Sexual Health Q&A
Erectile dysfunction (ED) is a common problem for diabetic men. In fact, diabetic men are four times more likely to develop ED than those without diabetes. They also tend to develop ED ten to fifteen years earlier and have more severe cases.
Erectile difficulties associated with diabetes are usually caused by neuropathy, atherosclerosis, endothelial dysfunction, venous leak, or low testosterone.
Neuropathy is a nerve disorder. In normal circumstances, when a man is sexually aroused, a message travels through his nervous system to signal the start of an erection. For a man with neuropathy in his penis, this transmission gets disrupted and the penis does not respond in the typical way.
Experts don’t know why neuropathy occurs in diabetics. Some believe that abnormal proteins formed by high blood sugar cause the nerve damage. High blood sugar could also interfere with message transmission.
Atherosclerosis is a hardening, or thickening, of the arteries. When a man has an erection, his penis fills with blood. Arteries are a critical part of this process, as they expand in response to sexual stimulation and allow blood in. Veins constrict to keep the blood in the penis until the man ejaculates. Then, the blood flows back into the body.
Atherosclerosis makes it difficult for blood to enter the penis. Depending on how severe the condition is, the blood flow may be insufficient for an erection firm enough for sex.
Endothelial dysfunction. The endothelium is tissue that lines the blood vessels, including those in the penis. High blood sugar can damage this tissue, making it more difficult for blood to flow in and form an erection. High blood sugar can also interfere with the production of nitric oxide, an important compound for erections. Insufficient nitric oxide may contribute to endothelial dysfunction.
Venous leak occurs when veins are unable to keep enough blood in the penis for a suitable erection. As noted earlier, a firm erection results when blood flows into the penis. Veins normally constrict to keep the blood inside until the man ejaculates. A venous leak prevents blood from staying in the penis. Instead, blood leaks back into the body and the erection fails to stay rigid.
Venous leak is often caused by problems with smooth muscle tissue, which needs to relax for a good erection to occur. Studies have shown that many diabetic men have less smooth muscle content and that this tissue does not always relax properly.
Low testosterone is another common problem for diabetic men. Testosterone is a sex hormone that affects a man’s sex drive. Testosterone deficiency can lead to erectile dysfunction.
Men with diabetes and ED are encouraged to see their doctor. Sometimes, erections improve when men make healthier choices, like exercising more, keeping blood sugar under control, and quitting smoking. There are also several ED treatment options available. A man’s doctor can advise which treatment path is best.
Being committed to a healthy lifestyle can help erections in other ways, too. For example, staying fit can improve a man’s mental health, body image, and self-esteem, resulting in greater sexual self-confidence and possibly better erections.
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