Erectile dysfunction (ED) is the persistent inability to achieve, and/or maintain an erection adequate to have sex. Not only does it decrease quality of life, but it is a common condition in the U.S., affecting approximately 12 million men.
There are several health conditions known to contribute to ED. One of the most common conditions associated with the development of ED is diabetes. Diabetes is a condition in which people have excess circulating glucose (a type of sugar) in their blood.
Men with diabetes were found to be three times more likely to develop ED than men who did not have diabetes. Some studies even indicate ED occurs in more than 50% of men who have diabetes. Additionally, while the likelihood of developing ED increases with age, men with diabetes have been shown to develop ED 10-15 years before men without diabetes.
Why does diabetes contribute to ED?
Diabetes affects a large portion of the population and can contribute to a variety of health complications. There are a couple of reasons that diabetes may cause ED. One reason may be the production of a chemical called nitric oxide (NO).
When aroused, the body will release NO, which relaxes and enlarges the blood vessels in the penis. In a man with diabetes, there may be a decreased availability of NO, which limits the flow of blood needed to produce an erection. Diabetes is also known to cause damage to small blood vessels and nerves over time.
Men need adequate NO, the hormone testosterone, and healthy blood vessels to achieve and maintain an erection. While men with diabetes are more likely to experience ED, a diagnosis of diabetes does not make the development of erectile dysfunction inevitable. Many steps can be taken to limit the damage to nerves and blood vessels and maintain a healthy life.
How is Erectile Dysfunction Diagnosed?
First, if you have noted any changes in your erections, or are concerned you may have ED, you should report your concerns to your physician. They may ask you for a short questionnaire that can help them quickly determine a diagnosis. Additionally, they may perform a physical exam to check for any potential abnormalities. After diagnosis, your doctor may want to check for other potential causes of ED.
There are reversible causes of ED, like low levels of the hormone testosterone. If they have not already, your doctor may also check you for diabetes and thyroid in addition to low testosterone. It is important to diagnose and treat any potential underlying condition that could be contributing to ED symptoms.
What Can I Do to Prevent Erectile Dysfunction?
The first-line treatment of ED is aimed at lifestyle changes that have been shown to reduce the incidence of ED in those with diabetes. These include controlling your blood sugar levels, maintaining a healthy weight, exercising, and quitting smoking.
Control of blood sugar
Blood sugar control is aimed at keeping your blood sugar levels as close to normal as possible. Maintaining normal blood sugar levels can prevent complications associated with diabetes. Several studies have shown a reduction in ED in diabetic men when they had better blood sugar control.
Diet, exercise, and weight management
Changes in your lifestyle, like increasing your physical activity, and eating a healthy diet can improve ED. Maintaining a healthy weight can increase your natural testosterone and balance your hormone levels. A healthy diet and exercise can also improve your blood flow, lower your blood sugar levels, and prevent the development of heart disease.
Being a cigarette smoker is associated with ED. Quitting has been shown to have a positive effect on the restoration of erectile function. Smoking is known to narrow blood vessels and decrease NO, which ultimately limits blood flow to the penis.
What Treatment Options are Available for ED?
Several medications can be taken by mouth that can help with achieving and maintaining an erection. The most common medications are a class called phosphodiesterase-5 inhibitors. These medications should not be taken by someone with heart disease, making it very important to discuss them with your physician.
Cialis and Viagra are two medications commonly taken by men with erectile dysfunction
Medications of this type you may be prescribed include:
Sildenafil (Viagra) – take 30 minutes before intercourse
Tadalafil (Cialis) – take 30 minutes before intercourse
Vardenafil (Levitra) – take one hour before intercourse
Avanafil (Stendra) – take 15 minutes before intercourse
Alprostadil (Vitaros) – topical cream
A vacuum constriction device may be an option depending on the cause of ED. It is a cylinder that is placed on the end of the penis, with a constricting band at the opposite end. The pump pulls blood into the penis, and the band is used to maintain the erection by stopping the backflow of blood out of the penis. Vacuum constriction devices work well in someone with diabetes, poor blood flow, or who has had prostate surgery.
Penile implants or prostheses are considered once all other treatment options have been exhausted. These implants are malleable, but typically have a pump attached to make them erect. Surgery is not without potential risks so this should be discussed thoroughly with a urologist.
The Good News
Treatments for ED have been found to be very successful. Although this can be very stressful to discuss with your doctor, it can greatly improve your quality of life. If you are concerned or have tried some treatment options that haven’t worked, your doctor can refer you to a Urologist, who is a specialist in this area.