Diabetes & Erectile Dysfunction: Causes & Treatment Options

High blood sugars can impact the nerves, blood vessels, and blood flow in every part of your body — including your penis. For men with type 1 or type 2 diabetes, erectile dysfunction is a common complication of high blood sugar levels.

Fortunately, erectile dysfunction is also something you can often prevent, manage, and treat.

Let’s take a closer look at how diabetes can increase your risk of erectile dysfunction, the causes and symptoms, and today’s best treatment options.

What is erectile dysfunction?

Erectile dysfunction (ED) is the inability to get or maintain an erection firm enough to participate in sexual intercourse, according to the Diabetes Research & Wellness Foundation (DRWF). 

Approximately 18 million men across the United States struggle with ED.

What happens during a healthy erection

In a healthy man, an erection begins when his brain and/or nerve-endings in his penis are signaled. This signal (and arousal) triggers the smooth muscle along the shaft of the penis to relax, which increases blood flow in the spongy tissue that also runs along the shaft of the penis. 

To ensure adequate blood flow to the penis, the blood vessels release nitric oxide into the bloodstream. This chemical tells the smooth muscles in your penis to relax which is what enables plenty of blood flow.

This means there is then significantly more blood within the penis compared to when it is not being aroused.

“As the blood flow increases, the pressure within the spongy tissue increases and the penis expands,” explains the DRWF. “As the pressure in the penis increases, the veins that drain blood out of the penis are compressed—trapping the blood within the penis—and an erection is achieved.”

And then when a man ejaculates or you are no longer aroused, the pressure decreases, the excess blood flows out of the penis, and it returns to its softer, non-erect shape. 

What happens during erectile dysfunction

In a man struggling with erectile dysfunction, there are several things that can interfere with the function of the smooth muscles, the release of nitric oxide, and the restriction of blood flow.

Erectile dysfunction can actually be the result of either a problem in your vascular system, endocrine system, or nervous system.

It can also be related to a medication you’re taking or another health issue entirely.

Pinpointing the exact cause of your erectile dysfunction can take some time. Your healthcare team will most likely examine the following aspects of your health to better determine the cause of your ED so it can be effectively treated:

• Your sexual activity
• Your sexual history 
• Physical exam  
• Signs of nerve damage throughout your body
• Signs of circulation/blood flow issues throughout your body
• Urinalysis
• Cholesterol levels
• Liver function 
• Kidney function
• Testosterone levels
• Psychological issues

Let’s take a look at the most common causes.

Causes of erectile dysfunction

Here are the most common and likely causes of ED according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Health conditions that can cause ED

• Type 2 diabetes
• Alcoholism
• Obesity 
• Smoking cigarettes
• Lack of exercise
• Illegal drug use
• Heart and blood vessel disease 
• Atherosclerosis
• High blood pressure
• Chronic kidney disease
• Multiple sclerosis 
• Peyronie’s disease
• Parkinson’s disease
• Injury from treatments for prostate cancer, including radiation therapy and prostate surgery
• Injury to the penis, spinal cord, prostate, bladder, or pelvis
• Surgery for bladder cancer 

Psychological conditions that can cause ED

• Fear of sexual failure
• Anxiety 
• Depression 
• Guilt related to sexual activity or performance
• Low self-esteem
• Stress about sexual performance or stress in general

Medications that can cause ED

• Blood pressure medicines 
• Antiandrogens—medicines used for prostate cancer therapy 
• Antidepressants 
• Tranquilizers, or prescription sedatives—medicines that make you calmer or sleepy
• Appetite suppressants, or medicines that make you less hungry
• Ulcer medicines
• And more…

Why diabetes causes erectile dysfunction

“Fifty percent of men with diabetes will suffer from erectile dysfunction,” explains the DRWF. 

Additionally, ED may actually develop 10 to 15 years earlier in a man with diabetes than a non-diabetic man because of the toll high blood sugars can take on the nerves and blood vessels in the penis.

Damaged blood vessels

As explained earlier, nitric oxide plays a critical role in increasing blood flow in the penis during arousal in order to become erect. 

In a man with persistently high blood sugar levels, the blood vessels experience ongoing damage which significantly interferes with their ability to release nitric oxide. This means the smooth muscles don’t properly relax and blood cannot flow fully into the penis to create an erection.

Damaged nerve endings

Just like high blood sugar levels can damage the nerve endings in your fingers and toes, it can damage the nerves in your penis that enable you to feel the pleasure of sex. (The same is true for nerve endings in a woman’s clitoris.)

This means you have two things working against your ability to enjoy sex: difficulty getting and sustaining an erection, and difficulty feeling the physical pleasure of sex which could hamper your ability to ejaculate.

Treating erectile dysfunction

If your erectile dysfunction can’t be treated by improving another issue in your overall health, more erection-focused treatment options are available.

Improve your blood sugars

First and foremost, improving your blood sugar levels is critical. No amount of Viagra is going to truly help if your body continues to endure damage from persistently high blood sugars.

Work with your healthcare team to make adjustments in your diabetes medications, nutrition, and exercise to bring your blood sugars down into a healthier range. 

You don’t have to achieve perfection — but simply bringing your average blood sugar down can have a big impact on your ED and every other aspect of your health.

Medications to enhance erections

You’ve likely heard of some or all of these medications that treat erectile dysfunction. They work by increasing blood flow to the penis when a man is sexually aroused. 

Talk to your doctor about the best option for you because while they all work similarly, there are different choices within each drug based on the time of increased blood flow and the duration of the drug in your system.

• Viagra
• Levitra
• Cialis

You absolutely should not take these drugs if:

• You take a nitrate medication for chest pain
• You take an alpha-blocker for high blood pressure or prostate problems
• You have high or low blood pressure
• You have a history of stroke or heart attack within the previous 6 months
• You have kidney or liver disease
• You have retinitis pigmentosa

Penile suppository 

This treatment involves a medication being inserted directly into your urethra (the tube within the shaft of your penis that expels both urine and semen). 

The medication is absorbed into the lining of the urethra and increases your ability to maintain an erection without the risk of unwanted prolonged erections. 

While it can be uncomfortable during and shortly after the insertion process of the pellet-shaped medication, it’s generally painless. 

Penile Injections 

This treatment involves an at-home injection of one of the following medications: alprostadil, phentolamine, or papaverine. 

These drugs all work by increasing the size of the blood vessels within the penis which increases blood flow. They are generally expected to help you maintain an erection for up to one hour.

While a doctor would teach you how to administer this injection the first time, it is something you would do on your own for ongoing use of this treatment.

Unwanted prolonged erections are considered rare with this treatment.

Vacuum Devices

A less invasive and non-medication approach is a vacuum device that creates a suction around the shaft of the penis, encouraging the flow of blood. 

A restrictive band is also used after the vacuum device has produced an erection. The band helps to ensure the blood supply stays in the penis during intercourse and is safe to leave on for about 30 minutes. 

While you don’t need a doctor’s appointment or a prescription, it’s still important to purchase a higher-quality penile vacuum to ensure safety, comfort, and efficacy. Some doctors may even have vacuum devices you can borrow to try at home and determine if it’s an effective option for you.

Surgery

Lastly, and least likely something you’ll need, is a surgical treatment option for “impotence.” This surgery involves the implanting of a “rigid but flexible” rod that can be manually bent upward (for intercourse) or downward for day-to-day life.

The second surgical option is an implant that can be inflated. A reservoir of fluid is placed under the skin in your scrotum or abdomen. Using the inflation device, the pressure is applied and fluid is pumped into the implanted cylinders located at the base of your penis.

After intercourse is complete, the fluid drains from the penis so you are no longer erect. 

Work with your healthcare to first pinpoint the cause of your ED

Erectile dysfunction is a very common issue, but rushing to your doctor for a prescription of Viagra isn’t necessarily the answer. Work with your healthcare team to fully understand the cause of your ED before determining the best treatment plan for you! 

And of course, work to improve your blood sugar levels, too.