The Link between Diabetes, Erectile Dysfunction and Intimacy Issues

Did you know that the root causes of Erectile Dysfunction (ED) can be linked to pre-existing health conditions?  There are several prevalent conditions that can increase the likelihood of developing Erectile Dysfunction. One such pre-existing condition that increases the likelihood of developing Erectile Dysfunction includes Diabetes. Research studies suggest that the prevalence of developing Erectile dysfunction for “men with diabetes ranges from 35%–75% versus 26% in general population.” ⁽¹⁾ This reveals that men with Diabetes have a significantly higher risk for developing Erectile Dysfunction then the general population due to complications resulting from Diabetes.

Overall men who are Diabetic have approximately a “threefold higher probability to develop Erectile Dysfunction compared with non-diabetics.” ⁽²⁾ This suggests that the chances of developing impotence are much higher if an individual has a pre-existing condition such as Diabetes. According to the American Diabetes Association “the onset of Erectile Dysfunction occurs 10–15 years earlier in men with diabetes than it does in sex-matched counterparts without diabetes.^{” (1)} Research also conducted by the Boston University Medical Centre, has found that “about half of men who are diagnosed with type 2 diabetes will develop ED within five to 10 years of their diagnosis.” ⁽³⁾

Not only is Erectile Dysfunction more common in men who have been diagnosed with Diabetes, research studies suggest that Erectile Dysfunction in Diabetic men “has been shown to be more severe and associated with a poorer quality of life”. ^{(5, 6)} Furthermore, studies have shown that men who have ED are “less responsive to medical treatment compared with ED in non-diabetic men.” ^{(5, 6)}

 So what’s causing Erectile Dysfunction stemmed from Diabetes?

Erectile Dysfunction can stem from several complications associated with Diabetes. One such complication includes poor long-term blood sugar control which results in damage to “damage small blood vessels and nerves” increasing the likelihood to develop Erectile Dysfunction. ⁽³⁾ Another complication includes “low nitric oxide levels which are commonly found in individuals with Diabetes.” ⁽¹⁾ When a man is aroused, a chemical called nitric oxide is released into the bloodstream. This nitric oxide signals the muscles and the arteries in the penis to relax, allowing for more blood to flow into the penis, giving an erection. When a man’s blood sugar levels are too high, there is less nitric oxide produced resulting in less blood flowing into the penis therefore causing the inability to achieve or maintain an erection. Gh levels of nitric oxide act as local neurotransmitters therefore facilitating the maximization of blood flow as well as penile engorgement. “Loss of erection occurs when nitric oxide–induced vasodilation ceases”, or with low nitric oxide synthase levels. ⁽¹⁾ Individuals with Diabetes have a higher chance of developing Erectile Dysfunction due to the interference of nitric oxide synthesis as it prevents “intracavernosal blood pressure from rising to a level sufficient to impede emissary vein outflow, leading to an inability to acquire or sustain rigid erection.” ⁽¹⁾

Another complication of Diabetes which can facilitate impotence includes the reduction of Norepinephrine- and acetylcholine-positive fibers two substances which attach to skeletal muscle fibers in the penile tissue region. These two substances are shown “to be reduced in people with diabetes” resulting in the “loss for muscle relaxation that is essential for achieving an erection.” ⁽¹⁾ The reduction in these two fiber substances arises from damage to the nerves as well as blood vessels caused by long term imbalances in blood sugar level. Additionally, the use of medications frequently assumed to be administered by diabetic patients, such as “antihypertensive drugs (β-blockers, thiazide diuretics, and spironolactone), psychotropic drugs (antidepressants), and certain fibrates, have all been associated with an additive deleterious effect on diabetic Erectile Dysfunction.” ⁽⁵⁾ Overall Erectile Dysfunction linked to Diabetes is multi-factorial in nature and there can be several underlying causes attributing to the condition so a global approach in regards to treatment may be required.

Let’s Talk about Prevention, Supplements and Treatment Options

The first step in preventing or resolving Erectile Dysfunction includes addressing the root cause of the problem. Initially, preventive measures or steps towards multi-factorial intervention can help to reduce the risk of developing Erectile Dysfunction. Preventive measure include but are not limited to taking initiatives to managing hypertension, maintaining lipid control, completely omitting cigarette smoking, engaging in adequate physical exercise, as well as reducing alcohol intake.

Treatment and prevention measures can also come in the form of glucose management, and diet changes. Recent clinical studies have shown that better glucose management has “been associated with improvements in sexual function” and reduces the likelihood of developing Erectile Dysfunction. ⁽⁷⁾ According to ISSM and the American Diabetes Association adopting a Mediterranean diet could cut the risk of a man developing erectile dysfunction by 40 percent. ^(12,11)  Additionally, the American Association of Diabetes states that the benefits of a Mediterranean diet “on erectile function might be related to an improved lipid and glucose metabolism, increased antioxidant defenses, and increased arginine levels which could raise nitric oxide activity and thus improve erectile function .” ^{(11, 10)}

Supplements can aid in the improvement of Erectile Dysfunction as well. Recent studies also show that “supplementation with amino acids called l-arginine and l-citrulline may help to improve erectile function as these acids are known to increase the body’s production of nitric oxide, which can increase blood flow to the penis.” ⁽⁸⁾ Substituting as well as removing medications that may be linked to Erectile Dysfunction is helpful as well. ^{(2, 9)} 

Below are listed lifestyle change measures to consider when treating or preventing Erectile Dysfunction: ⁽⁴⁾

1. Managing blood sugar levels

A diabetes-friendly well balanced diet assists in controlling blood sugar levels and decreases potential damage which might occur to both blood vessels and nerves.

2. Limiting the consumption of alcohol

Drinking can often times damage blood vessels which can contribute to erectile dysfunction.

3. Adopting an active lifestyle

Incorporating regular exercise can assist in controlling the blood sugar levels as well as improve circulation and lower stress.

4. Quit smoking

Smoking constricts blood vessels and reduces levels of nitric oxide in the blood, which in turn reduces the blood flow towards the penis, therefore contributing to the worsening the condition of erectile dysfunction.

For Diabetic men who have onset Erectile Dysfunction there are several effective therapy options available. Clinic for Him offers first line pharmacologic therapy options effective for treating Erectile Dysfunction for men who have pre-existing conditions such as Diabetes. The initial steps of Clinic for Hims consultation includes going over a patient’s background history through a thorough evaluation of their medical conditions, and current health statues in order to distinguish between psychogenic and primary causes. The second step Clinic for Him initiates includes administering quick, simple non-invasive tests in order to determine severity as well as prognosis. The third step of Clinic for Him’s comprehensive consultation includes prescribing the best recommended line of therapy for Erectile Dysfunction. Such pharmacologic therapies include oral medications and vasoactive agents in order to thoroughly address the issue at hand.

Sources:

1. https://clinical.diabetesjournals.org/content/19/1/45
2. https://journals.sagepub.com/doi/10.1177/2054270415622602
3. https://www.healthline.com/health/type-2-diabetes/type-2-and-erectile-dysfunction
4. https://www.wphealthcarenews.com/can-erectile-dysfunction-from-diabetes-be-reversed/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949699/
6. ncbi.nlm.nih.gov/pmc/articles/PMC4776250/
7. https://www.ncbi.nlm.nih.gov/books/NBK279101/
8. https://www.medicalnewstoday.com/articles/317012.php#treatments
9. https://www.webmd.com/erectile-dysfunction/guide/drugs-linked-erectile-dysfunction
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510347/
11. https://care.diabetesjournals.org/content/39/9/e143
12. https://www.smr.jsexmed.org/article/S2050-0521(17)30074-4/pdf