Erectile dysfunction, defined as the inability to maintain an erection sufficient for sexual intercourse, is a sensitive topic, one which many men are reluctant to discuss, even with their doctor. However, ED is also a common problem. Mild-to-moderate ED affects approximately 10% of men for each decade of life (i.e., 60% of men in their 60s, 70% of men in their 70s), and treatments are available that can give you back your sex life.
Board-certified urologist and men’s health physician, Dr. William Brant provides research-driven treatments for erectile dysfunction to his patients in Salt Lake City, Utah. He understands that ED can often be a symptom of an underlying medical condition and that prompt medical intervention is important so that you can regain your full sexual health. One condition that’s particularly linked to erection problems is diabetes. Here’s what you need to know about the problem — and the solution.
The 411 on diabetes
Diabetes is a metabolic disease that causes high levels of sugar in the bloodstream. In a healthy individual, the hormone insulin moves sugar (glucose) from the blood into the body’s cells, either to be stored or to be used for energy. With diabetes, however, the body has a problem with insulin, so the sugar builds up in the blood.
There are two main types of diabetes. Type 1 is an autoimmune disease in which the immune system mistakenly attacks and destroys the beta cells in the pancreas, where insulin is produced. Without the cells, there’s no insulin available to regulate glucose. About 10% of diabetics have this type.
Type 2 occurs when your body becomes resistant to the insulin that’s produced, leading to a buildup of sugar in your blood. Being overweight or obese and not exercising are two primary causes of type 2 diabetes. Carrying extra weight, especially around your waist, makes your cells more resistant to insulin’s effect on your blood sugar.
The 411 on erectile dysfunction
Achieving an erection involves proper functioning of many different body systems, including the brain, nerves, hormones, muscles, and blood circulation. If there’s a problem with any of these systems, you may be unable to achieve or maintain an erection. Psychological factors such as stress and anxiety can cause or worsen the problem, as the brain plays a key role in sexual desire and controlling the body systems responsible for an erection.
What’s the diabetes-ED link?
It’s estimated that between 35-75% of men with diabetes will experience at least some degree of ED during their lifetime. In addition, diabetic men tend to develop ED 10-15 years earlier than men without diabetes, and the numbers only increase as the men age.
Medical research has identified several likely causes for ED in patients who have diabetes. These include:
Blood vessel damage
With high levels of glucose in the bloodstream, microvascular disease — damage to the small blood vessels — occurs. This is what leads to kidney damage, neuropathy, and loss of vision, among other things. To achieve an erection, blood must flow into the corpora cavernosa — healthy masses of erectile tissue in the penis — and stay trapped inside. In the presence of microvascular disease, though, blood flow is weak or impeded, leading to ED. Men with both diabetes and high blood pressure can also see an increased risk of ED because of further damage to the penile vessels.
High levels of glucose may also cause nerve damage, especially in the nerves farthest away from the body. Many diabetics have foot problems, but they often have problems with their hands and penis. This can manifest as ED, loss of sensation, inability to climax, and other sexual issues. Having good glucose control may prevent this from worsening but typically once the damage is done, it does not spontaneously get better.
Low testosterone (T) levels
About 25% of men with diabetes have low T. Testosterone plays a role in sexual function in men, so low T can be responsible, in part, for ED.
Depression and anxiety
It can be anxiety-provoking or depressing to have to manage a difficult disease like diabetes, and depression is known to lead to various issues with having an erection. Depression can cause a lack of sleep, which itself results in a loss of morning erections, a natural occurrence in healthy men. And as we’ve seen, psychological factors can cause men to have difficulty achieving an erection or maintaining it during sex.
Medication side effects
Many men with diabetes depend on multiple medications to reduce complications from their disease and also their risk of heart problems. Some of these medications lower blood pressure or have physical and/or psychological side effects that make an erection difficult.
If you have diabetes and are also struggling with ED, there are treatments. They range from lifestyle choices like losing weight, exercising, lowering your blood pressure and cholesterol, and quitting smoking; to hormone replacement therapy, ED pills that increase blood flow to the penis, penis injections, and even penile implants.