Erectile Dysfunction (ED) & Diabetes

Hi, Dr. Abram McBride here, the Men's MD!

Today, I want to talk to you about the relationship between erectile dysfunction and diabetes. Did you know that half of men with diabetes have sexual troubles caused by diabetes? (1, 2) ED is common as men age, but diabetes can make it worse.

For men who have diabetes, we know that the symptoms of erectile dysfunction are less responsive to pills, and treating erectile dysfunction often requires higher dosages to achieve success (3, 4).

Treating men with diabetes and erectile dysfunction is not a lost cause, but I often need to consider treatment options beyond the pill. Before I dive into the treatment options, it's important to understand why these men suffer from erectile dysfunction.

There are two primary reasons; the first connection is between the diabetes disease process and the nerves.  Nerves transmit messages between our sensory organs, in this case the penis and the brain. Over time, the high blood sugar associated with diabetes can damage the nerves and reduce the transmission of sexual arousal to the brain.

When those nerves suffer damage over time, as we see in men with diabetes, those signals are disrupted. As we saw in a Massachusetts male aging study, ED was three times more common in diabetic compared with nondiabetic men (9). Nerve damage is one common pathway to erectile dysfunction for men with diabetes.

The other pathway or connection we see is through small arteries or blood vessels. Blood vessels can be damaged by high blood sugars. That can affect the blood vessels in the penis, which can make it harder to achieve an erection. For that reason, ED is common in men with diabetes-related nerve damage (5).

When you couple nerve damage and minor artery damage, a man's ability to have normal, natural erectile function may be impacted. So, how do we treat this? What are the available treatment options?

One option is oral medications like Viagra and Cialis that increase the body's natural production of nitric oxide to enhance blood flow into the penis to make the penis firmer with an erection and allow it to last longer (6, 7). These medications can be successful in many men, but many men also suffer side effects. Men with diabetes tend to have more significant symptoms of erectile dysfunction that are less responsive to the oral therapies (3).

Other treatment options for erectile dysfunction include penile injection therapy, vacuum erection devices, suppositories (medications that can be inserted through the urethra), and, of course, the penile implant.

I want to focus on the penile implant today to correct any misconception that men who have diabetes are not eligible or suitable candidates to have a penile implant procedure.  Most of these men are absolutely a candidate for a penile implant. An example of a man who may not be a candidate is a man with a severe diabetic condition, typically defined as a hemoglobin A1C level of 8.0 or higher.  

In my experience, if a diabetic male with erectile dysfunction has his diabetes well-controlled, he may be just as good of a candidate for a penile implant procedure as anyone else. What's also reassuring is that in men with diabetes, the satisfaction rate and the benefits of a penile implant procedure are just as high as in the other man who has erectile dysfunction. In general, we know that there's a high satisfaction rate in patients and partners to treat erectile dysfunction. (8)

In conclusion, it is common for men with diabetes to experience erectile dysfunction, and physicians should consider the same treatment options for both diabetic and non-diabetic patients – including penile implants.

If you'd like to learn about the connection between ED and diabetes and treatment options, including the penile implant and erectile dysfunction generally, please visit www.EDCure.org/understanding-ed/diabetes or www.themensmd.com. 

References

1. Diabetes, Sexual, & Bladder Problems. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/sexual bladder-problems. Accessed March 2024.
2. Phé V, Rouprêt M. Erectile dysfunction and diabetes: A review of the current evidence-based medicine and a synthesis of the main available therapies. Diabetes Metab. 2012 Feb;38(1):1-13.
3. Walsh TJ, Hotaling JM, Smith A, et al. Men with diabetes may require more aggressive treatment for erectile dysfunction. Int J Impot Res. 2014 May-Jun;26(3):112-5
4. Malavige LS, Levy JC. Erectile dysfunction in diabetes mellitus. J Sex Med. 2009 May;6(5):1232-47.
5. Hatzimouratidis K, Hatzichristou D. How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment. Curr Diab Rep. 2014;14(11):545.
6. Viagra Prescribing Information, Revised January 2023
7. Cialis Prescribing Information, Revised January 2023
8. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA Guideline (2018). https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline.
9. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: Results of the Massa chusetts Male Aging Study. J Urol 1994;151:54 61.

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1. Abram McBride, MD is a paid consultant of Boston Scientific.

The information provided in this article is based on the experiences and opinions of Dr. McBride. It does not represent the opinion or recommendation of Boston Scientific.

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