Erectile Dysfunction
Erectile Dysfunction with Diabetes – 9 Healthy Habits to Help Prevent and Control Erectile Dysfunction
One of the most neglected areas in diabetes education is the topic of men’s sexual health. As a diabetes educator, before each consult I like to ask what topics my patients would like to discuss. Over time I have come to the conclusion that erectile dysfunction (ED) needs discussion but only very few men are ready to discuss it. In the last few minutes of a consult if it is brought to my attention, bam! This is where the questions start! I have made it my policy to bring it up myself because left to the end of a consult there is hardly any time for understanding. As a very important subject we need to discuss erectile dysfunction so every man can have a starting place to approach the topic with his healthcare team.
What is Erectile Dysfunction?
The National Institutes of Health defines erectile dysfunction (ED) as: “the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. A period of persistence over three months has been suggested as a reasonable clinical guideline.”(1) When men with diabetes grow older, the problem of ED usually develops earlier than in those without diabetes. After age 50 estimates are as much as 50-60 percent of men with diabetes have this problem increasing to as much as 95 percent of men that are over 70 years of age. (2)
9 Prevention and Possible First Steps
Unfortunately, by the time men think about the topic, the window for prevention of ED may be gone. The following are recommended steps to take to prevent ED, but may also be first steps in helping to control ED. Make sure you discuss ED with your healthcare professional and discuss an individualized plan to help with prevention.
1. Stop smoking! If you never did then don’t start. Smoking can lead to narrowing of the arteries which can be a precursor of ED. (3,4,5,6) A meta-analysis study was conducted in 2013 evaluating the risk of ED between smokers vs. non-smokers. The total numbers of participants included in the studies was 28,586. Conclusions included the ED risk was increased by 51 percent for current smokers and 20 percent for ex-smokers compared with men that never smoked. The analysis also showed that when a smoker quits, the risk of ED may decrease. (7)
2. Don’t drink more than two alcoholic drinks per day. More than this can lead to reduction in blood flow and may affect testosterone levels. Proper testosterone levels help sex drive and erections. (4,5,6)
Many men are under the impression that a drink can be any size. Standards for the size of a drink are as follows:
- 12 ounces of a beer or wine cooler
- 8 ounces of malt liquor
- 5 ounces of table wine
- 1.5 ounces of 80 proof distilled spirits such as gin, vodka, whiskey, etc. (8)
3. According to a primary report published in the Journal of Sexual Medicine (2009), ED is commonly seen in heroin, amphetamine and Ecstasy users. (9)
4. Have a frank discussion with your physician and pharmacist about all medications you take (prescription and non-prescription). Ask if any have ED side effects and if so, can they be changed. Make sure you take all medications as prescribed. (3)(4) A list of medications that may cause problems can be found at nlm.nih.gov, Medline Plus publication.
Important: Do not stop or change any medications without consulting your physician!
5. Maintain a healthy weight. (3,4,5) Losing as little as five percent of body weight when obese can help improve problems with ED. A study involving 31 type 2 obese men with diabetes published in 2011 found that an eight-week low-calorie prescribed diet resulted in rapid reversal of ED in some experiencing a weight loss of five percent. (10)
6. Have a regular exercise routine approved by your healthcare team and stick to it! (3,4) Ask your physician if you can have a prescription to see a physical therapist to learn proper procedures for pelvic floor exercises. In one study, participants with ED over the age of 20 underwent such therapy for three months. In the group that exercised, over 75 percent of participants showed improvement or regained normal erectile function.
7. Preventing and controlling high blood pressure and limiting sodium intake, will decrease ED (5,6). People with diabetes are encouraged to follow the recommendations of The American Heart Association and the dietary guidelines for Americans of no more than 1,500mg of sodium per day (12,13). These recommendations were put in place to help control the increase of blood pressure that happens with aging and to help control increases that have already occurred.
8. Take steps to avoid high cholesterol as it can harden or block arteries all over the body including those needed for sexual function. (6) It is thought that successful treatment of high cholesterol can help to reduce ED. It is also important to note that ED is a risk factor for heart attack and stroke. Men with ED should make sure they ask their physicians to be screened for heart disease. (13)
9. Those with diabetes need to stay under good control. (3,4) According to Diabetes New Zealand: “Men with type 1 diabetes are more likely to experience impotence at an earlier age (this is because they have usually had diabetes for a longer period of time). Men who have type 2 diabetes (which usually develops in adulthood) may not experience the problem until later in life. If your diabetes is out of control, this can lead to temporary impotence.” (14) Treatment for those with diabetes includes improving blood sugar levels.
As you can see, ways to avoid ED include many healthy habits. Please do not be afraid to talk to your physician about this important issue.
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)
Erectile Dysfunction with Diabetes – Causes, Therapies and 5 Questions to Help You Have a Meaningful Discussion with Your Physician
There are many factors that contribute to Erectile Dysfunction (ED). Men with diabetes suffer with ED more frequently and at a younger age than those without diabetes. There are two kinds of medical specialists that should be included on your medical team if you suffer from ED. One is your endocrinologist (to discuss if there is a hormonal problem). The other specialist is an urologist (a doctor that specializes in the urinary tract of men and women and the reproductive system of men). (1) Know that ED is a very common problem in men who have diabetes. To get the proper diagnosis and treatment, ED must be discussed. This article contains possible causes and therapies for ED. Discussion will include hormones, medications, devices and surgery. Questions to ask your physician will be included to help you become comfortable in talking about ED with your medical team.
According to the National Kidney and Urologic Diseases Information Clearinghouse, ED is often caused by a physical disease or injury. (2) As mentioned in the previous section, potential reasons can also include side effects from medication. In men with diabetes the cause of ED can be complicated. Side effects from diabetes can include problems with nerves, blood vessels and muscle function which can contribute to ED. (3) Hormonal imbalances also need to be addressed.
The steps involved in treatment for ED may include filling out a screening form to gather information about your history and problems. The doctor most likely will want to perform a physical examination. Blood may be drawn to test for abnormal hormone levels as well as systemic diseases. Your doctor may also want to know if you have erections that occur during sleep and discuss any psychological reasons that may be contributing to Erectile Dysfunction. (2)
5 Questions for Your Doctor about ED:
Question 1: Could my ED be a hormonal problem? Do I have low testosterone, high prolactin, a problem with my thyroid or any other hormonal imbalances involved?
Hormones
Altered levels of many hormones may contribute to ED. Testosterone, prolactin and thyroid hormone are among the hormones that may be involved.
Testosterone
It is thought that low levels of testosterone without other risk factors affects less than five percent of men but it can contribute to ED in men with other risk factors. (4) Testosterone levels in many individuals decline with age.
The Endocrine Society’s Clinical Guidelines (2010) recommends offering testosterone therapy to men who have low levels and ED after evaluating for causes of ED and consideration of established therapies. There are some men in which testosterone therapy is not recommended even if testosterone is low. These include men with high hematocrit values, heart failure, untreated sleep apnea and those with high risk of prostate cancer as well as other conditions. (5)
According to the American Diabetes Association, men with type 2 diabetes are twice as likely to have a deficiency of testosterone as men without diabetes. (6) The Urology Care Foundation estimates that 50 percent of men with diabetes will develop low testosterone levels. (7) When testosterone therapy is needed and prescribed in men with type 2 diabetes, it may help with ED and studies also show insulin sensitivity is increased and resistance is lowered by as much as 25 percent. (8) Not all men with ED and diabetes that take testosterone will become functional. (9) Please consult with your physician to see if testosterone is a possibility for you. Do not forget to discuss benefits as well as potential side effects of taking this hormone.
Prolactin
Prolactin is a hormone that is made in the pituitary gland of both males and females. It is thought to have more than 300 functions in the human body. (10) High levels of prolactin are sometimes found in men with low testosterone levels. In men, the most common symptom of prolactinoma (high prolactin levels) is erectile dysfunction. (11) Ask if there is a problem with your body making too much prolactin.
Thyroid Hormones
Studies have shown that ED is very common with both hyperthyroidism and hypothyroidism, which can be a problem with too much thyroid hormone or too little thyroid hormone. It is suggested that if there is a thyroid dysfunction, this should be treated before undergoing any specific treatment for ED. Normalizing thyroid hormones, if abnormal, may be appropriate treatment needed for ED. (12)
Question 2: Would a medication advertised for ED such as Cialis, Viagra, Levitra, Staxyn, or Stendra help me with sexual function or would there be a potential problem if I was prescribed one of these medications?
Oral medication may be part of an ED treatment plan for men with diabetes that is under control. The drugs that are currently available include; Cialis, Viagra, Levitra, Staxyn, and Stendra. Using one of these drugs as prescribed by ones physician may help approximately 50-60 percent of men with diabetes. (13) Not everyone with diabetes should use these medications. Please be careful and use a reputable pharmacy to obtain your order. If you get your medications from a pharmacy online, make sure that it is certified by the National Association of Boards of Pharmacy. Go to the Verified Internet Pharmacy Practice Sites (VIPPS) program to check on your pharmacy provider. This is to make sure you are getting the correct medication and it is not counterfeit. If you are in a country where one or more of these medications do not need a prescription, make sure you have permission to use the medication from your physician, review what would be a safe dose and when you can safely use it. Discuss how the medication may react with other medications and food. Please discuss with your doctor and pharmacist any contraindications you may have to these medications.
Question 3: Are there injection treatments for ED?
When oral medications do not work, sometimes Alprostadil, which is approved by the Food and Drug Administration (FDA), can be used. This medication is injected with a small needle. A man will need to be able to do this or the man’s partner will need to be trained. An auto-injector is also available to make injection easier. Instruction needs to take place under your physician’s guidance. This medication may also be prescribed using a devise that inserts the medication into the urethral opening instead of using a needle.
Question 4: Are there any devices, pumps or vibrators that are recommended?
Devices that use vacuum pressure to aid with erection are an option for some men. There are some devices that are FDA approved which limit the amounts of pressure allowed to help prevent possible injury. It is not recommended to acquire a device without discussing the options and being counseled by your physician. Be wary of companies that sell devices that are not FDA approved as these could potentially cause bodily harm. Pumps come in both manually and battery operated versions. FDA approved devices have a safety feature to limit pressures inside of the chamber used.
The FDA has also approved the use of a battery-operated device called the “Viberect.” This device, which is available only through prescription from your doctor, uses vibration to help develop an erection.
Question 5: Am I a candidate for surgery to help resolve my ED? If so can you review my options and tell me the benefits and risks?
There are different types of surgery for ED that may be possibilities for some men:
Penile Prostheses
Penile prostheses devises are implanted in the body by a surgeon usually in the hospital. There are two kinds to discuss with your doctor:
- The first kind consists usually of flexible cylinders that are inflated with fluid to get an erection. Fluid can be removed and stored in an abdominal reservoir.
- The second is a malleable prosthesis. This type of prostheses is always rigid. It can be placed in the proper position for body functions such as intercourse and urination. Infections are noted in approximately one-third of surgical procedures for ED.
Vascular Reconstructive Surgery
When an artery is blocked for proper erectile function to happen, this type of surgery may be suggested. The surgeon takes an artery from the abdomen to bypass the blockage that inhibits blood flow. This surgery has a success rate in younger men with a single blockage of 50-75 percent, but unfortunately in older men results have only been successful five percent of the time.
Vein Ligation Surgery
This procedure is considered when veins leak and erections are not maintained. Veins are blocked surgically to aid in function. This procedure is not considered successful long-term and is not widely available in the United States.
There are many herbs and supplements that promise to help with ED. Remember not to take any supplements or herbs without first discussing possible adverse effects with your physician. Some substances may have dangerous side-effects and may also interfere with prescribed medications. An article from the University of Maryland discusses problems with some of the supplements including Yohimbe, Viramax, Gamma-Butyrolactone, L-arginine, DHEA and Spanish Fly.
The American Urological Society (AUS) also has statements and recommendations about herbs and supplements for ED. They do not recommend the use of herbal supplements. According to AUS, the only supplement identified so far that may potentially be of benefit for ED is Korean Red Ginseng. While promising, the efficacy of this supplement still needs to be validated by large clinical trials. Due to the lack of these trials and insufficient data available, not even this supplement is recommended. (14)
As you can see there are many kinds of therapies available to help with erectile dysfunction. Please do not be afraid to talk about this very important issue with your physician. We at DiabetesCare.net hope the information provided in our ED series will benefit you in discussions with your doctor and healthcare team.
