Diabetes and erectile dysfunction: What is the connection?

9), moderate obstruction (0.

Penile injections, vacuum pump devices, and surgical penile implants may help. Treatment for ED is more likely to be effective if given early, although complex regimens may be required. ED is also linked to other conditions common among men with diabetes, such as high blood pressure, coronary artery disease and obesity. But some diabetes problems hit guys directly below the belt: 45 Upregulation of nNOS in the central neurons is thought to be a compensatory mechanism to replenish the blood flow by vasodilation and neovascularization.

Currently, the only effective oral treatment is sildenafil, provided that there are no specific contraindications. The great majority of ED cases in diabetic men have a physical cause, such as neuropathy or circulatory problems. This would give an indication of kidney function.

If you’re feeling embarrassed or worried about a sexual problem, this can be really difficult and make you feel like you don’t want to or can’t have sex. And if the condition has already started to derail your physical relationships, your doctor can help you get back on track. Ask your doctor if you're taking the right steps to manage your diabetes. Neuropathic damage to both the somatic and autonomic nerves has been clearly defined in DM. Prevention is a key factor with DM.

3 were classified as “poorly compressible” and excluded from the analysis. MUSE is a single-use, medication system for the delivery of alprostadil to the male penis in treating patients who have difficulty maintaining adequate erection for sexual intercourse. (9) Normal (>12) 60 39. However, there are many more animal and human studies which showed that androgens play important roles in penile erection [31–33]. These conditions typically interfere with the ability of the penile vessels to work properly and ultimately cause ED.

  • Currently using the pump which works but it is a little cumbersome.
  • Ignoring your ED because it’s embarrassing could jeopardize your health.
  • Patient history often informs the degree and nature of the ED.

Can ED be avoided?

6% had some degree of ED, including 43% with serious ED. If erectile dysfunction is developing on the back of blood-vessel occlusion, very soon it can provoke a worsening of the heart, the onset of a stroke, a heart attack. Acute hyperglycemia alone may induce endothelial dysfunction and also decrease the velocity of nerve conduction in rodents [14,15]. Erectile dysfunction secondary to PAD often precedes the development of the classical symptoms of PAD by several years owing to the smaller diameter of penile arteries compared to the femoral and popliteal arteries. There are many ways to treat erectile dysfunction, including pills, injections, vacuum pumps, and surgery. Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.

Erectile dysfunction is common in men who have Type 2 diabetes, especially for those who have sustained nerve and/or blood vessel damage as a result of long-term poor blood sugar control. Address for correspondence: If oral medicines don’t work, there are other treatments that you can explore, including penis injections and surgery. These lifestyle habits include eating a balanced diet and getting regular exercise. ICI Alprostadil may be used as a mixture with two other drugs to treat ED. Poster LBA-9, ADA, 2020. What interpretations did the researchers draw from these results?

Jardin A et al, eds. When analysing this association, the researchers took into account other factors that can have an influence on erectile dysfunction or heart disease, including; smoking history, age, how long they had diabetes, use of blood pressure and other medications, blood pressure, blood cholesterol, BMI and waist circumference. Drugs known as PDE type-5 inhibitors increase penile blood flow. Sexual health (SHIM) questionnaire to help diagnose the presence and severity of ED.

Erectile dysfunction and diabetes: Take control today

What comes after an ED diagnosis in diabetic patients? Besides according to clinical findings, Cialis intake increases the testosterone level in blood. The prevalence of diabetes increases with age.

Subjects with HbA1c <7% were regarded as having good glycemic control. And you can take steps to improve your situation. According to multiple studies, many men with high blood pressure who were between the ages of 40 to 79 also suffered from erectile dysfunction.

With the aim of improving the work of the nervous system, enhancing the sensitivity of nerve endings, thioctic acid medications come to the rescue.

Take steps to cope with erectile dysfunction — and get your sex life back on track. Contrary to popular belief, insulin and other diabetes drugs don't hamper erections, says Kenneth Snow, M. 19 The study showed that, even after controlling for age and duration of diabetes, there was an association between glycated haemoglobin levels (HbA1c) and ED (OR 1. )You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary. Cui H, Liu B, Song Z, et al. It is important to discuss every aspect of your health with your doctor. This analysis took into account some other factors that might be responsible for the association.

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When a person is suffering from ED, it is extremely eminent to discuss the issue with the specialist. This is a natural part of the aging process. • Long-term uncontrolled diabetes can make ED permanent. Plymbridge, 2020; pp 65-102. (30) more likely than men without erectile dysfunction to experience a cardiac event during follow up. When erection is desired, the unit is activated by either squeezing or bending, depending on which of the two types of self-contained prostheses is used. Corpus cavernosometry Cavernosography measurement of the vascular pressure in the corpus cavernosum. These pelvic nerves form the pelvic plexus and send their message through first messenger, acetyl choline, to the cavernosal nerves.

Subjects were consecutively recruited from the outpatient diabetes clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, situated in the Southwest geopolitical zone of Nigeria, after obtaining a written informed consent. Erectile dysfunction — the inability to get or maintain an erection firm enough for sex — is common in men who have diabetes, especially those with type 2 diabetes. Penile injections can be used alone or in combination with an oral drug. At first glance, it’s not obvious why higher than normal levels of blood sugar would cause erectile dysfunction. Good thing, there are treatment options for diabetes and ED available in the market. Yet it’s vital that you do talk about it. If oral drugs don't work, the drug Alprostadil is approved for use in men with ED. Sex can be an important part of our lives, but it's something we still struggle to talk about.

A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. A structured questionnaire was used to document relevant demographic and clinical information such as age, cigarette smoking history, and duration of DM. Healthcare providers have long realized that ED can be the first symptom of DM. You may experience short-term episodes of impotence, but for about one in 10 men the problem may continue. Natural viagra: everything you need to know, in some cases, a treatable medical condition such as low testosterone or depression could explain a case of ED. When the problem is insufficient blood flow, vasodilators (such as nitroglycerine ointment) can be applied to the penis to increase penile blood flow and improve erections. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs.

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Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: This suggests that older age may be acting indirectly through other risk factors for the development of ED in the diabetic subjects and this underscores the importance of controlling these other risk factors since aging is not modifiable. These are people who have good control with their blood sugar levels. Both of these factors assist in controlling the risk of sexual disorders. Endothelial dysfunction (the small ed) then leads to erectile dysfunction (the big ED) through smooth muscle dysfunction in the microvascular tree of the penis.


Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Patients should avoid any factors that can increase the risk of ED. First, diabetes can cause damage to nerves (neuropathy) throughout your body-including the nerves to your penis. This finding is consistent with two large population-based observational studies which reported no significant association between the circulating lipid levels and the risk of ED and concluded that although dyslipidemia is common in diabetics, it has no significant role in the pathogenesis of diabetic ED [3, 35]. That’s because a lot of sugar in your urine provides a perfect breeding ground for the bacteria that causes thrush to grow. Identifying and treating the problem will prevent further damage. The prevalence of ED and its severe forms was high in this patient population.

Some 50% of men with Type 1 diabetes who try the drugs report improved erections, and some 60% men with Type 2 diabetes do, too. However, this is a poor indicator of the presence of PAD as it may not develop until decades into the onset of the disease and may never even develop at all. Yohimbine, trazodone, phentolamine, L-arginine, and OTC herbal remedies have been used with very limited success. Sexual dysfunction preceded the diagnosis of diabetes in 30%, and 45. Although less efficacious than ICI, an intraurethral prostin can be a good alternative for patients who do not wish more invasive therapies. Blood loss is typically small. Increasing age has consistently been shown to be a significant risk factor for ED both in the general population and in diabetic cohorts [4, 6]. Atherosclerosis is a hardening, or thickening, of the arteries.

All are portable, and costs range between $200-$500, covered under most insurance plans and Medicare Part B. The most common offenders are blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). It all has to do with blood flow. 6% of those who did not have ED giving a ratio of more than 3 :

A thorough physical exam and medical history, along with certain laboratory tests, can help your doctor determine what is causing ED, and then choose an appropriate treatment.


The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth. However, its risk factors have not been well studied. In erectile tissue, there is atrophy of the smooth muscle cells and lipid deposition in the corpus cavernosum [24]. Pills can help people with diabetes in about 60 to 70% of cases. If medical therapy fails, sperm can be retrieved from postcoital urine samples and used for insemination [65]. 3), mild obstruction (0. Some men prefer to see a male doctor or nurse.

Expert opinion about surgical implants has changed during recent years; today, surgery is no longer so widely recommended. Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. Less than five percent of men with ED may benefit from vascular surgery. Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to cancel some causes out. It’s Treatable! Over time, these high levels can cause irreversible nerve damage and narrow your blood vessels.

Yet another common erectile dysfunction treatment that can be used in combination with oral drugs is a vacuum pump. Penile tissues are innervated by autonomic nerves which mediate both penile erection and semen ejaculation. In particular, it’s unclear if the findings from the study are applicable to men in western countries as lifestyle factors across cultures may contribute differently to a person’s overall risk profile. Erectile dysfunction. However, ED can occasionally be the first presenting symptom of a new onset of DM. Saenz de Tejada. (7) Never smoked 111 73. Viewers should discuss the side effects with the doctor prior to using MUSE.

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Virtually all the participants who had moderate arterial obstruction and majority of those who had mild obstruction in this study had ED. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. ” Additionally, ED could be a sign of a serious, even life-threatening complication, such as congestive heart failure or kidney disease. According to the Mayo Clinic, you should not take these medications if you take nitrate drugs for angina, a blood thinning medication or certain types of alpha blockers. The blood tests also help in assessing if the problem is due to hormone imbalance. Men most often start having sex with their penile implants by eight weeks after surgery. The ABI was categorized as normal (0. )

The mean age was years and mean duration of DM was years. Erectile dysfunction is associated with grave psychosocial and clinical consequences including depression and poor quality of life [5]. In cases where medications or a penis pump won't work, a surgical penis implant might be an option. The EDDM patient has a variety of firstline options. Erectile dysfunction might occur earlier in men with diabetes than in men without the disease. The drugs and other medical options sold to conquer ED are often stop-gap remedies. Even if your blood sugar is under control, you may need an extra boost. Diagnosing erectile dysfunction If you notice a change in the frequency or duration of your erections, tell your doctor or make an appointment with a urologist.

Second, Diabetes can aggravate a condition known as atherosclerosis, in which the blood vessels become narrow or harden. Third, men with Diabetes need to control their blood sugar levels. Musicki says that an estimated "50 percent to 75 percent of diabetic men have erectile dysfunction to some degree, [a rate] about threefold higher than in non-diabetic men. "These are all common conditions in people with diabetes. The surgeon will explain when and how much exercise to do during the healing period. Thrush is a fungal infection and more common in women – but men can get it too. It is invasive, expensive and produces irreversible damage to the penile architecture, but under optimal conditions, it can be an excellent treatment option. Better medications, implants, vacuum devices and suppositories have all increased options for diabetic men with ED.

Psychological Impact

The connection between diabetes and ED is related to your circulation and nervous system. Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. A very small percentage of men will continue with these treatments as evidenced by a very high drop out rate and a very low refill rate for these treatments. Vacuum therapy devices have a few disadvantages. One person had an ankle brachial index >1. The sensory afferent nerves are the dorsal nerves of the penis. In rare cases, the pills may create “priapism,” a prolonged and painful erection lasting six hours or more (although reversible with prompt medical attention).

How is ED diagnosed? 6 11–15 28 18. Men with Diabetes have four main risk factors for ED. Thrush can cause the tip of the penis or under the foreskin to be sore or itchy. Medications for erectile dysfunction, several types of FDA approved vacuum therapy devices are available under prescription. With a reported prevalence of 35 to 85% [2, 3], ED is one of the most common complications of DM. For a man with neuropathy in his penis, this transmission gets disrupted and the penis does not respond in the typical way. Besides, taking Cialis is possible only after a normalization of health state. DM should be considered in all men presenting with ED.

Up to 28% of men complaining of ED have DM as the primary causative factor. It is unlikely that a man with diabetes who has other medical problems such as high blood pressure, is taking multiple medicines, and has not had sexual intercourse for several years will be able to have an erection adequate for intercourse the first time he takes a pill. The efficacy of ginkgo biloba and Korean red ginseng has yet to be demonstrated by randomized, placebo-controlled trials. Further, we will highlight the role of hypogonadism in the context of type 2 diabetes mellitus (T2DM) and its link with ED prior to discussing treatment strategies for ED with a focus on diabetes and cardiovascular disease (CVD) risk reduction.


The first line of approach is to quit smoking, lose excess weight, and increase exercise. Subsequent to processing in the central nervous system neural impulses are conveyed along the spinal cord, exiting through the pelvic parasympathetic preganglionic nerves. This article takes a look at what can be done to treat those men who do not respond to oral therapy. Arteries are a critical part of this process, as they expand in response to sexual stimulation and allow blood in.

The first successful vacuum erection device, or penis pump, was developed by Vincent Marie Mondat in the early 1800s. Damage to the nerves that control sexual stimulation and response can impede a man’s ability to achieve an erection firm enough to have sexual intercourse. Connective tissue synthesis is increased due to transforming growth factor-beta. About 25 percent of ED cases are caused by drugs. Want to learn more about diabetes and sexual health?

Causes of ED are extremely complex, and are based around changes that occur to the body over time affecting nerve, muscle and blood vessel functions. Diabetics and patients with hypertension frequently have heart disease. In some cases, however, these drugs may be unsuitable for patients with heart disease. Gene therapy is not being tested, and at some point may offer a permanent therapeutic approach to tackling diabetes and erectile dysfunction. In patients with persistent erectile dysfunction despite a normal testosterone level, medications such as MUSE can be helpful.

6 Absent 101 66.

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Some people find it harder to communicate with the doctor and accept that they have this disorder. “One of the things we do is recommend is that they see a cardiologist and perhaps have a stress test or some sort of evaluation. In this prospective cohort study, the researchers included men with diabetes at the Prince of Wales Hospital Diabetes Centre, Hong Kong between 1995 and 2020. Doxazosin (cardura), it may harm them. Diabetes can affect the process of a normal erection.

How do I know my ED is physical and not mental?

The cylinder is placed over the flaccid penis and held tight against the pelvis. “Rejoyn” is an inexpensive, nonprescription alternative to the vacuum-actuated devices. Europe pmc, most results from human trials rely on self-evaluation, which can be subjective and difficult to interpret. But people with diabetes are more at risk of sexual dysfunction (problems when you have sex).

Diabetes often causes kidney disease, and kidney disease, in turn, can cause chemical changes in the type and amount of hormones one’s body secretes, including the hormones involved in sexual response. These oral pills cause an improvement in the flow of blood to the penile tissue and are mostly well tolerated among men. Honig stresses that if pills don’t bring satisfaction, patients should seek out further options. These medicines facilitate an erection by increasing blood flow to the penis, but they do not act as an aphrodisiac or as an initiator of the erection. These chemicals may have an effect on potassium channels that facilitate intracellular calcium release and subsequent cavernosal smooth muscle relaxation. If this were the case, the researchers had no way of identifying those whose erectile dysfunction was actually a result of their heart problems.

Unfortunately, such facility is lacking in our centre. It uses a pump to draw blood into your penis to create an erection. It is estimated that about 35% to 75% of men with diabetes will experience at least some degree of erectile dysfunction -- also called ED or impotence -- during their lifetime. —William Bornstein, MD, EndocrinologistAlthough injecting a drug into the penis "sounds horrible," many men tolerate the injections well and find they are helpful, says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta.


But even these men should tell their doctor about the condition, Snow says. You might get an STI if you have sex with someone who’s got one, if you don’t use a condom. For the first month, men should limit their physical activity. Erectile dysfunction is very common. Various types of tests are administered for finding out whether the flow of blood towards the penile region is being affected. In patients receiving testosterone replacement therapy (TRT), beneficial effects on reported quality of life and sexual interest may manifest as early as 3 weeks, although effects on erectile function may take up to 6 months.

Erectile dysfunction is a common occurrence in men with diabetes. The cylinder is removed, leaving the tension ring at the base of the penis to maintain the erection. 19 In patients with diabetes, the severity of ED has been linked to the number of circulating endothelial microparticles. Ejaculatory dysfunction can be caused by medication such as selective serotonin reuptake inhibitors, surgery such as transurethal resection of the prostate or chronic medical disorders. Interestingly, insulin itself may, under certain circumstances, activate a membrane-bound hydrogen peroxide generating system that could theoretically exacerbate oxidative stress in susceptible tissues [44].

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This particular syndrome arises due to the damage to the nerves and also blood vessels which are being caused by long term imbalance to the blood sugar level. That does not mean you should stop taking these medications! 19 HDL cholesterol (mmol/L) 0. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient.

Don’t delay—erectile dysfunction doesn’t “just go away! 28 Duration of diabetes (years) 0. Excess alcohol can contribute to erectile dysfunction. You can cure ED. This finding had been demonstrated in many other studies [2, 3, 14, 17, 18]. Increased activation of protein kinase C, overexpression of endothelin and angiotensin II, increased synthesis of diacylglycerol, oxidative stress and increased production of plasminogen activator inhibitors are considered to promote vascular pathology in diabetic patients with ED [11]. ED can have psychological consequences as it can be tied to relationship difficulties and self-image. Anecdotal evidence suggests that current NICE guidance to assess ED annually and address contributory factors is not being comprehensively adhered to.

Sexually transmitted infection (STI)

Neither total cholesterol concentration nor any of the lipoprotein fractions (HDL, LDL, and TG) was significantly associated with ED in this study. Little by little, the muscle inside the penis shrinks. It’s not easy to talk about health—especially sexual health—but don’t drop the ball. You'll also feel better overall and improve your quality of life. In general, much less is known about sexual problems in women and this includes women with diabetes. The average UK male, however, suffers for 3 years before discussing symptoms of ED with a healthcare professional.

“Basically, diabetics develop micro changes in blood vessels which affect blood flow. This means taking the medicine 30–45 minutes before engaging in sexual intimacy; taking the drug on an empty stomach or at least avoiding a heavy or high-fat meal before taking the drug (this is especially important when using sildenafil); and engaging in adequate genital stimulation before attempting intercourse. NIH Consensus Development Panel on Impotence. Self-contained single-unit prostheses are similar to the inflatable types, but more compact. J Sex Reprod Med 2020;1(1):

There are also "surgical interventions that are also very effective, enabling men to get erections," says Dr. The bottom line is that nearly all men with diabetes who wish to have an erection adequate for sexual intercourse can do so with the therapies currently available. The major culprits are thiazide diuretics, beta-blockers, and centrally acting drugs such as alpha-methyldopa. Prevalence and risk factors for erectile dysfunction in Japanese diabetics. You may want to ask your doctor for a referral to a counselor, who can help you resolve whatever issues may be making it difficult to keep an erection. J Am Coll Cardiol 2020;55(4): Poorly controlled diabetes and high cholesterol increase the chances of vascular complications, which may lead to ED or other circulatory problems. Many of these drugs treat the symptoms.

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