You've Got Nerves

If you have diabetes, complications can make sexual activity difficult. One of these, diabetic neuropathy, derails the brain signals that would normally speed along the nerves from the spinal cord to the erectile tissue of the penis. These nerve messages normally release nitric oxide, a chemical that relaxes arteries in the penis, which allows increased blood flow and makes erection possible. Neuropathy disrupts the messages that are sent from the penis to the brain—for example, during physical stimulation of the penis.

In other words, there is a communication breakdown, and that means no sex. Diabetic neuropathy can occur at any time, although the chances of it developing rise the longer you have diabetes. The risk of diabetic neuropathy increases in men who are over 40 years old, who smoke, or have a cardiovascular condition. It is also more common in men who are overweight.

Get a Diagnosis

Neuropathy isn't the only cause of ED in men with diabetes. Damage to blood vessels (caused by elevated blood glucose levels) also occurs over a period of several years, generally without symptoms. Many people who have had diabetes for a long time will also have vascular disease, which may diminish the flow of blood to the penis.

In addition, hormonal imbalances, side effects of medications, and other physical problems that may or may not be associated diabetes can all lead to ED. The causes of ED also go beyond physical well-being. Psychological stress, too, can be a factor. Simply living with diabetes can be stressful enough in itself to affect sexual performance.

Your doctor will gather information by performing a physical exam and a taking a thorough patient history. Blood tests may also be done to look for other medical problems contributing to the erection problems.

Consider Seeing a Specialist

In many cases, general practitioners are capable of diagnosing and treating ED in their patients with diabetes. In some cases, however, it may be necessary to consult a specialist who focuses on sexual dysfunction.

Speak Up

Men also need to remember that their doctor is not a mind reader. Some doctors will ask you about ED, but no matter how embarrassing the situation may be, your doctor can't help you unless you talk about it. The most important thing you can remember is that you're not alone.

What might be perceived as ED may actually be the result of natural physical changes that occur as we age. While advanced age does not automatically lead to sexual dysfunction, many older men find it takes more time or effort to initiate and complete the act of sex. For example, failing to get an erection at the sight of a sexual partner may not be problematic at all. It may simply indicate that you need more tactile, rather than visual, stimulation to achieve an erection. Doctors should be willing and knowledgeable enough to probe for such important details, and as a patient, you need to share your concerns.

Treatment Options

Treatment begins by addressing the physical factors that may be contributing to the problem. These may include:

• Elevated blood-glucose levels
• Smoking
• Alcohol intake
• Medications and their dosages
• Low testosterone levels

If psychological factors are contributing to the problem then these will also need to be addressed, usually with counseling to resolve any emotional or stress-related causes.

Beyond diabetes-specific concerns, the methods used to treat ED in the general population may also be effective for men with diabetes.

Some approaches include:

• Oral drug therapy, such as vardenafil, tadalafil, or sildenafil
• Self-injections of erection-producing agents, such as prostaglandin
• Intrapenile doses of prostaglandins (that is, inserting suppository-like capsules into the urethra)
• Vacuum pumps, which use air pressure to draw blood into the penis
• Permanent surgical implants

Thanks to the variety of treatments available, most men who experience ED due to diabetic neuropathy can find a solution that works. That's something to get excited about.