Linking Erectile Dysfunction and Diabetes

What causes Erectile Dysfunction?

There are many physical causes for erectile dysfunction: vascular issues and diabetes account for 70% of the causes.

Medications, pelvic surgery, such as radical prostatectomy, trauma, neurologic disorders, and endocrine problems can also cause a man to experience erectile dysfunction.¹

Why do men with Diabetes have Erectile Dysfunction?

A normal erection requires a neurologic response to increase arterial blood flow, smooth muscle relaxation to allow for the increase in blood flow and restriction of venous outflow to maintain the erection.²

An erection starts in the brain. A neurological response, arousal, causes the release of chemicals that relax the smooth muscles in the penis. When the smooth muscles relax and open, arterial blood flow increases while at the same time, restriction of venous outflow occurs. This pressure traps the blood within the corpora cavernosa.^2,4

Phosphodiesterase type 5 (PDE-5) breaks down the chemicals that caused the muscles to relax and allowing the muscles in the penis to constrict and veins to open. This allows the penis to return to a soft, flaccid state.^2,4

Diabetes can affect the process of a normal erection.

If diabetes has not been well controlled, it may cause irreversible damage to the nerves, blood vessels and smooth muscle function, which are necessary for erections to occur.^2,6-9

Up to 70% of people with diabetes have nerve damage which impacts the neurological response and limits the signal to increase arterial blood flow.11

In addition, diabetes has been shown to accelerate the process of endothelial dysfunction.⁶ Endothelial dysfunction is a condition in which the endothelium (inner lining) of blood vessels fails to function normally.⁸

In recent years it has become apparent that endothelial dysfunction is an important factor in coronary artery disease (CAD), hypertension, microvascular angina (cardiac syndrome), diastolic dysfunction, and other cardiovascular conditions.^6,8-9

The endothelial layer maintains the proper dilation and constriction of the blood vessels.⁸The proper functioning of the endothelial layer is necessary for the normal function of the body’s tissues and organs. Without adequate endothelial function, smooth muscle relaxation and dilation compromises the blood flow into the penis.^2,6,8-9

Damage to the nerves and endothelial function will affect how well PDE-5 inhibitors work for men with diabetes.^4,6,8,9

Patients with ED and diabetes are often considered one of the most difficult populations to treat due to the multifactorial pathophysiology of diabetes and comorbidities.

Hormonal changes -> Diabetic ED | cavernosal structural/functional changes -> Diabetic ED | endothelial dysfunction -> Diabetic ED | neuropathy -> Diabetic ED

The relative risk for ED in men with diabetes increases in patients with diabetes associated comorbidities and factors such as:⁶

Age
Diabetes duration
Poor glycemic control
Presence of microvascular complications
Cardiovascular disease
Renal disease
Retinal disease
Diabetic foot

How common is Erectile Dysfunction in men with diabetes?

1 in 5 men ages 20+ suffer from some degree of ED > Of the men with diabetes, more than 50% have ED caused by their diabetes which means 1 in 2 men you see could be suffering with ED.

Men are often embarrassed, ashamed, or feel like they are the only person dealing with the issue of ED. Most men with diabetes don’t know there is a connection between ED and diabetes. Depression is common for both the man and his partner and it can negatively impact a partner’s willingness to support your patient’s efforts to manage their diabetes.

Understanding the connection between ED and diabetes could motivate men and their partners to better control their blood sugar levels and make healthy lifestyle choices.

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