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Erectile Dysfunction in Type 2 Diabetes

Erectile dysfunction (ED) is a common complication of type 2 diabetes. ED is the inability to achieve or sustain an erection firm enough to have satisfying sexual intercourse.1,2,3 This is caused by damage or constriction of blood vessels and nerves in the penis.2,3

ED, also known as impotence, is often thought of as an age-related condition affecting more than 20% of men over age 40. It is especially common in men of all ages with type 2 diabetes. 1,2 Thought in part to be due to complications from poor long term glycemic (blood sugar) control, ED is also associated with other medical conditions that are typical for men who have diabetes. Those include high blood pressure and cardiovascular disease. ED is a common complication of diabetes that affects the quality of life and is often indicative of underlying vasculopathy (conditions that affect blood vessels), which can be a predictor of more serious cardiovascular issues.1

Type 2 diabetes on the rise

The number of people with diabetes has risen globally from 108 million in 1980 to an estimated 425 million in 2018. Incidence rates for adults developing diabetes have nearly doubled in that time. People are living longer around the world, so the aging population is experiencing an increased prevalence of diabetes mellitus.1 Diabetics typically have medical complications that affect the physiological systems of the heart, blood vessels, eyes, kidneys and nerves. There are also links to cancer, cognitive decline and depression.1

Erectile dysfunction early in type 2 diabetes

Erectile dysfunction may affect up to 75% of all men with diabetes.1 Prior studies have reported that erectile dysfunction may develop earlier in men with diabetes than without and maybe an early symptomatic indicator that precedes the diagnosis of type 2 diabetes.2

Seeking treatment for erectile dysfunction

Talking to anyone about ED can feel embarrassing but it is important to talk to your doctor because early detection can improve both psychological health and overall quality of life.1 Interference with sexual activity can be a source of concern and even depression in men with ED. It is often correlated with a reported decline in quality of life.1 A multifaceted approach to the management of ED can lead to general health improvement. This includes metabolic specialists, urologists, counselors, and education.

Options to consider:

  • Manage your diabetes: get good glycemic control
  • Counseling: see a mental health specialist for anxiety and stress to develop strategies to help you and your partner cope with ED
  • Medications: Talk to your doctor about medications you may be taking that could have side effects contributing to ED
  • Drug therapy: there are oral medications that can help blood flow to the penis e.g., Viagra, Cialis, Levitra, and Stenda. There are also suppositories and injectable medications if pills are not a viable option. These medications are contraindicated in patients with blood pressure issues, liver problems, and chronic heart disease.
  • Vacuum constriction: also known as a penis pump, it is a tube you pump to draw blood into the penis.
  • Penile implants: surgically implanted devices that are an effective option for some men.

Lifestyle choices

Take steps to make changes that can improve both the condition of erectile dysfunction as well as to achieve overall good health. People who stop smoking, maintain a healthy weight, limit alcohol intake, and exercise daily find they feel better, have improved diabetes management and may see improvement in their ED.

What does the research say?

Study findings over the years have considered the presence of an association between erectile dysfunction and many cardiovascular risk factors, including smoking, diabetes, hypertension, hyperlipidemia, metabolic syndrome, and depression.1 Researchers evaluated published studies over a 36 year period which focused on ED. They identified more than 3,700 articles that evaluated 145 studies on erectile dysfunction, involving over 88,000 men. All participants had diabetes and ranged in age from 23 to 71.1

Meta-analysis results showed that the overall prevalence of erectile dysfunction in diabetes was 59.1%. The prevalence rates were significantly higher in men with type 2 diabetes at 66.3%; compared with 37.5% of those with type 1 diabetes.1 Diabetic men are seen to develop erectile dysfunction 10–15 years sooner than those without diabetes. As the prevalence of ED worldwide is estimated to reach 322 million cases by the year 2025 (up from 152 million in 1995) routine screening for erectile dysfunction in men with diabetes should be a part of a clinical evaluation which includes assessment for cardiovascular risk.1

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