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Treating Diabetes: Talking about sex?

If you treat a man with diabetes, you might want to ask how his sex life is going.

That’s because there’s a strong link between diabetes and erectile dysfunction (ED). According to the American Diabetes Association, about half of men with diabetes experience ED at some point. And the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that diabetic men may experience ED ten to fifteen years earlier than men who don’t have diabetes.

Diabetes can damage the nerves and blood vessels needed for a man to sustain an erection. Normally, when a man is sexually aroused, a signal goes from his brain to his penis and starts the erection process. If there is nerve damage, this signal cannot be transmitted properly and the erection will either not happen or not be firm enough for sexual intercourse.

Similarly, in a healthy man, the sexual stimuli will cause the blood vessels in the penis to relax and expand, allowing the penis to fill with blood and become erect. But if there is blood vessel damage, this won’t happen the way it should.

In most cases, ED is caused by underlying physical problems. Diabetes is just one. Others include heart disease, high blood pressure, atherosclerosis, obesity, low testosterone, tobacco use, and alcoholism.

Fortunately, ED is treatable and a variety of options exist for men with diabetes. Common treatments include medication, injections, or devices like penis pumps. Sex therapy can also help men whose ED stems from psychological causes.

So it seems that treatment for ED would be the key to solving some of these issues. The problem is – a lot of men don’t want to discuss their sexual problems, even with their health care providers. Many don’t want to admit that they’re having trouble in the bedroom because it makes them feel “less of a man.” They may feel embarrassed and nervous or think that certain providers can’t help them.

Indeed, a recent poll of men and women over age 50, commissioned by LIFESPAN (manufacturer of 112 Degrees, a men’s sexual health supplement), indicated that roughly a third of men waited over a year before acting on their ED symptoms. In addition, while 100% of the men surveyed said they had symptoms of ED, only 32% of the women reported that there were ED experiences in their relationship.

Sexual performance is often tied closely to a man’s identity and self-esteem. Therefore, it’s not surprising that men with ED can be stressed and anxious about it. They may feel inadequate because they cannot please their partner and worry that their partner will go elsewhere for sexual satisfaction.

Relationship problems are a common complication of erectile dysfunction. Sexual issues aren’t always easy for a couple to talk about. They may isolate themselves and withdraw from the relationship. All of this can exacerbate the problem of ED. The more anxious a man feels about ED, his sexual performance, and his relationship, the worse the ED becomes.

Eventually, depression and anxiety can interfere with other aspects of his health, his other relationships, his job, and his overall well-being.

Communication about ED is important. But how do we get reluctant men talking?

Health care providers may need to start the conversation. If you suspect a man under your care has ED but isn’t seeking help, ask some questions. How is his relationship going? How are things at work? Has he been anxious or depressed?

Even if he doesn’t open up, you can still let him know that ED is common in diabetic men, that it’s nothing to be ashamed of, and that treatments are available. You can offer to refer him to a urologist or therapist. Or, he might decide to go on his own or discuss it with his partner.

No matter what happens, there’s no reason for a man to suffer in silence. It might be awkward, or outside your area of expertise, but just starting the dialogue may be all that’s needed for your client to move forward with treatment for his ED and on to a happier, healthier life.