Men's Sexual Health

There are many effective treatments-get the help you need

By Richard R. Rubin, Ph.D., C.D.E.

If you are a man, you probably worry about how diabetes affects your sexual functioning. And for good reason: more than half of all men with diabetes will suffer from erection problems during their lifetimes. Nearly every man has trouble getting an erection at least occasionally, but you have what is technically called erectile dysfunction, only if all or almost all the time your penis does not get hard enough for you to have intercourse.

A person’s sexuality is a personal matter, so many men who have erection problems suffer in silence. That’s too bad, because there is so much these men can do to improve matters. No doubt you have heard of at least one of these things: a pill called sildenafil, sold under the brand name VIAGRA®. This medication was introduced in the United States in 1998, and former Senator and presidential candidate Bob Dole has appeared in television commercials talking about his own problems and promoting VIAGRA. In the years since, other drugs including vardenafil (Levitra®) and tadalafil (Cialis®) have become available for treatment of erectile dysfunction.   

If you are concerned about your sexual functioning, read on for more facts about diabetes and sexual health, including things you can do to get the help you need.

What we know about diabetes and sexual health:

• Sexual problems are more common if you have diabetes; this is true for both men and women.
• Many men over the age of 50 have sexual problems even if they do not have diabetes, but with diabetes these problems often develop 10 to 15 years earlier.
• The most common causes of erection problems among men with diabetes are diabetes-related nerve and blood vessel complications.
• Depression can also contribute to sexual problems, and depression is two to four times more common in people with diabetes.
• Certain medications can also cause erection problems, including some drugs used to treat high blood pressure, anxiety, depression and ulcers.

What can you do to avoid sexual problems?

• Keep your blood sugar levels as close to normal as possible. This helps prevent or limit blood vessel and nerve damage. Protecting your blood vessels keeps normal levels of blood flowing to your penis; you need that blood to make your penis hard. Protecting your nerves is also critical, so the signals get through to those healthy blood vessels, telling them to start pumping.
• Quit smoking, since smoking contributes to blood vessel and nerve damage.
• Drink less alcohol. Alcohol enhances desire but hurts performance.
• Keep your blood pressure under control, because high blood pressure also contributes to sexual problems.

Figuring out the cause of your sexual problems

You are the only one who can decide whether you need help for a sexual problem. Some men (and their partners) are comfortable living without sexual intercourse or even without any sex at all. If you feel otherwise and want help, please talk to your health care provider. Your provider can help identify what is causing your problem, and he or she can help you decide what to do about it. Here are some things you can do together:

• Review the medications you are taking. Some medications can cause sexual problems.
• Take part in sleep studies. Most men have several erections each night while they are asleep. There are simple tests (including ones you can do at home) to see if you are having erections during the night. If you are, psychological issues might play a big part in your sexual problem. Most erection problems are caused at least to some degree by psychological factors, and there are effective treatments for erection problems regardless of their cause.
• Undergo tests for blood vessel damage, a common cause of erection problems, and nerve damage, another common cause.
• Get your testosterone levels tested. In rare cases, low levels of this hormone can cause erection problems.

Help for your sexual problems

The treatment most likely to help you depends in part on the cause of your problem.

If your problems are due mostly to psychological issues, talking to a mental health professional could help. Remember, there is no shame in asking for help, but it is a shame when you don’t ask for the help you need, because there is so much help out there.

If your problems are mostly due to physical causes, there are lots of treatments available, including pills like VIAGRA and other medications. VIAGRA is the most popular and successful pill for treating sexual problems, but other medications are available. Research supports the benefits of VIAGRA: in one study more than half the men who took the medication said it improved their erections. That was much higher than the rate of success among men in the study who took a placebo medication. It seems VIAGRA helps regardless of what is causing the problems. Despite its promise, VIAGRA does not work for everybody, and some people experience side effects like headaches, diarrhea and muscle aches when they take the medication. People should not take VIAGRA if they take heart medications like nitroglycerine, since this combination can lower your blood pressure to dangerously low levels.

There are also pills (suppositories, actually) you can place into the end of your penis to improve erections. Most men find this approach less neat and convenient than swallowing a pill, but it is an option for those can’t take VIAGRA or don’t respond well to it. In addition, there are medications men can inject into the penis to make erections. Pain, inconvenience and erections that don’t go down are the most common side effects of this approach.

There are two kinds of mechanical devices for men with erection problems. Vacuum devices work for problems regardless of their cause. These devices use negative pressure to pull blood into the penis to make it hard, and a constriction ring (placed at the base of the penis) to maintain the erection. Some people do not like this approach because it can take the spontaneity out of making love, but most say they quickly get used to it and find it works well. Some men have a pump device surgically implanted; these men can literally “pump themselves up.” Pump devices were more popular before other effective treatments became available.

Men whose erection problems are caused by limited blood flow to the penis can have surgery to increase the flow, but the surgery is not that successful overall. Men with low levels of testosterone can take this hormone, but, as I said earlier, this is a rare cause of erection problems for men with diabetes.

The bottom line

Though sexual problems are more common when you have diabetes (that’s true for women as well), there are many effective treatments. If your sexual functioning isn’t what you want it to be, don’t suffer in silence. Talk to your health care provider to get the help you need.

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