Diabetes and Erectile Dysfunction

Most people with diabetes know the long-term effects it can have on the body. That's why they strive to live a healthy lifestyle and monitor their condition. If you're a man with diabetes, you have an increased chance of erectile dysfunction (ED), which doctors call having a "risk factor" from diabetes. Men with type 1 diabetes have a greater risk of ED than men with type 2 diabetes.

It is thought that at least 50% of diabetic men have erectile dysfunction. Erectile dysfunction occurs at a younger age in diabetic men and usually occurs within 10 years of diagnosis of the disease. It also is well known that not all diabetics develop erectile dysfunction, but those individuals with certain associated diabetic related complications such as peripheral neuropathy have a very high association of erectile dysfunction. On the other hand prostate problems can also occur in diabetics. Our goal is, in this communication, to update you on the current management of diabetic erectile dysfunction in light of the introduction of Sildenafil.

If you have ED or some other sexual problem, it’s normal to feel embarrassed or upset. You may blame yourself or your partner. Some men feel guilty and angry. Others feel like there’s no hope. These feelings can make it hard to talk openly with your partner or your doctor. But talking about ED means you’re a step closer to getting help.

Normal male sexual function requires a complex interaction of vascular, neurological, hormonal, and psychological systems. The initial obligatory event is acquisition and maintenance of an erect penis, which is a vascular phenomenon. Normal erections require blood flow into the corpora cavernosae and corpus spongiosum. As the blood accelerates, the pressure within the intracavernosal space increases dramatically to choke off penile venous outflow. This combination of increased intracavernosal blood flow and reduced venous outflow allows a man to acquire and maintain a firm erection.

Nitric oxide also plays a significant role. High levels of nitric oxide act as local neurotransmitters and facilitate the relaxation of intracavemosal trabeculae, thereby maximizing blood flow and penile engorgement. Loss of erection, or detumescence, occurs when nitric oxide-induced vasodilation ceases.

Low intracavernosal nitric oxide synthase levels are found in people with diabetes, smokers, and men with testosterone deficiency. Interference with oxygen delivery or nitric oxide synthesis can prevent intracavernosal blood pressure from rising to a level sufficient to impede emissary vein outflow, leading to an inability to acquire or sustain rigid erection. Examples include decreased blood flow and inadequate intracavernosal oxygen levels when atherosclerosis involves the hypogastric artery or other feeder vessels and conditions, such as diabetes, that are associated with suboptimal nitric oxide synthase activity.

Erections also require neural input to redirect blood flow into the corpora cavernosae. Psychogenic erections secondary to sexual images or auditory stimuli relay sensual input to the spinal cord at T-11 to L-2. Neural impulses flow to the pelvic vascular bed, redirecting blood flow into the corpora cavernosae. Reflex erections secondary to tactile stimulus to the penis or genital area activate a reflex arc with sacral roots at S2 to S4. Nocturnal erections occur during rapid-eye-movement (REM) sleep and occur 3-4 times nightly. Depressed men rarely experience REM sleep and therefore do not have nocturnal or early-morning erections.

In addition to medication, your doctor may recommend the following.

Controlling Blood Sugar

This may help prevent and reduce nerve and blood vessel problems. Some of the things your doctor recommends may be part of your diabetes program already. Be sure to discuss any new recommendations with all of your doctors and healthcare professionals, as some new advice may conflict with your current program.

Be "Heart Healthy"

Since heart disease and high blood pressure can contribute to ED if you have diabetes, you should do what you can to keep your heart healthy and control your blood pressure. This may include changes in diet and exercise. Be sure to discuss any diet or exercise program with your doctor before starting it. If you have a cardiovascular condition already, you should continue to work with your doctor to make sure both conditions are treated together safely.

Avoid Large Amounts of Alcohol

Drinking large amounts of alcohol can make achieving an erection more difficult. Usually, men should have two or less drinks per day.

Quit or Reduce Tobacco Intake

Tobacco products can cause arteries to narrow and become blocked over time, which can also lessen the blood flow needed to achieve an erection.

Counseling

Depression, anxiety and stress can all contribute to ED, whether caused by diabetes or not. Counseling can alleviate these feelings, and help restore a more positive, confident attitude.

The information contained here is provided from a third-party publication as a courtesy to our visitors. It is not to be considered an endorsement by Lilly ICOS LLC. Remember, only your doctor or other healthcare professional can determine if you have erectile dysfunction and if treatment is right for you.