the main cause of the erectile dysfunction. If it is due to nerve damage then the treatment choice would be mechanical assistive devices, shots or even surgery. If the ED is due to anxiety and depression then counseling is needed.

The first step is to discuss the problem of erectile dysfunction with a doctor. For one thing, you should not just accept sexual dysfunction as inevitable just because you are a diabetic. In addition, the doctor needs to know all the problems you are experiencing in order to have a full picture of the state of your health. The doctor will consider all of the possible causes, complete medical tests and possibly offer a solution to ED.

References 

[1]Jamieson, F; Chalmers, J; Duncan, C; Prescott, RJ; and Campbell, IW (2008). “Erectile Dysfunction in Type 1 Diabetic Males.” British Journal of Diabetes & Vascular Disease, 8: 232-234.

[2] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[3] Jones, TH; Matsumoto, AH; Nehra, A; Perelman, MA; Swerdloff, RS; Traish, A; Zitzmann, M; and Cunningham, G (2011). “Low Testosterone Associated with Obesity and the Metabolic Syndrome Contributes to Sexual Dysfunction and Cardiovascular Disease Risk in Men With Type 2 Diabetes.” Diabetes Care, 34(7):1669-1675.

[4] Grossmann, M; Thomas, MC; Panagiotopoulos, S; Sharpe, K; Macisaac, RJ;   and Associated with Insulin Resistance in Men with Diabetes.” J Clinical Endocrinology and Metabolism93(5):1834-1840.

[5] Levin, (2009) op.cit.

[6] Aversa, A (2010). “Systemic and Metabolic Effects of PDE5-Inhibitor Drugs.” World J Diabetes, 1(1): 3–7.

[7] This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.