It is a well-known fact that chronic illness can cause problems with sexual function. Today, erectile dysfunction, also called impotence, affects an estimated 30 million men in the United States. It is a problem that often leads to frustration, embarrassment, loss of self-esteem, isolation, and depression. It can also lead to strain in a relationship, particularly if a man withdraws from his partner rather than communicating openly about what he is experiencing. Men with diabetes have a higher incidence of erectile dysfunction, yet it is often ignored and left untreated.
Men willing to seek help, though, find that erectile dysfunction is treatable. Today, there are many options that work well and have restored erectile function to many men.
Erectile dysfunction has a variety of definitions and forms, but the one discussed in this article is “the persistent inability to get or maintain an erection sufficient for sexual intercourse.” It is usually caused by disease, injury, or a drug and is not a normal part of the aging process.
An erection normally occurs when sexual stimulation causes nerves in the penis to release certain chemicals that start a cascade of reactions, resulting in the widening of blood vessels entering the penis and a narrowing of vessels leaving the penis. The increased blood flow allowed by the widened arteries fills the spongy tissues of the penis, causing the penis to thicken and lengthen. The engorged tissues compress the veins that take blood out of the penis, further narrowing them, which limits blood outflow and maintains the erection. (Click here for more information about how an erection occurs.)
There are many complications associated with diabetes; however, the two complications that have a direct effect on erections are blood flow problems and nerve problems (neuropathy). High blood glucose levels can contribute to blockages or narrowing of blood vessels. Better known for causing problems such as atherosclerosis and peripheral artery disease (narrowing of the blood vessels supplying the legs and arms), this process can also affect blood vessels that supply blood to the penis.
Diabetic neuropathy also contributes to erectile dysfunction. Nerves are involved in signaling the blood vessels of the penis to widen or narrow (dilate or constrict). Over time, high blood glucose levels damage nerves, and as a result, they cannot properly signal the vessels to open and close, making an erection difficult to achieve.
Most often, erectile problems in men with diabetes are a result of problems with both blood flow and nerve function. However, getting regular exercise, controlling one’s blood pressure, and controlling one’s blood glucose, in addition to being good for controlling one’s diabetes, can prevent or delay neuropathy and vascular problems and help improve sexual function. For men already experiencing erectile difficulties, though, there are several treatment options.
The three main categories of treatment are drugs, mechanical devices, and surgery. Drugs can be taken orally, as a suppository, or as an injection. Mechanical devices cause more blood to enter the penis (vacuum devices), prevent blood from leaving the penis (constriction bands), or support the penis to make it more rigid (splints). Surgical treatment involves implanting a device into the penis. Some men have to try several of these options before finding the one that works best for them and their partners. (See “For More Information” to learn more about treatments for erectile dysfunction.)