In addition to the other health issues brought about by diabetes, some men with diabetes can experience impotence, also called erectile dysfunction. ED is when a man can no longer achieve or maintain an erection. You may occasionally hear some people refer to it as “impotence,” however, most health care providers use this term less often now.
While there can be many different causes of ED, numerous aspects of the diabetic condition can affect erectile performance. ED resulting from diabetes is typically from diabetic neuropathy, which is the medical term for nerve damage. About half of all people with diabetes have some form of nerve damage. Diabetes can also damage blood vessels, especially the smallest blood vessels such as those in the penis, as well as bring on heart disease and other circulatory problems which negatively affects proper blood flow – which is essential to achieving an erection. Yet another important function that can be affected include hormonal changes. The kidney disease sometime brought about by diabetes can cause chemical changes in the type and amount of hormones a man’s body secretes, including the hormones involved in sexual response.
Complications of ED may include emotional problems such as depression, anxiety and low self-esteem; a loss of intimacy between you and your partner, resulting in a strained relationship; an unfulfilled sex life; and, for those seeking to have children, the inability to get your partner pregnant.
No — It’s not easy to accept
It will likely be difficult to come to terms with the fact that you may have ED. And for many men, it can be even more difficult to talk about it. Talking with your primary care physician about ED is the only way to learn about treatments and get the help that you need. A healthy sex life is part of a healthy life. So while it is normal to feel embarrassed discussing such a personal issue, your health care provider is a professional who is there to help you in all aspects of your health.
What you can do
• Explain to your health care provider the symptoms
you’ve been experiencing
• Inform your them of any emotional or physical changes you may have experienced
• Review the medications you may be taking which may be affecting these symptoms
• Ask your health care provider about treatment options and which he recommends to fit your needs
• Remember, talk with your health care provider or diabetes educator before trying any treatment for ED or before stopping any of your medicines.
What urologists can do
Working with your primary care physician, a urologist diagnoses ED with a medical and sexual history as well as a physical exam. Some of the tests a urologist might conduct include blood tests; a “nocturnal” (night time) erection test; an injection test; an ultrasound; and a mental health exam.
ED treatment options are varied, and the treatment you receive will vary, depending on many factors. Lifestyle changes are looked at first and these changes can include quitting tobacco use, limiting or stopping the use of alcohol and increasing your physical activity.
You can see a counselor if psychological or emotional issues are causing or affecting your sexual performance. A counselor can teach techniques to decrease anxiety or stress associated with intercourse. Your partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques can help relieve anxiety or stress when treating the physical causes of ED.
If one of your medications is causing ED or affecting your performance, working with your primary care physician a urologist may change medications that treat diabetes or other health conditions you may have. You may also be prescribed new medications to help get an erection. Oral medications to treat ED include sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis), avanafil (Stendra), or others to attain and maintain an erection.
If necessary, putting medicine called prostaglandin into your penis or using a vacuum tube and pump to draw blood into the penis to create and erection can produce very satisfactory results. Lastly, surgery to put a device in the penis or to fix blood vessels so more blood will flow to the penis can be performed.
The next step
Talk to your primary care physician, and know that they will treat your concerns about ED seriously and respectfully. If referred to a urologist, the urologist will work with you to treat your ED while working with your doctor to ensure all other aspects of your health are addressed.
Working together, we can restore this important aspect of your life. It begins with you.
Mark Leo, MD, FACS is director of operations at Urology Specialists of Nevada. He is also clinical assistant professor of surgery at University of Nevada School of Medicine.