Diabetes
and erectile dysfunction
Erectile
dysfunction (ED) is a common problem amongst men who
have diabetes. Some sources indicate anywhere between
35 and 75 per cent of men suffering from diabetes
will experience some degree of erectile dysfunction
over the course of their lifetime.
Men who
have diabetes are thought to develop ED between 10
and 15 years earlier than men who do not suffer from
the disease. As men facing diabetes age, erectile
dysfunction becomes more common. Over the age of 70,
there is a 95 per cent likelihood of facing difficulties
with erectile function.
When you
have diabetes, the main risk factors for developing
erectile dysfunction are:
- Nerve
damage (neuropathy)
- Blood
vessel (vascular) damage
- Poor
blood sugar control
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.
Many other
factors bear on ED amongst diabetic men. These include
being overweight, smoking, 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 per cent of ED cases.
How
is ED diagnosed?
Erectile
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. Systemic diseases such as
blood counts, lipid profile and liver enzymes may
all give indications. Further tests such as monitoring
nocturnal erection (nocturnal penile tumescence) can
help to cancel some causes out. Furthermore, psychological
examination can reveal psychological factors.
What
you can do ?
You can
take steps to help prevent erectile dysfunction from
occurring or worsening.
- Talk
to your doctor. Initially, you might be
embarrassed to talk to your doctor about sexual
health. But because erectile dysfunction is a common
diabetes-related problem, your doctor won't be surprised
when you mention the topic. Your doctor may ask
you about it first, in fact. Talking to your doctor
before a problem occurs can help you prevent or
delay erectile dysfunction. Your doctor can also
help determine if erectile dysfunction is the result
of diabetes or another condition.
- Control
your blood sugar. Good blood sugar control
can prevent the nerve and blood vessel complications
that lead to erectile dysfunction. If you're having
trouble controlling your blood sugar, talk to your
doctor about refining your treatment strategy.
- Avoid
tobacco. Smoking and other tobacco use
cause blood vessels to narrow, contributing to blockages
that can lead to erectile dysfunction. Smoking also
can decrease nitric oxide levels.
- Avoid
excessive alcohol. Drinking excessive amounts
of alcohol can cause erectile dysfunction by damaging
blood vessels. In general, for men that means no
more than two alcoholic drinks a day, and for women,
no more than one.
-
See
a urologist. Urologists have special
expertise in sexual health. Some specialize specifically
in erectile dysfunction. They can help assess
your condition, determine its cause, and identify
safe and effective treatments.
Your
urologist may recommend oral medications such
as sildenafil (Viagra), tadalafil (Cialis) and
vardenafil (Levitra). A small number of men have
lost vision in one eye after taking these medications,
causing the Food and Drug Administration to issue
a warning in July 2005.
Other
options include small penile suppositories that
contain prostaglandins, or intra-penile injections.
Your urologist may recommend surgery to implant
a penile prosthesis.
A less
invasive option is a vacuum tube that you place
over your penis. A gentle vacuum develops as you
pump air out of the tube, causing the penis to
become erect. Once enlarged, you can place a ring
at the base of your penis to maintain the erection.
- Get
mental health treatment. Stress, anxiety
and depression can cause erectile dysfunction. Even
the fear of having erectile problems can make them
worse. Talk to your doctor to see if these issues
are playing a role in your erectile dysfunction.
Treatment with a mental health professional might
help.
- Reduce
your cardiovascular disease risk. Men with
diabetes who also have cardiovascular disease, such
as heart disease or high blood pressure, face an
even greater likelihood of developing erectile dysfunction
because of the added damage to blood vessels. Reducing
your risk of developing cardiovascular disease,
or taking the right steps to control existing conditions,
can help prevent erectile dysfunction.
Knowing
more about how diabetes-related complications can
lead to erectile dysfunction may help you take measures
to avoid the condition or prevent it from worsening.
And as erectile dysfunction becomes more widely understood
— thanks in part to mainstream television —
it may become easier for you to discuss, just like
any other medical condition.
By working
closely with your diabetes care team, you can take
preventive steps and learn about the best treatments
for your situation so you and your partner can enjoy
a healthy sexual relationship.
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. Brand
names include Viagra, Cialis and Levitra. However,
these medicines can all affect the heart rate, and
detailed consultation with your doctor is necessary
to determine the best course of action. Additional
treatments include intracavernous injection therapy,
vacuum constriction devices, intraurethral therapy
and sex therapy.
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.
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.
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