Diabetes & erectile dysfunction

How common is it for men with diabetes to develop sexual problems?

Many of my patients who are having problems getting or maintaining an erection feel they are not ‘normal’, but in fact erectile dysfunction (or ED), is very common, as it affects at least one in 10 men. Unfortunately, men with diabetes are more likely to experience difficulties: research shows that around half are likely to be affected. It is estimated that only about 10% of men with ED receive treatment for it, probably because many do not know there is help available or feel they cannot talk about it. But once you’ve taken that first step, the good news is that there are effective treatments available.

Why are men with diabetes more likely to experience ED?

A high blood glucose level in itself is associated with a greater risk of ED. Another potential cause is damage to small blood vessels or nerve supplies, which are known complications of diabetes, so aiming for really good blood glucose control over the long term is important, as this can help prevent all kinds of complications. Men with diabetes are also more likely than average to have other conditions, such as high blood pressure, heart disease or depression, and may be taking medication that can have ED as a side effect. ED is also more likely to occur as men get older, but it can become a problem for men with diabetes about 10-15 years earlier than average. There are some factors that can increase the likelihood of ED in men of all ages, such as obesity, smoking, excess alcohol; and stress, so adopting a healthy lifestyle as early in life as possible is a key way to minimise their effects. Physical exercise also has a positive effect on ED, at all ages.

How does ED typically affect men emotionally?

ED can have a huge impact on men’s emotional life, as it can affect their confidence, self-esteem and mood. Having a long-term condition like diabetes can be hard to cope with at the best of times, and having sexual problems does nothing to make it easier. In some men, this even leads to clinical depression. Intimate relationships can also be profoundly affected. There is a real risk of men with ED losing interest in sex, or withdrawing from all intimate contact, with consequent damage to a loving  relationship. A failure in sexual advances can knock confidence and make couples drift apart, with the man occasionally becoming emotionally as well as physically distanced from the relationship.

What treatments are available and are they effective and safe?

Thankfully there are many effective treatments for ED that are available through your doctor. The first step will be to assess exactly how you are affected (through a confidential questionnaire), and then to suggest which treatments might work for you. Tablets are usually the first line of treatment; there are three types commonly used and men with diabetes and ED generally respond well to them. Penile injection therapy can also be very effective. Other options include MUSE (applying a small pellet of a drug via the urethra), using a vacuum pump, and – less commonly – hormone treatment or penile prosthesis. I also advise my patients to make positive lifestyle changes, such as stopping smoking, cutting down on alcohol, losing weight and reducing stress, as they can potentially make a difference to ED and, of course, benefit your general health too.

What are the best ways to ensure your relationship survives a diagnosis of ED?

It is always best to admit that there is a problem and talk about it with your partner as having your partner’s understanding and support is crucial before and during treatment. Sometimes, for example, partners can unwittingly put pressure on men to ‘perform’, which only makes the problem worse. The next step is to seek further help from your doctor. Depending on each individual’s needs, a mixture of counselling, such as relationship therapy or sex therapy, with medication can be helpful.

Why is it important to seek medical advice about ED whether you're in a relationship or not?

Good sexual health is an important part of general good health (5) and ED is important to address regardless of whether you currently have a partner or not. Erectile dysfunction can cause significant distress whenever it occurs. For men with diabetes, the onset of ED might be the first warning sign of other conditions, such as heart disease or nerve damage (neuropathy), even if you don’t have other symptoms. So it is important not to ignore ED if you have diabetes, as improving your blood glucose control and lifestyle will help to prevent any problems getting worse.