Sexuality and Impotence

Impotence — the failure to get or maintain an erection — is one of the most common and most distressing side effects of diabetes. Between 35 and 75 percent of men with diabetes have experienced impotence at some point since diagnosis. If you've had problems with erectile dysfunction (ED), you are not alone.

Some men delay getting treatment for ED because of embarrassment or self-consciousness, but ED can be the first sign of a more serious underlying diabetes complication, such as cardiovascular disease or neuropathy, so it's important not to ignore it or delay medical attention for the problem. Your doctor is quite used to dealing with impotence issues and has a variety of treatment options at his disposal.

Fact

Smoking can contribute to erectile dysfunction by causing constriction of blood vessels, leading to hypertension. Nicotine also promotes the growth of artery-clogging cholesterol plaques, which contribute to high blood pressure.

What Causes ED

There are many possible causes of male impotence, ranging from surgery to smoking; the following are most likely to affect men with diabetes:

  • Medications. Drugs such as high blood pressure medications, certain antidepressants, and tranquilizers can trigger episodes of impotence. Your doctor may be able to adjust your dosage or substitute another medication.

  • Neuropathy. Nerve damage to the penis itself or to the autonomic nervous system may be the cause of ED.

  • Cardiovascular disease. Clogged arteries, especially those that feed the corpora cavernosa (the spongy vascular tissue of the penis) can impair circulation enough to inhibit an erection.

  • Psychological issues. Depression, anxiety, and stress related to diabetes management can inhibit sexual performance.

Treatment Options

There are a number of options available for treating ED, including medication, vacuum devices, surgery, and psychosocial therapy. The least-invasive non-pharmaceutical method of treatment is a mechanical vacuum device. A cylinder is placed over the length of the penis and a hand-operated vacuum pump is used to remove the air from the cylinder, creating a vacuum and pulling blood into the penis to create an erection. Once erection has been achieved, it is sustained with the use of a tension ring placed at the base of the penis.

Alert

Men who use nitroglycerin ointment (applied to the penis) to treat ED should wear a condom during intercourse. Nitroglycerin is absorbed through the skin, including the vagina, and can cause a headache or other symptoms in your partner. Of course, wearing a condom is always recommended if you aren't involved in a long-term, monogamous relationship.

The thought of a hypodermic syringe anywhere near your groin area might send shivers down your spine, but many men with ED caused by neuropathy can be helped with one of several drugs that are injected directly into the penis (papaverine hydrochloride, phentolamine, and alprostadil, also known as Caverject or Edex) to dilate, or widen, blood vessels and cause an erection.

Alprostadil is also available in a suppository (Medicated Urethral System for Injection, or MUSE) that can be inserted into the urethra, a more palatable choice for some men. Topical vasodilators (e.g., nitroglycerin ointment, minoxidil) — medications that are rubbed on the penis to improve blood flow — may also be an option, but reports of their success are mixed.

Several oral medications have been approved for the treatment of erectile dysfunction, including sildenafil citrate (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs have helped millions of men with erectile dysfunction problems since Viagra — the first — was released in 1998.

These drugs are taken before sexual activity and work by enhancing the effects of nitric oxide on the body, which dilates blood vessels and acts as a smooth-muscle relaxant. This improves blood flow to the penis and facilitates an erection when sexual arousal occurs.

I have a heart condition. Can sex make it worse?

Unless your heart is severely impaired (i.e., congestive heart failure), there is really very little risk of normal sexual activity triggering a heart attack. Halting all exercise — and sex — is probably one of the worst things for hypertension. A chat with your doctor about your concerns will help you ease your mind about sex.

One potential drawback of Viagra and Levitra is the need to take these drugs before sex; if you're a spur-of-the-moment kind of guy, you'll need a new strategy. Cialis, on the other hand, works for up to 36 hours, giving you a larger window of opportunity.

Insertion of a penile implant, or treatment and repair of arterial and venous damage related to ED, are more invasive options to treat impotence. Your doctor can discuss treatment options that are right for you.

If your impotence is rooted in depression, anxiety, or other emotional issues, your doctor may refer you to a counselor, psychiatrist, or psychologist for help in sorting through it all. A couple's therapist may also be helpful for uncovering sources of marital tension.

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