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Erectile Dysfunction in Diabetic Population

Published on Oct 03, 2018 and last reviewed on Sep 14, 2022   -  4 min read


Erectile dysfunction is a failure to achieve an erection adequate to have intercourse, which is common in diabetes patients. Read the article below to know more.

Erectile Dysfunction in Diabetic Population

Why Is Erectile Dysfunction Common in People With Diabetes?

People with diabetes are at a higher risk (three times more likely) of developing erectile dysfunction (ED) than non-diabetic people. At least half the diabetics develop erectile dysfunction, and the risk increases with age. ED is the most neglected complication of diabetes, which is prevalent among the general population between 40 to 70 years. Improved techniques in the diagnosis and treatment of erectile dysfunction have given males with diabetes some confidence in managing this prevalent and emotionally disturbing complication. Erectile dysfunction is commonly seen in men with type 2 diabetes mellitus.

Why Does Erectile Dysfunction Happen?

Erectile dysfunction is when the person cannot achieve or maintain an erection adequate to have intercourse. It is common in people with diabetes. People with diabetes are not only at a higher risk (three times more likely compared to nondiabetic people) of developing erectile dysfunction compared to nondiabetic people, but they also develop it at an earlier age (preceded by at least 10 to 15 years). At least half the diabetic people develop erectile dysfunction, and the risk correspondingly increases with age.

How Does Erection Happen Normally in the First Place?

Understanding this will help you understand the "why" of erectile dysfunction in diabetes mellitus.

The penis, in its normal and more common physiological state, remains flaccid. The other physiological state for this organ is the erection. The fluctuation between these two states results due to the activity of muscle cells in the corpora cavernosa. The contraction of the muscles leads to the flaccid state, and the relaxation of the same muscles leads to the erect state. The erection occurs by the release of chemical messengers like nitric oxide, acetylcholine, etc. This relaxation of the smooth muscles leads to an increase in blood flow to the penis. The arterial supply increases due to the arteriolar dilatation.

On the other hand, venous compression leads to the reduced outflow of blood from the penis in the venous system. This causes a rise in the pressure within the urethra in the penis and may lead to the change of the physiological position from the dependent (or flaccid) state to the full erection phase. Some other muscles also help the erection allowing the rigid erection phase.

Therefore, to shatter another common myth, neither the age nor race of a person nor the size of the penis in the dependent (flaccid) state affect or predict the erectile length of the penis. So, why is this article shattering this myth here? Because many diabetic males are overly concerned about the length of the erect penis and wrongly call a shorter length of the penis as erectile dysfunction.

Why Does Diabetes Mellitus Lead to Impotence?

A longer duration of diabetes mellitus, poor control of sugar, older population, and patients with diabetic neuropathy are at a higher risk of developing erectile dysfunction. These factors also cause erectile dysfunction to be more severe as compared to that in the non-diabetic population. Such patients also report a lower response to medicines. Therefore, both the impairment and the reduced quality of life are higher in the diabetic population.

The Mechanism of Erectile Dysfunction in People Who Suffer from Diabetes Mellitus:

1. It is a neuropathic process - diabetic neuropathy involves both autonomic as well as somatic nerves. These nerves are the ones that are largely responsible for penile erection. Nitric oxide (also known as an endothelium-derived relaxing factor) is a signaling molecule (or a chemical, biological messenger) in the body that is supplied through the nerve. The cell lining of the blood vessels all over the body uses nitric oxide to allow vasodilatation and increase blood flow. When the nerves are affected, this messenger is reduced, and the usual regular relaxation of the corporal smooth muscle does not happen. This relaxation of the corporal muscle is the main reason behind the occurrence of a penile erection. Since the release mechanism of nitric oxide is impaired due to nerve damage, an erection does not happen.

2. It is also a vascular problem - diabetic vascular dysfunction occurs due to lipid deposition in the blood vessels (also known as atherosclerosis). This leads to a reduction of the diameter of the vessel wall lumen where the lipids are deposited. The decrease in the lumen wall reduces the blood flowing in the blood vessels (and therefore to the penis). Thus, an erection is not achieved. This vascular damage also affects the release of nitric oxide (whose need is already explained above).

3. It is a hormonal problem (other than diabetes mellitus) - there is a lower testosterone level in diabetic men because of its effect on the 'master endocrine gland,' the pituitary. This reduces the reproductive functioning and sexual desire amongst diabetic men.

4. It has a large psychological component in many patients - Depression, a common psychiatric condition, is much more commonly seen in diabetic men. This, coupled with other factors described above, aggravate erectile dysfunction further. Erectile dysfunction itself increases mental stress, which affects personal relationships, sexual life, and quality of life. This further propagates depression.

How to Tell If Erectile Dysfunction Is Due to Psychological Cause or a Disease?

Patients with a psychological cause usually report a sudden onset of erectile dysfunction. It occurs in specific situations and usually does not bother them when they masturbate. Often, spontaneous erections do occur. It usually signifies a relationship problem, a significant life event or problem causing anxiety or depression, or fear.

These features are not observed if one has erectile dysfunction due to a disease like diabetes mellitus. Often, these patients complain of associated pain in the penis.


Proper treatment of diabetes mellitus, regular screening for low testosterone, and early detection of erectile dysfunction can improve these people's health and quality of life.

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Last reviewed at:
14 Sep 2022  -  4 min read




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