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Erectile Dysfunction in Diabetic Population

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Erectile Dysfunction in Diabetic Population

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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.

Medically reviewed by

Dr. Anuthanyaa. R

Published At October 3, 2018
Reviewed AtJanuary 3, 2024

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 some confidence in males with diabetes 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 adequate erection 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 as 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. The 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 a 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 and 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, or 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 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 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 (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,' that is the pituitary gland. 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, aggravates 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 Increase Blood Flow to Penis Naturally?

The blood flow to the penis can be increased naturally. It can be increased by adopting a healthy lifestyle. The other factors that can increase blood flow to the penis naturally are as follows:

  • Engage in regular exercise, such as walking, cycling, jogging, and swimming to improve heart health. People can do pelvic floor exercises that can improve blood flow to the genital area.

  • A healthy and balanced diet that is rich in fruits, vegetables, and lean proteins. Citrus fruits, berries, and leafy green vegetables support blood vessel health.

  • Maintenance of a healthy weight by regular exercise may improve blood circulation.

  • Hydration improves heart health.

  • Quit smoking. Because smoking may impair the blood flow to the penis.

  • Limit alcohol consumption.

  • Manage stress.

  • Take adequate sleep.

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 a problem causing anxiety 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. An erectile dysfunction prescription can be obtained online in a telemedicine platform or through an in-person consultation. early detection is crucial for better results.

Frequently Asked Questions


Does Diabetes Cause Erection Problems?

Diabetes is a debilitating disease that, left uncontrolled, can cause extensive vascular damage and neuropathies (nerve damage). Erection, which is a vascular response to neural stimuli, can be affected by diabetes. Diabetic men are likely to have three times the difficulty in having or maintaining an erection.


What Is the Remedy for Erectile Dysfunction in Diabetic Patients?

Erectile dysfunction is common in diabetic males, but it can be managed. To successfully treat the dysfunction, the individual must first focus on controlling the blood sugar levels through medication, weight management, diet control, lifestyle choices, and overall mental and physical well-being. Medications like Sildenafil, Tadalafil, Vardenafil, or Avanafilcan make it easier to get and maintain an erection.


Is It Possible to Reverse Diabetic Erectile Dysfunction?

Erectile dysfunction borne out of uncontrolled diabetes can be managed to some extent, making it easier for individuals with erections. However, any existing vascular damage and neuropathies cannot be reversed. The best way to prevent worsening is to manage the diabetic levels via a strict anti-diabetic protocol and erectile dysfunction medications.


Do All Diabetics Have Erectile Dysfunction?

According to estimates, 35 % to 75 % of diabetic men will acquire some degree of erectile dysfunction. Diabetic men develop this problem around 10 to 15 years earlier than their non-diabetic peers. According to a study, 90 % of men complaining of erectile dysfunction had diabetes or at least one diabetic risk factor.


How Safe Is Viagra in Diabetic Patients?

Originally conceived as an antihypertensive and cardioprotective drug, Viagra (or, Sildenafil) has been a boon for men with erectile dysfunction. Sildenafil is an effective and safe drug for erectile dysfunction in diabetic males, potentially increasing successful intercourses by about 6 % to 49 %.


What Is the Effect of Metformin on Erection?

Metformin is an oral hyperglycemic drug used to treat type-2 diabetes. As with any medication, Metformin carries its own set of side effects like reduction in testosterone levels and sex drive, which induces low testosterone-induced erectile dysfunction in diabetic males. Diabetes-induced peripheral neuropathy, vascular damage, and Metformin use can significantly affect the sex life of diabetic males.


Why Is Viagra Ineffective in Diabetics?

Around 50 % of erectile dysfunction males with type-1 diabetes and 60 % of type-2 diabetes reported improved conditions. However, the drug stops working in some patients mainly due to diabetic neuropathy and vascular damage that makes Viagra unable to increase blood flow to the penis.


Does Too Much Sugar Intake Cause Erectile Dysfunction?

Too much sugar intake, once in a while, would cause no harm to erection capabilities. However, regular high-sugar and high-fat diets can decrease testosterone levels and sex drives and induce erectile dysfunction. A long-term unhealthy diet can cause diabetes which is responsible for most erectile dysfunction cases due to nerve and vessel damage.


Can Exercise Help With Erectile Dysfunction?

Along with medications, exercise can help people with erectile dysfunction. Individuals who participated in moderate to high-intensity exercises at least four times a week, each session of at least 40 minutes, reported the best results. Overall, weekly exercises of 160 minutes for six months reportedly decrease erection problems in males and aid in diabetes management.


How Can a Woman Help Her Husband With Erectile Dysfunction?

Men with erectile issues often suffer low self-esteem and avoid discussing the problem, even with their wives. Women would be aware of their husband's issues and can initiate destigmatization with a conversation regarding the same, which is the first step of management. Some of the steps that the women might take are:
- Find the right time to talk.
- Discuss the concern and confront the issues.
- Reassure him that he is not alone.
- Educate one’s own self about the condition and possible treatment options.
- Offer to accompany him for a specialist visit.
- Guide and help through lifestyle choices and changes.
- Express affection in other ways.
- Be creative and adventurous in intimate activitie


Which Exercises Can Help With Erectile Dysfunction?

Exercise, especially aerobic and ones involving the pelvis, has been reported to improve erections in diabetic males. Some aerobic exercises to help with erectile dysfunction are cycling, spin classes, boxing, rowing, running, and skipping. Exercises involving the pelvis, also known as Kegels (pelvic floor exercises), include floor lying on back squeezes, floor lying in side squeezes and sitting in a chair squeezes. Pilates exercises like knee fallouts, supine floor raises, and pelvic curls also help with the problem.


Can Viagra Increase Blood Sugar Levels?

On the contrary, Viagra reportedly increases insulin sensitivity by about 20 %, which translates to improved sugar intake by the muscle cells, thereby decreasing blood glucose levels. Hence, Viagra can help reduce risks in prediabetic individuals and help manage erectile and hyperglycemic conditions in diabetics.


Is It Okay to Take Viagra With Metformin?

Metformin creates erectile dysfunction conditions, while Viagra helps treat the same. However, no inter-drug interaction was found between the said drugs. In a very small group of men, it was found that Metformin increased the effectiveness of Sildenafil (Viagra).


Is It Possible for Diabetics to Increase Testosterone Levels?

High-intensity exercises and strength training can increase testosterone levels. Aerobic exercise, pelvic exercises, and pilates improve erectile problems and increase insulin sensitivity. Hence, regular workout helps with diabetes, weight management, stress management, diabetes risk factors, erectile dysfunction, and testosterone levels.


What Does Erectile Dysfunction Feel Like?

Erectile dysfunction affects not only sexual health but also mental health. Individuals have low self-esteem, low self-confidence, lack of sexual drive, and self-doubt, avoid intimacy with their partner, and feel guilty and embarrassed. Due to low testosterone, individuals also report high fatigue, muscle weakness, and loss of body hair.
Source Article IclonSourcesSource Article Arrow
Dr. Saumya Mittal
Dr. Saumya Mittal

Internal Medicine


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