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Diabetes – The Number One Cause of Erectile Dysfunction

Diabetes is the number one cause of severe erectile dysfunction. ED is 3 times more common in diabetics as compared to non-diabetics.

In addition, ED among diabetics is notoriously difficult to treat.  Furthermore, men with diabetes suffer from ED at an earlier age compared to those without diabetes.  Finally, erectile dysfunction is often the first sign of diabetes. About 12% of men with new-onset ED have undiagnosed diabetes[1].

Type 1 vs Type 2 Diabetes

There are two basic types of diabetes.  Type 1, or insulin-dependent diabetes, is due to a lack of insulin production in the pancreas. Insulin is a hormone that is responsible for lowering blood glucose levels.

Patients with Type 1 diabetes have high blood glucose levels because they lack insulin in the bloodstream.

Patients with Type 2 diabetes have normal insulin production but their body does not respond to insulin in the normal fashion.  These patients have high glucose levels because they are resistant to insulin.

Incidence of Diabetes

The incidence of Type 2 diabetes has increased dramatically – largely due to the obesity epidemic.  According to the CDC, there are about 30 million diabetics in the United States.  About 95% of diabetics have Type 2 diabetes[2].

How Does Diabetes Cause ED?

Diabetes produces ED for several different reasons. Diabetes interferes with virtually every aspect of the erection process.  Diabetes has a negative impact on the erection pathways that involve:

  • The brain
  • The vascular system
  • The neurologic system
  • The endocrine system

Diabetes Causes Depression

Depression has a negative impact on libido or sex drive.  Depression also adversely affects overall sexual performance.  Depression among diabetics is common and is believed to be the result of the negative toll that diabetes takes upon the overall health of the individual[3].

Diabetes Harms the Vascular System

Diabetes can harm the vascular system.  The vascular system is critically important to the erection.  Diabetes damages the large arteries, diabetes damages the small arteries and diabetes causes endothelial dysfunction.  Endothelial dysfunction means that the inner lining of the blood vessels is not able to function properly[4].

Diabetes Damages the Large Penile Arteries

Diabetes often results in the deposition of atherosclerotic plaque on the inside surface of the larger arteries to the penis.  This slows down the flow of blood to the penis.  This means that the penis cannot properly fill with blood during the erection process.

Diabetes Damages the Small Penile Arteries

Diabetes can result in damage to small arteries in the penis.  These vessels supply blood to the nerves that are involved in the erection process.  Because diabetes damages these smaller arteries, diabetes results in nerve damage.  The nerves are vital to the erection process and impaired nerves lead to ED.

Diabetes Causes Endothelial Dysfunction

Finally, diabetes causes endothelial dysfunction. The endothelium refers to the inner lining of the blood vessels.  One of the main functions of the inner lining of the blood vessels is to prevent blood clot formation[5].

Diabetes Damages the Penile Nerves

Diabetes results in damage to the nervous system – this impairs the erection process.  Nerve damage can result in decreased penile sensation.  In addition, nerve damage can interfere with the release of nitrous oxide which is the most important messenger of the erection process[6].

Diabetes Lowers Testosterone Levels

Diabetes often results in low testosterone levels.   Testosterone is important for the sex drive or libido.  Testosterone also facilitates several important biochemical steps of the erection mechanism. Finally, testosterone is important for the structural integrity of the penis.

Many Diabetics Have Peyronie’s Disease

The incidence of Peyronie’s disease is markedly increased among patients with diabetes.  Patients with Peyronie’s disease are prone to scar formation within the penis.  This scar can lead to painful erections and it can lead to bending of the penis during the erection.  In severe cases, Peyronie’s disease results in erectile dysfunction.

Treatment of Diabetic ED

Diabetic ED is notoriously difficult to treat.  Treatments include Viagra, testosterone supplementation, and penile injection therapy with prostaglandin E1.

Often these conservative therapies do not work.  Many patients with diabetes and ED ultimately undergo penile prosthesis implantation.

If you have diabetes, there are things you can do to improve your erectile function. Weight loss and exercise are important.  You and your physician should strive to keep your blood glucose level and blood HbA1c level within the normal range[7].

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[1] Malavige, L, Ley, Erectile Dysfunction in Diabetes Mellitus, Journal of Sexual Medicine, 6, 1232 – 1247, 2009
[2] Besiroglu, H, Otunctemur, A, and Ozbek, E, The Relationship Between Metabolic Syndrome, Its Components, and Erectile Dysfunction, Journal of Sexual Medicine, 12, 1309 – 1318, 2015
[3] Ibid 1
[4] Kamenov, Z, A Comprehensive Review of Erectile Dysfunction in Men with Diabetes, Exp Clin Endocrinol Diabetes, 123, 141 – 158, 2015
[5] Ibid 4
[6] Ibid 6
[7] Ibid 3