• Erectile Dysfunction: A Concern for Men With Diabetes

    IMAGE For many otherwise healthy men, impotence can be an infrequent source of embarrassment and mild concern. But for some men with diabetes, impotence is a painful fact of daily life. The cause: diabetic neuropathy, a nerve disorder that can disrupt the neural pathways responsible for creating and sustaining an erection.

    You've Got Nerves

    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 also disrupts the "erection messages" that are sent from the penis to the brain—for example, during physical stimulation of the penis.
    In other words: a communication breakdown. And that means no sex.
    According to the National Diabetes Information Clearinghouse, diabetic neuropathy can occur at any time, although the chances of it developing rise the longer a person has diabetes. It usually develops over a period of years and initially shows no symptoms. The risk of neuropathy appears to be more common in smokers, people over age 40, and those who have had problems controlling their blood glucose levels. Researchers believe that diabetic neuropathy is likely caused by a combination of factors including: metabolic problems (eg, high blood glucose), damage to blood vessels, genetics, and lifestyle factors (eg, smoking, alcohol use).

    Get a Diagnosis

    Neuropathy isn't the only cause of impotence in men with diabetes. Many people who have had diabetes for a long time 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 unrelated to diabetes can all lead to impotence. And the causes of erectile dysfunction 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 erectile dysfunction in their patients with diabetes. In some cases, however, it may be necessary to consult a specialist who focuses on sexual dysfunction.

    Speak Up

    Patients also need to remember that a doctor is not a mind reader. Unless a physician has a complete picture of a man's situation—no matter how embarrassing that picture may be to the patient—he will be ill-equipped to recommend a solution.
    What might be perceived as impotence 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 impotence at all. It may simply indicate that he needs more tactile, rather than visual, stimulation to achieve an erection. Doctors should be willing and knowledgeable enough to probe for such important details, and patients need to share them.

    Treatment Options

    Treatment begins by addressing the physical factors that may be contributing to the problem. These may include:
    • High 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.
    Beyond diabetes-specific concerns, the methods used to treat impotence in the general population are also effective for men with diabetes.
    Some approaches include:
    • Oral drug therapy, such as vardenafil (Levitra), tadalafil (Cialis), or sildenafil (Viagra)
    • 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 impotence due to diabetic neuropathy can find a solution that works. That's something to get excited about.

    RESOURCES

    American Diabetes Association http://www.diabetes.org

    Joslin Diabetes Center, Sexual Function Clinic http://www.joslin.harvard.edu/

    National Diabetes Information Clearinghouse http://www.niddk.nih.gov

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca/

    College of Family Physicians of Canada http://www.cfpc.ca/

    References

    Erectile dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 25, 2012. Accessed August 5, 2012.

    Diabetic Neuropathies: The Nerve Damage of Diabetes. National Diabetes Information Clearinghouse, National Institute of Health. Available at http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/#effect . Updated June 25, 2012. Accessed August 5, 2012

    Diabetic neuropathy. EBSCO Health Library website. Available at: http://www.ebscohost.com/pointofcare. Updated December 30, 2011. Accessed August 5, 2012.

    Diabetic peripheral neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 26, 2012. Accessed August 5, 2012.

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