How common is sexual dysfunction in men with diabetes?
Men with diabetes can experience a variety of sexual dysfunction. The best characterized is erectile dysfunction. (ED) ED is 3 times more common in men with diabetes compared to those without diabetes. Older men with diabetes have higher likelihood of ED. As they become older, up to 85 % of men may experience ED.
What is ED?
The inability to achieve and sustain an erection for satisfactory sexual activity is called ED. Your penis may simply fail to stay hard enough for a satisfying sex.
How does diabetes cause ED?
The penis maintains erection with the help of nerves and blood vessels along with a hormone called testosterone.
Excess sugar (glucose) in your blood can damage the nerves and blood vessels responsible for erections. Your brain might be ready to have sex, but that information isn’t relayed to your penis — so it doesn’t respond.
Conditions that often accompany diabetes, such as cardiovascular disease, can narrow or harden your blood vessels. This may reduce blood flow to your penis, which makes it tough to achieve or maintain an erection.
Poor blood sugar control can inhibit the release of a chemical known as nitric oxide. Too little nitric oxide may hamper blood flow to your penis, which — again — makes it tough to achieve or maintain an erection.
People with diabetes may have lower testosterone in the blood. This can also lead to poor erections.
Are there any tests that we can do to diagnose ED?
ED is primarily diagnosed from history of the patient. As ED may be associated with diseases involving any of the organ systems in the body, the doctor will look into all systems. The doctor will do tests which assess blood sugars, cholesterol, kidney functions and liver functions. The endocrinologist will check the medications that the patient is consuming and see if any of them worsens ED.
The doctor will further order tests for thyroid, prolactin and testosterone to understand if ED is associated with some hormonal problems. NPT (nocturnal penile tumescence), penile sensations using penile biothesiometry and duplex scanning of the penis can help reach a diagnosis.
How can we treat ED?
The cause of ED has to be treated. The patient has to control the blood sugars, blood pressure and cholesterol. He has to quit smoking and limit consumption of alcohol. You have to stop medications (e.g. some antihypertensives, antidepressants) that worsen ED.
Your endocrinologist can help you with medications like Sildenafil, Tadalafil or Vardenafil that can help improve erections. These drugs aren’t safe for all men, however, especially those who take nitrates to treat heart disease or alpha-blockers to treat prostate enlargement or high blood pressure.
Penile injections, vacuum devices and surgical prosthesis are other mechanical methods to treat ED