Diabetes and erectile dysfunction

Erectile dysfunction, or “impotence”, is the inability to get or maintain an erection that’s sufficient to ensure satisfactory sex for both partners. Diabetes is one of the most common causes.

Research shows that between 35 and 50% of men with diabetes have erection problems. Fortunately more and more men of all ages are seeking help for erectile dysfunction, and treatment has advanced rapidly.

How does a successful erection work?
An erection begins with sensory and mental stimulation. Impulses from the brain travelling down the spinal column and impulses from the nerves in the penis relax smooth muscles in two spongy cylinders that run the length of the penis, parallel to the urethra (the conduit for urine and semen).

When the impulses cause the muscles to relax, blood flows into spaces in the spongy tissue, and this pressure makes the penis swell. A membrane surrounding the cylinders helps to trap the blood in the penis and maintain the erection. The penis returns to its flaccid state if the muscles contract, stopping the inflow of blood and opening outflow channels.

An erection problem can occur if any of the events in this sequence are disrupted: in diabetics, the problem may involve nerve impulses or responses in muscles, fibrous tissue as well as veins and arteries in the penis.

What are the symptoms?
• Inability to have an erection at any time, either alone or with a sexual partner.
• Inability to maintain an adequate erection until completion of the sexual activity.

When erection problems become persistent, they can affect your self-image and sex life. If you’ve had persistent erection problems, "performance anxiety" can worsen your problem. A man who cannot have satisfactory intercourse may still have a strong sex drive, which can be frustrating.

When to see a doctor
Erectile dysfunction could be a temporary, easily reversible problem. Don’t expect it to recur. If possible, forget about it and anticipate a more successful experience next time. Discuss the problem and fears or anxieties with your partner.

However, if you are having persistent, bothersome erection problems, talk to your doctor. Men wait an average of five years before seeking treatment for erection problems and this is unnecessary.

See a health professional who has experience and interest in dealing with erection problems. Urologists are specialists in this area and your GP will be able to refer you to one.

Treatment for erectile dysfunction depends on whether the problem is caused by psychological or physical factors, or a combination of these. Even if erectile dysfunction has a physical cause such as diabetes, it often has adverse psychological effects that make the problem worse and treatment more complicated.

The following treatments have a reasonable chance of success:

• Improving lifestyle, giving up unhealthy habits/behaviour
• Treatment to modify reversible causes
• Change in current medication, e.g. blood-pressure medication
• Hormone replacement with male hormone testosterone
• Corrective surgery in case of penile curvature (Peyronie’s disease) and trauma

First-line treatment
• Medication – a number of prescription drug therapies (e.g. Viagra, Cialis) are available in Australia
• Vacuum-constriction devices (this pump and band helps you to get and maintain an erection)
• Psychosexual therapy
• Intra-cavernosal injection therapy (an injection into the shaft of the penis)
• Surgery (prosthesis)

The least invasive treatment should be considered first. Non-surgical treatments work for 60 to 70% of men and may make surgery unnecessary.
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