Sexual dysfunction. You've seen the ads on television, you've heard the jokes, and, if you're like most men, you've tried your best to block it from your mind. But if you have diabetes, this is one touchy subject you shouldn't ignore. A full 75 percent of diabetic men have some trouble achieving or maintaining an erection long enough to have intercourse.
But diabetes doesn't have to be a deathblow to your sex life. You can protect your sexual functioning by keeping your diabetes under control. And if the condition has already started to derail your physical relationships, your doctor can help you get back on track.
How does diabetes cause sexual dysfunction?
Erections take teamwork from several parts of the body: Your brain makes you aroused, your nerves sense pleasurable feelings, and your arteries carry a flood of blood to the penis.
Unfortunately, poorly controlled diabetes can ruin that teamwork. Blood sugar that stays too high for too long can both deaden your nerves and damage the arteries that feed your penis. You can still get aroused, but you'll have trouble turning those feelings into action.
The breakdown doesn't happen overnight. Most men have diabetes for many years before they notice a problem with erections. Diabetic men rarely have any erectile dysfunction before they reach 30.
The key is controlling your diabetes. But when it comes to blood sugar, how high is too high? There's a national movement to describe sugar levels in terms of A1C (also known as glycosylated hemoglobin or HbA1c)), a lab test that reports average blood glucose over a period of two to three months. If your A1C is below 7 percent, your blood sugar is under control. But as A1C gets higher than 7 percent your long-term risk of damage to nerves and arteries increases, and that can also increase your risk of erectile dysfunction.
Contrary to popular belief, insulin and other diabetes drugs don't hamper erections, says Kenneth Snow, M.D., Director of the Joslin Diabetes Center Sexual Dysfunction Clinic in Boston. By reducing your blood glucose levels, these medications slow down damage to your nerves and arteries. Such medications can actually help keep your love life healthy, he says.
Can diabetes cause other sexual problems?
Some men with diabetes -- as well as men without diabetes -- develop a condition known as retrograde ejaculation. Instead of ejaculating through the penis, their semen goes backward into the bladder. This doesn't make sex less pleasurable, but a man with the condition may need medical help in order to father a child.
How is erectile dysfunction treated?
If you're a diabetic man who has a problem with erectile dysfunction, don't suffer in silence. "Too many diabetic men think that this is a rare problem and that their doctor will think they are strange if they bring it up," Snow says.
Not every man with erectile dysfunction wants treatment. In fact, some hardly miss their erections. But even these men should tell their doctor about the condition, Snow says. The doctor can then make sure the dysfunction isn't a symptom of some other hidden disease.
To overcome erectile dysfunction linked to diabetes, you have to tackle the root of the problem: high blood sugar. If you can bring your A1C level below 8 percent, your sexual problems may disappear without any other measures, Snow says. But if your A1C stays over 10 percent, even the most aggressive treatments may not be enough to restore your erections.
Even if your blood sugar is under control, you may need an extra boost. One option is oral medication that enhance the blood flow to your penis. But if diabetes has already deadened the nerves in your penis, these medications may not work for you. There are three prescription medications approved by the FDA: sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). All three drugs work in a similar way, but they vary in dosage, duration of effectiveness and possible side effects. 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. And, these medications may not be a good choice for you if your diabetes is uncontrolled or if you have heart disease, very low or high blood pressure, or have had a stroke.
If these medications don't help, there are many other treatments to consider. For instance, the drug alprostadil (Muse) -- which you insert into your urethra -- can usually bring an erection in eight to 10 minutes. Another commonly used method is to self-inject with papaverine. Another method is to use a vacuum pump that can help pull blood into the penis. If you have trouble maintaining an erection, a constriction ring can help keep the penis rigid. If nothing else works, you may need inflatable implants. Today's implants are extremely effective and entail only a small risk of infections or mechanical breakdowns. Your primary care physician (with the help of a urologist, if necessary) can usually help you find the right treatment.
If your blood sugar is under control and the doctor rules out other possible causes, your difficulties may have a psychological basis. 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.
Here are some other points to keep in mind:
A little alcohol may help put you in the mood, but too much (more than a drink or two) can actually interfere with erections.
Smoking can damage the blood vessels that feed the penis. If you value your sex life and the rest of your life, for that matter -- it's time to kick the addiction.
Many medications -- including some antidepressants, ulcer medications, and blood pressure drugs -- can cause erectile dysfunction. Ask your doctor if any of your medications could be causing trouble. A simple change of prescriptions could make a big difference. If you think your medications could be the problem, it's important to talk with your doctor before making changes on your own.
Understand that all men experience some decrease in sexual drive and performance as they age. Men of any age can still have erections, but erections may be less firm or last for shorter periods of time. This is a natural part of the aging process. But if you have good communication with your partner and doctor, sex can continue to be richly intimate and exciting.
Men and Diabetes. American Diabetes Association. http://www.diabetes.org/main/info/risk/default2.jsp
Sexual Dysfunction Causes and Symptoms. Joslin Diabetes Center http://www.joslin.harvard.edu/education/library/causes_symptoms.shtml.
Sexual Dysfunction Treatment Options. Joslin Diabetes Center.
Mayo Clinic. Erectile dysfunction in diabetes: keys to prevention. February 2005. http://www.mayoclinic.com/health/erectile-dysfunction/DA00045
Mayo Clinic. Erectile dysfunction. January 2008. http://mayoclinic.com/print/erectile-dysfunction/