ED in Patients with Diabetes: Most Effective Treatment Options

by Alex Shteynshlyuger MD


If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call 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 the 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 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.

Reasons Contributing to Risk of ED in Diabetic Patients

Erectile dysfunction is also present in many conditions other than diabetes. For example, it 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 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

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.    Complications of surgery include a risk of developing infections, pain, and bleeding among others.  A penile implant can help men even when other treatment options are ineffective.


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