ED in Patients with Diabetes: Most Effective Treatment Options

by Alex Shteynshlyuger MD


If you have any questions, to schedule a consultation, please contact us or call/text: 1-646-663-5211.


Diabetes and Erection Problems

What is Diabetes?

shutterstock_111223349-diabetesDiabetes is a condition in which the body is unable to control blood glucose levels resulting in higher than normal blood glucose values. Whenever glucose levels in the body increase, there is secretion of insulin from the pancreas.

Insulin causes the uptake of glucose into the cells, where it is either stored in the form of glycogen or utilized for the production of energy. In diabetes, either insulin production is decreased, or the cells become insensitive to insulin. There are two types of diabetes. In Type I diabetes the production of insulin is impaired; it typically occurs in younger people.

Type II diabetes occurs later in life, usually caused by decreased sensitivity of cells to circulating insulin.

Cause of Erectile Dysfunction in Diabetic Men

Elevated glucose levels over long periods of time (years) damage nerves, blood vessels, and muscles in the body. This damage is responsible for a number of complications of diabetes including impotence, neuropathy (loss of sensation or abnormal sensation).

Erectile dysfunction, or difficulty with obtaining and maintaining erections, results from damage to nerves, blood vessels and smooth muscles caused by diabetes.  Diabetes-induced damage to nerves and blood vessels of the penis causes decreased blood flow to the penis.  Because erections depend on high blood flow to the penis, decreased blood flow causes weak erections that are difficult to keep hard.

Over time as many as 70% of all diabetics will experience some level of erectile dysfunction with the incidence increasing with age and duration of diabetes. Among men older than 60 years old with diabetes, 50-60% experience erectile dysfunction.

Symptoms of Erectile Dysfunction

Erectile dysfunction presents as an inability to achieve a normal erection during sexual intercourse. Usually, the desire for sex or libido is not lost but erection is either partially achieved or if achieved, cannot be maintained for long periods and is usually lost before ejaculation.  Often the erections are not sufficiently hard.  

Diabetes may have a negative effect on testosterone levels. Low testosterone levels can make it difficult to maintain erections.   Some diabetic patients also lose libido due to low testosterone levels.

Conditions Contributing to the Risk of ED in Diabetic Patients

Erectile dysfunction is caused by many conditions in addition to diabetes. For example, ED is associated with heart disease, high blood pressure, diseases of the nervous system, and other conditions that affect nerves and blood vessels. It is necessary to exclude other causes of erectile dysfunction before definitively relating it to diabetes.  Some of these conditions, such as high blood pressure, often co-exist in diabetic patients.

At New York Urology Specialists we offer a comprehensive approach to treating men with diabetes for ED.

Treatment of ED in Diabetic Men

Erectile dysfunction in diabetic patients presents with a long history of diabetes, poor sugar level control and initially, partial erectile dysfunction. There is often a loss of nocturnal erection i.e. the erection is not present on waking up, also known as early morning or sleep erections.  Erections may not as hard as they used to be.  As the problem progresses, it may be difficult to keep an erection hard long enough and difficulty with getting erections.

Treatment for ED includes addressing the underlying glycemic control. In other words, good control of diabetes is necessary. Ideally, Hemoglobin A1C levels should be around 6.5.   Medications such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) work well in most diabetic patients.

Medications such as Viagra and Cialis should not be taken by patients who are taking nitrates such as nitroglycerin. Headaches and visual changes (halos) are common adverse effects of PDE5 inhibitors such as Viagra and Cialis.

In men for whom Viagra, Cialis or Levitra do not work, another commonly used treatment option involves injections of medications directly into the penis (corpus cavernosum).  Alprostadil (prostaglandin E) or a combination of medications known as Trimix is used. It maintains an erection and is effective in 70 – 80 % of patients. Injectable options are effective in producing an erection in patients suffering from erectile dysfunction due to nervous system disease. 

Shockwave therapy for ED is another effective treatment option for men with diabetes. Shockwave therapy is administered in our offices, it is painless and allows many men with diabetes to obtain better erections with or without medications.

Vacuum erection devices, or VEDs, are another alternative to medical therapy.  Vacuum erection devices are effective for many men, inexpensive but sometimes cumbersome.

A penile implant is another effective treatment for erectile dysfunction.  A penile implant can help men even when other treatment options are ineffective.


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ED is Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction.  We understand the challenges that ED creates for our patients, their relationships and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We Treat Some of the Most Complex ED Problems Including:

Schedule an Appointment with Dr. Shteynshlyuger:

Call/text today: 1-646-663-5211 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in evaluation and treatment of sexual and erection problems in men using modern effective and proven treatment methods.  We offer inflatable penile implant, shockwave therapy for ED and treatment for Peyronie’s disease.

He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.


If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.

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