What is Erectile Dysfunction (ED)?
Erectile Dysfunction refers to the inability to achieve or maintain an erection of sufficient rigidity for satisfactory sexual intercourse. Occasional ED is common. Many men experience the condition during times of stress. However, frequent ED can be a sign of health problems that require treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional.
ED is an under-recognized, under-discussed, and commonly untreated complication of diabetes because people believe that it is an inevitable occurrence with advancement in age. Men are usually uncomfortable about discussing sexual matters especially if it is bound to portray them negatively. On the contrary, it is also one of the most treatable diabetic complications.
What causes erectile dysfunction?
Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, blood vessels and muscles. Erectile dysfunction can result from a problem in any of these. Its occurrence amongst Diabetic men is higher than in the general population mainly because of the effect of poorly controlled Diabetes on nerves and blood vessels. High blood sugar causes damage to blood vessels including those supplying blood to the nerves. Consequently, due to the limited blood supply, the nerves die (neuropathy) because of insufficient oxygen. Nerves in the penis play a crucial role in relaying communication to the brain to increase blood flow to the penis and elicit an erection during periods of sexual desire. Damage to these nerves as well as the blood vessels that deliver blood to the penis greatly interferes with this process and is the root cause of increased erectile dysfunction cases in Diabetic men. Diabetes has also been found to cause testosterone deficiency and emotional imbalance (depression symptoms) further complicating the problem.
What are the symptoms of erectile dysfunction?
- People who are suffering from Erectile Dysfunction regularly experience:
- Difficulty getting an erection
- Trouble maintaining an erection during sexual encounters
- Loss of interest in sex
In addition, ED has an association with other sexual disorders such as:
- Premature ejaculation
- Delayed ejaculation
- Inability to reach an orgasm
What are the factors that worsen erectile dysfunction or increase your risk of getting it if you are Diabetic?
- Poor glycemic control
- Cigarette smoking
- Excessive alcohol intake
- Sedentary lifestyle – not engaging in physical activity
- Side effects of some anti-hypertensive drugs (B-blockers and thiazide diuretics) and some anti-depressants
- Uncontrolled Hypertension
- Hyperlipidemia – Abnormal cholesterol levels in your blood
- Testosterone deficiency
- Advanced age
- Duration of Diabetes
- Psychosexual and relationship issues – Sexual orientation; Performance anxiety; details of sexual technique; and relationship problems
- Performance anxiety
- Vascular insufficiency
As a Diabetic, what can one do to either delay the onset of erectile dysfunction or improve erectile function?
- Regular screening for Erectile Dysfunction and testosterone levels should be done after diagnosis and treatment options discussed with the doctor.
- Tight Glycemic Control – A combination of taking your diabetes medication as prescribed; engaging in regular physical activity; and eating right will not only help in ensuring tight glycemic control but will also lead to increased confidence; improved feeling of well-being; enhanced lipid control and better BP control all of which result in improved erectile function.
- Reduce alcohol consumption
- Stop smoking
- Losing weight for those who are overweight or obese
- Combining Pelvic floor/Kegel exercises with lifestyle modification
- In case your anti-hypertensive drugs fall within the class of Beta-blockers or thiazide diuretics, then you can work closely with your doctor to get replacement drugs that have minimal effects on erectile function but can still improve your blood pressure control.
- Emotional or relationship counselling – This is also very important since some studies have found that some Diabetic men usually get their usual morning erection or erect while masturbating but cannot get or sustain an erection during intercourse. Therefore, the problem could me more psychological than physical.
- Medical therapy – Medical treatment options exist but you have to work with your doctor to determine which treatment option best works for you.