Are erectile dysfunction and diabetes connected?

If you’ve ever watched a football game or a baseball game on television, you’ve likely seen the ads for erectile dysfunction (ED) treatments. Be ready when the time is right, these men’s health ads promise. And as men get older, they may experience more of those occasions when they might need a little boost to help out “when the time is right.” That’s because age is a major factor in the incidence of erectile dysfunction, regardless of any health conditions that a man might have.

But having diabetes increases the likelihood of experiencing ED even more. Fortunately, there are some treatments that you can try to ward off this particular complication of diabetes (and aging). Here’s what you need to know about the association between diabetes and ED.

Can diabetes cause erectile dysfunction?

Let’s answer the big question first: Yes, there is an association between erectile dysfunction and diabetes. But it’s important to understand what that means.

“Erectile dysfunction is a well-recognized complication in diabetes mellitus and it is common in older men,” wrote the authors of a 2016 report in the Journal of Clinical and Diagnostic Research. “Also, decreased libido and orgasmic dysfunction are commonly associated with erectile dysfunction in patients with Type 2 diabetes mellitus.” 

That is, men with Type 2 diabetes mellitus have an increased likelihood of developing ED. The incidence of ED in men with any form of diabetes can vary, of course. But one group of researchers analyzed 145 studies that incorporated nearly 89,000 men, and their 2017 analysis noted that the overall prevalence of ED in men with diabetes was nearly 53%. And their research also indicates that Type 2 diabetes and erectile dysfunction is more common than Type 1 diabetes and erectile dysfunction. In fact, they found that the rate of ED in men with Type 2 diabetes was 66.3%, compared with 37.5% in men with Type 1 diabetes. Additionally, a SingleCare survey found that 19% of respondents believed their ED was caused by diabetes.

Erections are more complex than you might think. According to urologist Thomas Masterson, MD, an assistant professor in the department of urology with the University of Miami Miller School of Medicine,  a man needs five elements for a successful erection: blood flow, nerve function, appropriate levels of the right hormones (such as testosterone), relaxation, and sexual stimulation.

But people with diabetes, with their higher blood glucose levels, tend to develop some damage to their small blood vessels and nerves. Over time, especially in people with poorly controlled diabetes, this leads to complications of diabetes like microvascular disease, such as diabetic retinopathy, kidney disease, and peripheral nerve damage in the extremities, explains John Anderson, MD, a Diabetes Leadership Council medical adviser. 

The blood vessels in the penis are also very small, and they’re subject to the same potential for damage, which can, yes, impede a man’s ability to get and maintain an erection.

According to the Mayo Clinic, other causes of ED include:

• Health conditions such as heart disease, atherosclerosis, high blood pressure, high cholesterol, metabolic syndrome, multiple sclerosis, Parkinson’s disease, and low testosterone levels
• Peyronie’s disease
• Surgeries that affect the pelvic region or spinal cord
• Injuries to the pelvic region or spinal cord
• Tobacco use
• Sleep disorders
• Alcoholism
• Prostate cancer treatments
• Treatment for enlarged prostate
• Certain types of medication

Psychological factors, including stress and depression, can also contribute to problems with erectile function, as can relationship woes. ED as a result of diabetes may not be a life-or-death issue. But sexual dysfunction is certainly a quality-of-life issue. And you should let your healthcare provider know about it so you can discuss treatment.

How to overcome erectile dysfunction with diabetes

While it’s the diabetes that’s really a major culprit, you may have also wondered if the treatment you receive for your diabetes may be responsible for some of your erectile function issues. 

Metformin is one commonly prescribed medication to help people manage Type 2 diabetes, and some research suggests that it has an association with disrupting erections. But some experts suggest that metformin may not actually cause erectile dysfunction. 

“It’s kind of up in the air about whether it does or it doesn’t,” says Nilem Patel, MD, an endocrinologist in Los Angeles, California, who is affiliated with Adventist Health-White Memorial. “It may cause a reduction in testosterone, which is a different mechanism and that may lead to erectile dysfunction.” 

As the 2016 JCDR report noted, metformin is known for leading to reduced levels of testosterone production and sex drive. Consequently, it’s associated with a greater incidence of low testosterone-induced erectile dysfunction. 

But first, you want to focus on controlling your diabetes. Essentially, if you can successfully keep your blood sugar levels within your targeted range, you’re warding off the potential nerve and blood vessel damage. And that can help improve your neuropathy and your circulation, which should then help with any erectile function issues, according to Dr. Patel. 

And if you have any specific concerns about the diabetes treatment you’re undergoing, definitely raise your concerns with your doctor.

Safe ED medications for men with diabetes

Keeping your blood sugar levels under good control will of course be a priority. But even if you’re doing that, you may still benefit from an erectile dysfunction medication. 

One caveat: Before you try taking any type of oral medications for ED, the American Diabetes Association recommends talking to your doctor. It’s important to identify or rule out other factors that could be addressed, such as any other medications that you’re taking that might affect your sexual function or other underlying health conditions. Your doctor can also talk to you about reducing any other risk factors for ED that you might have. 

If you’re looking for an ED medication that’s safe to try, you do have some options such as:

• Sildenafil, an ED med that’s also indicated to treat high blood pressure in the lungs, a condition better known as pulmonary arterial hypertension (PAH). The general recommendation is to take sildenafil one hour before sexual intercourse. 
• Tadalafil, which can also be used to treat PAH as well as the symptoms of benign prostatic hyperplasia (enlarged prostate). This medication belongs to a group of drugs known as phosphodiesterase (PDE) inhibitors, which boost blood flow to the penis during stimulation, which can in turn facilitate an erection. It comes in tablet form and can be taken in one of two ways: daily or “as needed.”
• Vardenafil, which is also a PDE inhibitor. It comes in tablet form and must be taken 60 minutes before the effects will be needed. 
• Avanafil, which also belongs in the PDE inhibitor class of drugs. Currently, it is available under the brand name Stendra. 

The recommended dosage amounts and the instructions for when to take the medicine will vary from drug to drug. 

However, just because your doctor has given you the green light to try an ED drug doesn’t mean that you don’t need to watch out for possible side effects. For example, think about those ED medication commercials you’ve seen. You may have heard them caution that you might experience flushing of the face, headache or heartburn, among other mild side effects. 

But in some cases, more severe side effects are possible. For example, Viagra—which is a brand name for sildenafil—is considered safe to try. But it’s important to know that sildenafil has also been known to cause blurred vision, dizziness, a sudden loss of vision, and chest pain, as well as erections that last hours longer than they’re supposed to. You don’t want to ignore those symptoms. 

You might also need to watch out for potential drug-drug interactions. Sildenafil, for example, can interact with a number of other meds, including some intended to treat high blood pressure, so you want to make sure your doctor is aware of all the medications that you’re taking. And as Dr. Masterson notes, use of ED meds in combination with nitrates for other conditions is contraindicated. 

Also, be very cautious about anything that’s not approved by the U.S. Food and Drug Administration, such as herbal supplements, says Dr. Anderson. “That’s a definite buyer-beware,” he says. 

For some men, an oral ED medication may not be enough to restore their erections. According to the Mayo Clinic, other options to help them enjoy sexual activity include:

• Injectable medication, such as alprostadil
• Suppositories or pellets that can be inserted into the urethra prior to sexual activity, such as the alprostadil pellet known as MUSE (Medicated Urethral System for Erections)
• Vacuum device, or vacuum constriction device, which employs a pump to draw blood into the penis
• Penile implant or penile prosthesis, which is implanted surgically to help a man achieve an erection

While your primary care provider may prescribe one of the oral ED meds for you, you may need to see a urologist for these other types of treatments. But a urologist can’t manage your diabetes for you, so make sure you continue your relationship with your regular physician. 

Another possible treatment option is testosterone therapy. According to a recent report on a study presented at the 2021 Sexual Medicine Society of North America Fall Scientific Meeting, long-term testosterone therapy seems to be an effective way to improve erectile function in men with Type 2 diabetes and hypogonadism.  

How to prevent ED from diabetes

You do not have to resign yourself to the prospect of struggling with ED just because you have diabetes. Certain preventive measures, including a few positive lifestyle changes, may reduce your risk. Keep these strategies in mind when you resolve to improve your sexual health, as well as your overall health:

• Maintain good control over your blood glucose levels.
• Keep good control of your blood pressure, too.
• Watch your cholesterol levels.
• Eat a healthy diet and maintain a healthy weight.
• If you’re overweight, try to shed a few extra pounds. 
• Don’t smoke—or quit smoking if you do.