Diabetes is the most important risk factor for severe erectile dysfunction. Up to 50% of diabetics have ED.[1]. In addition, ED is one of the first signs of diabetes, and about 12% of patients with new onset ED have undiagnosed diabetes[2].

Does Diabetes Cause Erectile Dysfunction?

Diabetes interferes with virtually every aspect of the erection process.  Diabetes causes damage to the blood vessels and to the nerves that are essential for the erection[3].  Diabetes often results in low testosterone levels[4].  Diabetes damages the corpora cavernosa – the two long cylinders in the penis that are responsible for the erection.  Diabetes causes depression which ruins sexual performance.  Finally, diabetes increases the risk of Peyronie’s disease or bent penis, which is an important cause of ED.

Best Treatment for Diabetic Erectile Dysfunction

The penile implant is the most effective cure for ED due to diabetes. Diabetics tend to have the most severe form of ED that is resistant to conservative, non-surgical therapies.  About one-third of all patients undergoing penile implant have diabetes[5] .

Before you consider the penile implant, you should first try medical therapy for ED.  This includes Viagra, Testosterone supplementation (if your testosterone levels are low), and penile injection therapy with PGE1. If these medical therapies do not work, then you are a candidate for the penile implant.

Can Penile Implant Cause Infection?

Penile implant used to be the biggest problem for diabetics receiving the penile implant.  But not anymore.  Thankfully, the risk of penile implant infection is now low, whether you are diabetic or not.  The overall risk of infection in all patients undergoing the penile implant is about 1.6%[6].

The number of implants that become infected has dropped for two reasons.  The first reason is improvement in the design of the implant, and the second reason is improvement in surgical technique.

Starting in 2003, the 3 piece penile implant was coated with antibiotics in order to prevent infection.  This change has resulted in a three-fold decrease in penile implant infection[7].

Besides, advances in the manufacture of the devices, there have been a number of advances in surgical technique.  One important advance is the “No Touch” technique whereby the implant never contacts the patient’s skin prior to insertion.

Does Diabetes Increase the Risk of Penile Implant Infection?

Although controversial, the answer is yes. The risk of implant infection is slightly higher in diabetics compared to non-diabetics. One very large study shows the rate of implant infection in diabetics was 1.8% and the rate in non-diabetics was 1.5%[8].

There are several reasons why diabetics have an increased risk for infection. For example, diabetics tend to have poor wound healing.  In addition, diabetics tend to have an impaired immune system.

If I Have Diabetes, How Can I Reduce My Risk of Implant Infection?

Your risk of penile implant infection is lower if your diabetes is well-controlled. HbA1c is the test that most closely measures how well your diabetes is controlled. The higher your HbA1c level, the higher your risk of penile implant infection[9].

So – if you are diabetic, you should to keep your glucose level under control.  Daily exercise and caloric reduction are two additional things that you can do to lower your HbA1c levels and reduce your risk of implant infection.

Diet and exercise will also decrease all of the cardiovascular risk factors associated with diabetes.  This will reduce the risk of all of the complications related to surgery and anesthesia – not just infection.

Can the Penile Implant Cure My Diabetes?

The penile implant will not cure your diabetes. Surprisingly, however, the resumption of sex after you receive your implant, can improve your diabetes.   Sex is ultimately a form of rigorous aerobic exercise and exercise has been shown to improve diabetes.

The penile implant has been shown to lower HbA1c levels in type 2 diabetics an average of 2.5%[10].  This small but significant reduction can help reduce the complications of diabetes including damage to your kidney, damage to your retina, damage to your nerves, and damage to your cardiovascular system.

So, if you are diabetic,  not only can the penile implant restore your sex life, but it can improve your health.

Footnotes

[1] Selvin, E, Burnett, Al, Platz, EA, Prevalence and Risk Factors For Erectile Dysfunction in the US, American Journal of Medicine, 2007, 120, 151-157

[2] Lewis, RW, Epidemiology of Erectile Dysfunction, Urologic Clinics of North America, 2001, 28, 209-216

[3] McVeigh, GE, Brennan, GM, Johnston, GD, McDermott, BJ, McGrath, Lt, Henry, WR, Andrews, JW, Hayes, Jr, Impaired Endothelium Dependent and Independent Vasodilation in Patients With Type 2 Diabetes Mellitus, Diabetologia, 1992, 35, 771-776

[4] Corrales, JJ, Burgo, RM, Garca-Berrocal, B, Almeida, M, Miralles, JM, Partial Androgen Deficiency In Aging Type 2 Diabetic Men And Its Relationship to Glycemic Control, Metabolism, 2004l, 53, 666-672

[5] Mulcahy, J, Carson, C, Long-Term Infection Rates In Diabetic Patients Implanted With Antibiotic-Impregnated Versus Non-impregnated Inflatable Penile Prosthesis: 7-Year Outcomes, European Urology, 60, 2011, 167-172

[6] Ibid 5

[7] Ibid 5

[8] Ibid 5

[9] Habous, M, Tal, R, Tealab, A, Nassar, M, Mekawi, Z, Mahmoud, S, Abdelwahab, O, Elkhouly, M, Kamr, H, Remeah, A, Binsaleh, S, Ralph,  D, Mulhall, J, Defining a Glycated Haemoglobin Level, HbA1c, That Predicts Increased Risk Of Penile Implant Infection, British Journal of Urology International, 2018, 121, 293-300

[10] Talib, R, Canguven, O, Ansari, A, Impact of Sexual Activity on Glycated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus After Penile Prosthesis Implantation, Urology Journal, Volume 11, No. 4, August 2014, 1813-1816