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Take-home points
- Many diabetic patients suffer from erectile dysfunction, with estimates suggesting up to 75% experience erectile dysfunction at some point in life.
- The primary causes of erectile dysfunction in men with diabetes include high blood sugar, excess body fat, and also low testosterone.
- There are several treatment options available for erectile dysfunction depending on the cause, from tablets, creams, to therapy.
- It is important to speak to your healthcare professional if you are concerned about any erectile issues.
Erectile dysfunction is a common issue for men, including those with diabetes. Up to 75% of male diabetics suffer with erectile dysfunction, so it’s clear a relaionship exists between diabetes and erectile dysfunction.1
In this article, we’ll go into the basics of erectile dysfunction, explore the link between diabetes and erectile dysfunction, and discuss how effectively managing diabetes can help men avoid developing erectile dysfunction.
What is erectile dysfunction?
Erectile dysfunction is when a man can’t get an erection that’s firm enough for sexual intercourse (or is unable to keep an erection for long enough to have sex). It affects around 50% of men between 40-70 years old.2
There’s not just one cause of erectile dysfunction. Many physical and psychological factors are linked to the condition.
Physically, changes in nerve, muscle, and blood vessel function can all contribute to developing erectile dysfunction. Some of the known risk factors include heart disease, high blood pressure, high cholesterol, smoking, obesity, and of course diabetes (more on this later).
Psychological factors such as anxiety, depression, stress, and relationship problems can also contribute to erectile dysfunction.
Learn more about erectile dysfunction, including symptoms, causes, and treatment
Treating erectile dysfunction
Psychological treatment
Many men with erectile dysfunction can benefit from sex and relationship counselling. Even if a physical cause is largely responsible, erectile dysfunction can still impact a man’s mental health and relationships. Research suggests that receiving psychological therapy and erectile dysfunction medication together improves outcomes even when a physical cause has been identified.3
Tablets
Erectile dysfunction medication is generally the most common treatment option. Many men think of Viagra as the only medication for erectile dysfunction, but there are several other erectile dysfunction drugs including tadalafil, vardenafil, and avanafil.4
The medications all belong to a drug family called PDE-5 inhibitors. They work by relaxing the smooth muscle in the penis, which in turn relaxes the blood vessels and increases blood flow. The penis can fill with blood more easily, leading to an erection.
You’ll still need to be sexually aroused to get an erection; the medication just makes the process easier.
Other treatments
If medications aren’t effective, there are other options such as injectable medications, creams, vacuum pumps (to encourage blood flow to the penis), and even penile implants that are placed inside the penis surgically. It’s important to discuss these options with a healthcare professional before getting started.
One of the most important treatments that we haven’t mentioned yet is lifestyle changes. Quitting smoking, limiting how much alcohol you drink, increasing physical activity, and maintaining a healthy body weight all help maintain good blood flow to the penis and avoid erectile dysfunction.
These lifestyle changes can be particularly important in men with diabetes, as they’re more likely to develop blood vessel and nerve damage in the penis. Let’s explore why.
Learn more about treatments for erectile dysfunction
The link between diabetes and erectile dysfunction
Men with diabetes are 3.5 times more likely to experience erectile dysfunction.5 But why is this?
One aspect of diabetes is having high blood sugar levels. Long-term, high sugar levels can cause inflammation of the blood vessels. This leads to scarring, making the vessels smaller and harder to pump blood through. If this happens to the blood vessels in the penis, it can cause erectile dysfunction.5
High blood sugar levels also interfere with nerve function, which can impact the nerves leading to and from the penis. As the penis requires input from your nerves to become and stay erect (in the form of physical or mental stimulation), this can lead to erectile dysfunction.
Obesity is a common cause of type 2 diabetes. Diabetic men with excess body fat are more likely to have atherosclerosis (narrowing of the blood vessels), reducing blood flow to the penis. They’re also more likely to have hormonal imbalances, such as low testosterone.
Nearly 30% of men with diabetes also have low testosterone levels.6 Some research suggests low testosterone in diabetic men is associated with erectile dysfunction, but more research is needed to say for sure.7 Low testosterone is known to reduce libido, which can itself cause erectile dysfunction.
It’s clear that diabetes can increase the likelihood of developing erectile dysfunction, but there are several things you can do to reduce the risk of this.
How to avoid/improve erectile dysfunction if you have diabetes
Avoiding erectile dysfunction
Keeping your blood sugars well controlled from as early on as you can is important to avoid erectile dysfunction. If your sugars have been high for a while, getting them under control can still help improve erectile dysfunction symptoms, but may not be as effective if damage has already been done to the nerves.
Depending on the type and stage of diabetes that you have, you may be able to control your blood glucose levels using diet, insulin, and/or other diabetic medications. Studies show that metformin can improve erectile dysfunction symptoms, especially in insulin-resistant men.8
Improving your lifestyle, where possible, can also help with erectile dysfunction. This includes maintaining a healthy weight. Eating a lower-calorie, balanced diet and exercising regularly has been shown in studies to reduce erectile dysfunction symptoms.9 Another study found that diabetic men who exercised regularly were less likely to have erectile dysfunction.10
Learn more about how you can tell if you have erectile dysfunction.
Treating erectile dysfunction
PDE5 inhibitor medications are an effective way for diabetic men to treat their erectile dysfunction. Most erectile dysfunction medications are suitable for men with diabetes, although researchers can’t agree on which type is better.5 Erectile dysfunction medications have the added benefit of improving blood flow to other areas of the body, which decreases the risk of cardiovascular diseases.5
Men who fail to respond to PDE5 inhibitor medication can try a variety of other treatments, including suppositories within the penis, creams, injections, vacuum devices, and even implants.
If you are diabetic and struggling with erectile dysfunction, it’s important to make an appointment with your doctor. They’ll be able to advise you on how best to control your blood sugar, prescribe any suitable medications, and suggest different erectile dysfunction treatment options. This is especially important because erectile dysfunction can be a predictor of cardiovascular disease – learn more about the link here.
References
- Tamás V, et al. Handb Clin Neurol 2014; 126: 223-32.
- NHS Inform. Erectile dysfunction. Available from: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence/
- Dewitte, M et al. Sex Med 2021; 9: 100434.
- NHS. Erectile dysfunction (impotence). 2019. Available from: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
- Defeudis G, et al. Diabetes Metab Res Rev 2022; 38(2): e3494.
- Dandona P, et al. J Clin Endocrinol Metab 2011; 96(9): 2643‐2651.
- Korani MA, et al. Alexandria Journal of Medicine 2018 Dec; 54(4): 319–21.
- Patel JP, et al. Transl Androl Urol 2017; 6(3): 556-565.
- Gupta BP, et al. Arch Intern Med 2011;171(20):1797-803.
- Minami H, et al. J Diabetes Investig 2018;9(1):193-198.
