Among men, the diagnosis of diabetes brings with it the concern about impotence or erectile dysfunction (ED). But, are problems with erections really more common in men with diabetes than men without diabetes? Because so many men suffer in silence, it’s difficult to count how many men with and without diabetes actually have a problem. Here’s what we do know:

•   ED is age related. It is primarily a problem among men over 40, with and without diabetes.
•   Of all men with diabetes over the age of 50, it is estimated that 50 to 60 percent have some degree of ED.

ED has a range of severity. The numbers about ED count all types, from occasional to complete impotence. Complete impotence occurs much less often. So just what is impotence?

 

Being impotent means that most or all of the time, the penis fails to become or stay hard enough for sexual intercourse. If, on occasion, you fail to maintain or achieve an erection, you’re not impotent. You are also not impotent if you experience a decrease in sexual desire, have premature ejaculation, or if you fail to ejaculate or reach orgasm. If you are impotent, you can’t achieve or maintain an erection. However, many of these other problems can also occur with impotence.

Paul had been diagnosed with type 2 diabetes a few years ago. He had been keeping his blood glucose levels in check, but had recently been traveling quite a bit. He wasn’t exercising very often and was eating out most of the time, and he also noticed that he had put on a few pounds. But the worst part was the effect on his sex life. For the past several months, it had become increasingly difficult to sustain an erection. And he had been unable to achieve an erection the last dozen or so times he attempted sexual intercourse. Now he had just given up trying.

ED can be caused by physical or psychological factors or both. The most common causes in men with diabetes are blood-vessel and nerve-related damage. If you have experienced neuropathy or cardiovascular complications of diabetes, you are at risk for ED. The way to reduce your risk is to keep your blood glucose levels as close to normal as possible. In addition, it will help to quit smoking, decrease your alcohol intake, and keep blood pressure near normal. Psychological factors, depression in particular, are also common culprits in men with diabetes.

Figuring out why ED occurs can be difficult. Sexual desire begins in the brain, and signals are sent through the nervous system to the blood vessels to trigger an erection. The male sex hormone testosterone is also involved in sexual desire and achieving erection.

Hearing so much about ED can create fear that contributes to the problem. And if you know that you are at increased risk because you have diabetes, you may even expect it to happen.

For instance, you may be unable to have an erection if you feel pressured to perform. Sometimes, not being able to maintain an erection can create fear and anxiety that can eventually lead to ED. Worry and stress can decrease your brain’s response to testosterone. However, because your nerves and blood vessels are in working order,  you might have erections during the night. Most healthy men have several erections each night while they sleep. There are simple tests you can do to find out whether you are having erections in your sleep. This means that the problem is not physical and may reassure you that you’ll be able to recover your ability to have erections.

ED caused by physical problems usually comes on slowly and gets worse with time. Early symptoms include a less rigid penis during sexual stimulation and when you wake up. Over time, men with ED may not be able to sustain firm erections long enough to enjoy sexual intercourse. 

Some of the side effects of diabetes can directly cause ED.

Blood vessel damage is a common cause of erection problems in men with diabetes. When blood flow to the penis is reduced, the penis no longer can become erect. A frequently used test for this is an ultrasound study of the penis. Sound waves are used to measure blood flow through the arteries and veins. Another test involves injecting a drug or mixture of drugs into the penis to cause an erection. The drug is injected in such a way that it bypasses the penile nerves. If the injection causes you to have an erection, damaged blood vessels are not the cause. If you don’t have an erection, it means there may be some damage to your blood vessels.

Nerve disease is also a culprit. When the nerves that signal the penis are damaged, erection can be impaired. You may be referred to a urologist to find out if the nerves in your penis are affected.

Because ED can also,  in rare cases,  be caused by low amounts of testosterone, your testosterone level may also be measured. If it is too low, your problem may be caused by a hormonal problem not related to diabetes.

Also be aware that certain medications can cause temporary ED. Tell your provider about all the medications you are using - even over-the-counter remedies. Drugs frequently used to treat high blood pressure, anxiety, depression, and peptic ulcers can all be factors. If you have signs of trouble and suspect that it may be related to a new medication you are using, tell your provider. There may be other medicines you can use.

But don’t stop taking the medicine. Smoking and alcohol consumption can also contribute to erection problems.