Diabetes respects no boundaries, not even a closed bedroom door. In fact, it’s a leading cause of complications in sexual health. For men with diabetes, that often translates to erectile dysfunction, or ED.
ED is more common in men with diabetes—an estimated 35 to 75 percent of men with diabetes struggle with ED as opposed to 26 percent of men without diabetes. ED also tends to set in earlier for men with diabetes than those without. But though ED incidence does increase with age for all men, it’s far from a foregone conclusion, and there’s a long list of treatment options.
Erectile dysfunction refers to when a man experiences an inability to achieve or maintain an erection rigid enough for sexual intercourse. The majority of men experience ED at some point during their lives, but if it becomes frequent enough to substantially affect sexual satisfaction, it’s time to seek treatment.
Physical causes of ED include vascular damage, trauma, damage from surgery, neurological damage, or low testosterone. It can also be a side effect of certain medications. Psychological contributors include depression, performance anxiety, or problems in a relationship. Diabetes can contribute by causing low testosterone and/or vascular damage.
High blood sugar from diabetes can damage arteries and compromise blood flow to the genitals, making it difficult to achieve and maintain an erection. In an erect penis, the influx of blood also creates pressure that limits outflow in order to maintain an erection. Atherosclerosis, or artery hardening, caused by chronic high blood sugar means that there may not be enough inflow to achieve an erection and not enough pressure to limit outflow.
Diabetic neuropathy, or nerve damage, can affect the nerves responsible for sending the proper signals to facilitate an erection. Other diabetes-related contributors are depression and low testosterone.
The first step is discussing the issue with a doctor so that the cause of ED can be determined. ED is a common, often treatable, issue that many men continue to struggle with simply because they are unwilling to discuss it. Once the cause or causes are determined, a doctor may recommend:
- Oral therapy. Sildenafil (Viagra) improves ED in over half of men with diabetes. It’s considered a first-line therapy and requires sexual stimulation to be effective. Sildenafil is contraindicated for some men.
- Intracavernosal injections. These may be an option for those who are not candidates for oral therapy. Injections are administered directly into the corpora cavernosae (the chambers in the penis that engorge to cause an erection). This form of therapy is over 70 percent effective. Injections should happen 10 to 15 minutes before intercourse and are generally not painful.
- Intraurethral alprostadil (Muse). This is a suppository inserted directly into the penis five to 10 minutes before intercourse that causes an erection for up to an hour.
- Mechanical therapy. Vaccuum-assisted erection devices can help achieve an erection by pulling blood into the penis in combination with a tension ring put onto the base of the penis to maintain pressure. The erection lasts until the ring is removed.
- Penile prosthesis. For men for whom other options are not viable, a non-adjustable, semi-rigid prothesis may be inserted. The prosthesis can be inflated and deflated on-demand. The most common complication of the implant is postoperative infection.
- Testosterone therapy. For men who deal with low testosterone levels, hormone injections or patches may be an option.
It’s important to remember that there are psychological causes of ED which may occur with or without physical causes. Depression (related or unrelated to diabetes), performance anxiety, stress, and relationship strain can contribute to ED. Counseling can be an important part of working through these obstacles. A man and his partner should consider counseling or therapy as ED effects both partners. A trained therapist or sex therapist can help a couple more comfortably articulate issues and move toward solutions.
Improving blood sugar control, reducing high blood pressure, and reducing tobacco and alcohol use can also help reduce the risk of ED and may help improve symptoms.
Discussing sexual health, especially performance issues, is difficult. But making the difficult decision to address the problem can lead to greater sexual satisfaction and relationship intimacy both both partners, and initiating a conversation can bring a lifetime to benefits.
Katie Taylor started writing in 5th grade and hasn't stopped since. Her favorite place to pen a phrase is in front of her fireplace with a cup of tea, but she's been known to write in parking lots on the backs of old receipts if necessary. She and her husband live cozily in the Pacific Northwest enjoying rainy days and Netflix.