Diabetes - Erectile Dysfunction
How often do men with diabetes experience ED?
Erectile dysfunction is a common issue in diabetic men -- in fact, research indicates that men with diabetes are four times more likely to experience erectile dysfunction as men without diabetes.
Erectile dysfunction occurs 10-to-15 years earlier in men with diabetes than in men without diabetes and diabetic men with ED may also suffer more severe ED than men without diabetes. The severity of their ED also increases with age, length of time and poor diabetes control. ED may also worsen with the presence of cardiovascular complications and therapy.
Understand that, with proper treatment of diabetes, the chances of diabetic men being affected by ED are reduced, but not eliminated.
Why does diabetes cause ED?
Diabetes has to do with the body's metabolism. Most of the food we eat is broken down into glucose, a type of sugar in the blood. After digestion, glucose moves into the blood stream to help cell growth and energy. A hormone, called insulin, changes glucose into the energy the body needs for daily life. In people with diabetes, though, the body produces either too little or no insulin. People with diabetes may experience frequent changes of high and low blood sugar levels.
Very high levels of blood sugar associated with diabetes can affect the penis in a variety of ways, and lead to ED. The effects include blood vessel damage, nerve damage and damage to erection tissue itself. This nerve and blood vessel damage can disrupt normal sexual function.
Diabetes can cause neuropathy, or damage to nerves, throughout the body, including the penis. These damaged nerves cannot communicate properly, meaning that the proper information is not being relayed from the brain to the penis making it difficult to have an erection firm enough for intercourse.
Additionally, poor blood sugar control in diabetic men can slow the creation of certain chemicals in the penis that enable erections, such as nitric oxide. Nitric oxide is the major neurotransmitter involved in the development and maintenance of an erection. A lack of nitric oxide can prevent the pressure of blood from rising enough to close off the valve mechanism which allows blood to flow out of the penis, preventing the man from keeping his erection.
In diabetes, chemicals known as advanced glycation end-products (AGE) are associated with stiffening of certain tissues including erectile tissue. Stiffening of these tissues can lead to a defective valve mechanism inside the corpora cavernosa. Such a defect, known as 'venous leak,' can result in severe ED and poor response to erection drugs, in particular drugs like Viagra®, Levitra® and Cialis®.
Diabetes is associated with accelerated atherosclerosis, the hardening and narrowing of blood vessels. If the blood vessels become too narrow or hard, it can result in poor circulation of blood and oxygen into the penis. This, too, can affect pressure inside the penis and lead to ED.
What diabetes factors are predictors of ED?
Prolonged high levels of glucose in the blood of men with diabetes may be a predictor of ED. Control of blood glucose levels is an important risk factor for developing ED. Neuropathy, or damage to nerves in the body, including the penis, can also lead to ED.
Symptoms of coronary atherosclerosis (narrowing of the coronary arteries) or symptomatic coronary artery disease can be predictors of ED. Getting older, damaged nerves, retinopathy and long duration of diabetes can also be factors.
Also, many diabetic patients have asymptomatic (silent) coronary artery disease (CAD), which puts them unknowingly at risk for ED. In the case of CAD, high blood pressure and problems with cholesterol can also be predictors of ED.
Do men with diabetes and ED differ from the general population with ED?
Many oral ED medications may not work as well for men with diabetes. These men may need penile injections or penile implant surgery. ED can also indicate undetected cardiovascular disease in diabetic men.
Can ED in men with diabetes indicate other underlying conditions?
Erectile dysfunction with diabetes can indicate the presence of chronic diabetes complications, such as endothelial dysfunction. A healthy endothelium (a layer of cells that lines blood vessels) is important for cardiovascular health. Endothelial dysfunction is closely related to atherosclerosis and cardiovascular disease. This can be a signifier of silent or early cardiovascular disease such as coronary heart disease, stroke and peripheral vascular disease.