Erectile dysfunction in diabetes – Managing strategies

erectile dysfunction

Do you know when men are sitting ducks to quacks? Do you know when strong, successful men too fall for sleazy marketing?  It is, my friends, when they search online for products like “Stamina X Plus,” “Size Up,” “Wild Horse Fire,” “Mustang,” and the inimitable “Goat Weed extract with Antarctic krill oil.”

You might wonder at the number of exotic products available that allegedly cures erectile dysfunction. It is but natural for you to conclude that popping in one of these pills makes you a better man. Mind you, the first conclusion you must be drawing is that since there are so many products in the market, the problem of erectile dysfunction is really huge.

So, why doesn’t it come out? Because the worst kind of insult society gives to a man is that he isn’t one!  That is why many men suffer erectile dysfunction even as they fall flaccid and cannot uplift themselves.

This is not the best move as the causes of erectile dysfunction may also lead to cardiovascular events! Read on to know more…

What is erectile dysfunction?

Erectile dysfunction also known as impotence is a sexual dysfunction that leads to an:

  • Inability to develop an erection
  • Inability to sustain an erection

This means that a person with erectile dysfunction cannot develop an erection and if he does, he cannot maintain the erection adequate enough to perform sex.

Erectile dysfunction (ED) is one of the most common sexual problems that men (and their partners) face. Though some men have problems with erections from time to time, it is unusual for a man to have problems with erections if it progresses over time. In such cases, there is need for a thorough evaluation.

Erectile dysfunction Symptoms

To go for further evaluation of ED, having these two simple erectile dysfunction symptoms persistently are clear markers. These include:

  • Inability to get an erection
  • Getting an erection, but the erection does not last long enough to perform sex

If you notice these symptoms, please do not hesitate to consult a doctor as erectile dysfunction can be caused due to cardiovascular disease. Having erectile dysfunction increases the risk of getting a heart attack and stroke.

If you have diabetes along with erectile dysfunction symptoms, it is even more important to consult a diabetologist as the health risks are even higher.

Causes of Erectile Dysfunction

While mental aspects of sexual activity are highly subjective, physical inability is something that prevails whether the mind is willing to indulge or not. This is important as certain psychological issues are also causes of erectile dysfunction.

Psychological causes of erectile dysfunction

You cannot drag the horse to the pond even with Wild Horse Fire! When a person is suffering from psychological problems, has issues in relationship, or is in emotional distress, there is every chance for erectile dysfunction. Psychological causes of erectile dysfunction include:

  • Worrying about sexual performance
  • Conflicts of relationships
  • Stress at work or home
  • Anxiety
  • Depression

Physical causes of erectile dysfunction

Even though it is common for someone to have erectile dysfunction due to psychological reasons, a vast number of people suffer from erectile dysfunction due to physical causes. It is quite usual for people with the below conditions to have erectile dysfunction. These are potential risk factors for ED.

  • Age above 40 years
  • Having diabetes and chronic high blood sugar levels
  • Hypertension
  • High cholesterol levels
  • Smoking
  • Alcohol abuse
  • Physical inactivity
  • Obesity
  • Past history of cardiovascular disease

Apart from these risk factors, the physical causes of erectile dysfunction are classified originating from:

  • Neurological
  • Hormonal
  • Vascular

Neurological causes of erectile dysfunction

People suffering from conditions like schizophrenia, Alzheimer’s disease, and Parkinson’s disease, and people who have had trauma to the brain and spinal cord have decreased ability to be sexually aroused. Damage to the spinal cord also causes disruption in the neural pathways to the sacral region. This directly affects the process of getting an erection.

Hormonal causes of erectile dysfunction

During the process of getting an erection, there is a lot of hormonal activity. Hormones like testosterone, androgens, adrenocorticotropic hormone, prolactin, and oxytocin are active during sexual arousal and sexual activity. Certain hormonal disorders like hypogonadism interfere with the process of erection. Moreover as men age, their testosterone levels also drop. This can influence their ability to achieve and maintain an erection.

Vascular causes for erectile dysfunction

This is one of the major causes for erectile dysfunction. Conditions that affect both the small and the large blood vessels are known to directly affect the ability to achieve and sustain erection. The process of erection involves blood flowing into the blood vessels of the penis. Conditions like hypertension, coronary artery disease, cardiovascular diseases, high cholesterol levels, and atherosclerosis have an increased risk of erectile dysfunction.

Diabetes and erectile dysfunction

Many studies have shown that India is a high prevalence of diabetes. And, strange as it might seem, though we have a proclivity to procreate, India is only second to China in the prevalence of erectile dysfunction. It is known that 50% of Indian men with diabetes and the age of 40 have ED.

How does diabetes cause erectile dysfunction?

Nitric oxide (NO), which is a neurotransmitter and functioning as a blood vessel dilator is also involved in the process of erection. Since the process of erection is primarily blood flowing into the penis as a response to the signals of central nervous system, nitric oxide and its derivative nitric oxide synthase play a key role in the blood vessels of the penis dilating and accommodating blood for erection.

In diabetes, there is a constant pressure of high blood sugar levels. These high blood sugar levels become toxic and start to damage small blood vessels and nerves in a process called oxidative stress. This damages the inner most parts of small blood vessels called endothelium.

When endothelium of small blood vessels is damaged in the penile area, the action of erection-causing nitric oxide is severely reduced and leads to erectile dysfunction.

Diabetes is a major cause that leads to erectile dysfunction, cardiovascular diseases, stroke, retinopathy, and nephropathy. That is why it is very important to never neglect erectile dysfunction in diabetes.      

Erectile Dysfunction Treatment

You now know the risks involved in suffering erectile dysfunction in silence or seeking virility from shady medicines. For erectile dysfunction treatment, once you consult your endocrinologist, he/she would refer you to an urologist. The initial workup to diagnose ED involves measuring blood pressure, peripheral pulses, and a physical examination of the penis.

Further tests include:

  • Hormonal tests
  • HbA1c test to measure the patient’s diabetes control
  • Prostate exam
  • Urinalysis
  • Prostaglandin E1 test (to measure dilation of blood vessels)
  • Biothesiometry (to measure nerve function)
  • Penis & Testicles Ultrasound
  • Angiography

Once the diagnosis of ED is made and the underlying cause is identified, erectile dysfunction treatment is done with oral medications, injections, implants, topically applied medications, external vacuum, and vascular reconstruction surgery.

Other major aspects of erectile dysfunction treatment are:

  • Smoking cessation
  • Avoiding alcoholism
  • Pelvic exercises
  • Reducing weight
  • Getting adequate sleep
  • Reducing high blood pressure
  • Managing cardiovascular diseases
  • Reaching ideal cholesterol levels
  • Reaching target HbA1c levels and blood glucose levels

While oral medication PDE5 inhibitors, popularly known as Viagra, are useful for some, it is not advised for people with heart disease.

Apollo Sugar Approach

Apollo Sugar Clinics helps you control diabetes and prevent/manage erectile dysfunction. We help you reach your target HbA1c and other clinical parameters and avoid a host of diabetes complications including ED. With an integrated approach, we provide services at the clinic and beyond the clinic.

While our endocrinologists and diabetologists help you with clinical care, our expert diabetes care team helps you manage diabetes in real-time. Our programs for diabetes include a doctor-connected glucometer that passes on your blood glucose levels as soon as you measure them. Based on these sugar levels, our care team assists you with diet, medication, and exercise.

85% of our patients have reached target HbA1c levels and 87% of our patients have reached target total cholesterol levels. By managing their blood pressure, sugar levels, and weight, our patients have been able to avoid diabetes complications like ED.


Dr. Sudeep Putta Manohar

B., B.S, M.R.C.P (UK), MRCP (Endocrinology), CCST

Dr. Sudeep Putta Manohar