Erectile dysfunction is a condition when the person is not able to achieve or maintain an erection adequately to have intercourse. It is common in diabetics. People with diabetes are not only at a higher risk (three times more likely compared to nondiabetic people) of developing erectile dysfunction compared to non-diabetic 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 the increase in blood flow to the penis. The arterial supply increases due to the arteriolar dilatation.
On the other hand, there is a venous compression. This leads to the reduced outflow of the blood from the penis in the venous system. This causes a rise in the pressure within the urethra of the penis, and this leads to the change of the physiological position from the dependant (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 or race of a person nor the size of the penis in the dependant (flaccid) state, affect or predict the erectile length of the penis. So, why is this article shattering this myth here? Because, a lot of 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 nondiabetic population. Such patients also report a lower response to medicines. Therefore, both, the impairment and the reduction in the quality of life, is higher in the diabetic population.
The Mechanism of Erectile Dysfunction in People Who Suffer from Diabetes Mellitus Are:
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 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 which increases the blood flow. When the nerves are affected, this messenger is reduced and the usual normal 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 mechanism of release of nitric oxide is impaired due to the 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 (a process also known as atherosclerosis). This lead to a reduction of the diameter of the vessel wall lumen where the lipids are deposited. The reduction 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 affect on the ‘master endocrine gland’, the pituitary. This reduces the reproductive functioning and sexual desire amongst the diabetic men.
4. It has a large psychological component in a huge number of 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 the depression.
How to Tell If Erectile Dysfunction Is Due to Psychological Cause or a Disease?
The 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 that is causing anxiety or depression or fear.
These features are not observed if one actually 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, a regular screening for low testosterone, and early detection of erectile dysfunction can improve the health and quality of life of these people.