Erectile dysfunction (impotence) associated with diabetes Symptoms, causes, treatment & prevention

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Erectile dysfunction (impotence) associated with diabetes
Symptoms, causes, treatment & prevention
Article compiled and edited by Lahle Wolfe
Source: NIH Publication No. 06–3923; December 2005

Diabetes related erectile dysfunction: a common problem

One of the more common complications in males with diabetes is impotence, also known as erectile dysfunction (ED). It can, and should be treated as early as possible. A person with diabetes related ED should not hesitate to mention the problem to his doctor because it is nothing to be ashamed about and treatment can either prevent it from worsening, and in many cases safely treat the problem so that a fulfilling sexual life can again be enjoyed.

More men with type 2 diabetes (46%) suffer from erectile dysfunction than those with type 1 diabetes (32%). (International Journal of Impotence Research (2002) 14, 466-471)

What is erectile dysfunction (ED)?

ED, is defined as a man’s inability to achieve, or maintain, an erection allowing for normal intercourse. It is normal for men to experience isolated incidents of impotence; ED is diagnosed when it is an ongoing or repeated problem more than 75% of the time during attempted intercourse. It is not the same thing as diminished or low sexual drive, or ejaculatory issues.

Symptoms of erectile dysfunction

Any man can have ED problems, but the condition of ED has several characteristics among those with diabetes:

It is more common among diabetic men. ED is a problem many men are not comfortable talking about but it is estimated that as many as 75% of men with diabetes develop erectile dysfunction (compared with 5-25% in the general population).

It begins earlier in life. Typically, men over age 65 may begin to develop erectile dysfunction. In diabetic males ED issues are more likely to appear 10 to 15 years earlier, on average. Men in their 30s and younger with diabetes have also experienced sexual dysfunction. But the overall risk of impotence can be diminished through good glycemic control.

Risks are higher. The longer a person has had diabetes and the more out of control blood glucose is, the more likely a man is to develop erectile dysfunction.

Diagnosing erectile dysfunction
Certain tests can aid in diagnosing ED. They include:

* Laboratory Tests. Tests to rule out other systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine, and liver enzymes.

* Testosterone. Tests to measuring the amount of free testosterone in the blood is indicated in patients with decreased sexual desire. The levels of free testosterone can reveal valuable diagnostic information about the endocrine system.

* Nocturnal Erections. Healthy men experience involuntary erections while sleeping. If they do not occur, it may be due to ED. This is not a totally reliable determining factor in diagnosing ED but it can help rule out psychological causes.

Emotional and psychological impact

The inability to perform and enjoy sexual activities can lead to stress, depression, tension in relationships, frustration, and discouragement. Some men may feel less masculine, a sense of loss of control, or withdraw emotionally from their partners. Since all of these things can lead to less concern and attention to diabetes control (which only worsens the problem of impotence) it is important to speak up and seek treatment.

Diabetes and erectile dysfunction

Many factors can contribute to the development of impotence, both physical and psychological in nature. And just because a man has diabetes and develops impotence it could still be from some other cause or combination of things including medications, high blood pressure, or high cholesterol. It is important not to self-diagnose impotence, but to see your physician who can help determine the cause and an appropriate course of action.

Diabetes-related impotence is preventable with tight blood glucose control. The main risk factors for men with diabetes include:

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Neuropathy - Nerve damage which leads to loss of sensation, lack of nerve communication, as well as poor circulation.

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Peripheral Neuropathy – Poor glucose control can inhibit nitric oxide production. Nitric oxide is necessary to maintain the pressure of blood in the corpora cavernosa from rising enough to close off veins to the penis.

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Vascular Damage - Blood vessels can become narrowed or hardened (atherosclerosis) by conditions associated with diabetes, such as cardiovascular disease. When atherosclerosis occurs in arteries that supply the penis or pelvic area, sexual function may be disrupted.

Prevention and treatment for diabetes related erectile dysfunction

The conditions of diabetes that contribute to the development of erectile dysfunction can be minimized…

Talking with your doctor at the first sign of impotence is important because he/she can help determine if erectile dysfunction is the result of diabetes or another condition. Other things you can do to minimize your risk of impotence include:

ü Keep good control of your blood glucose. High blood glucose is what causes damage to nerves and leads to blood vessel complications. If you have trouble keeping your blood glucose in a good range tell your doctor so that he/she can help you revise your diabetes care plan.

ü Keep your HbA1c below 8. One study of 78 diabetic men at the Cleveland VA Medical Center showed a direct relationship between HbA1c scores and erectile dysfunction. Those with am HbA1c below 8 had no greater rate of impotence than normally seen in the general population. Those with an HbA1c above 8 showed an increase rate of impotence – and approximately ten years earlier than would normally be seen in the general population.

ü Eat a healthy diet. Since high cholesterol and high blood pressure can contribute to the development of erectile problems, it is important to follow your meal plan as prescribed.

ü Exercise. Being physically active can improve circulation, enhance mood, and help keep blood sugars in check; all important in maintaining healthy erections.

ü Limit caffeine to moderate amounts. Excessive caffeine can cause blood vessels to constrict, and can also mimic symptoms of hypoglycemia. If you feel low from too much caffeine you may snack when you don’t need to. Be sure to test your blood glucose levels often.

ü Avoid alcohol. Excessive amounts of alcohol can cause erectile dysfunction by damaging blood vessels. Excessive doesn’t necessarily mean large quantities. Men should consume no more than two alcoholic drinks a day, and women, no more than one. Since alcohol can cause hypoglycemia, the less you drink the better.

ü If you smoke, quit. Smoking and other tobacco use cause blood vessels to narrow, contributing to blockages that can lead to erectile dysfunction. Smoking also decreases nitric oxide levels needed to maintain an erection.

ü Counseling helps. Stress, anxiety, and depression can all contribute to impotence, in fact, even worrying about it can make erectile problems worse. If you have an existing problem, counseling can be an effective part of an overall treatment program.

ü Consult a urologist. Urologists have more experience in treating sexual disorders in men than other doctors. They are best able to identify the source of problems and come up with a treatment plan that works for you. Treatments a urologist may recommend include medications, surgical implantation of a pump or rod, and vacuum devices that use pressure to draw blood into the penis.

ü Medications. Drugs known to aid in erectile dysfunction include Tadalafil (Cialis), Sildenafil (Viagra), and Vardenafil (Levitra).