Diabetes as a cause of ED

What is type 2 diabetes?

Type 2 diabetes mellitus occurs when your pancreas cannot produce enough insulin. As insulin plays a vital role in blood glucose control, your blood sugar levels become very high as there is not enough insulin.

The condition is generally caused by a poor diet and little physical activity, unlike type 1 diabetes which is caused by factors out of your control.

“5 million people in the UK are diabetic”

In the short-term, diabetes can cause frequent urination, recurrent thrush, slow-healing wounds and fatigue. However, in the long-term, it causes complications in your nerves, eyes, feet and heart. It is also a huge risk factor for obesity.

Almost 5 million people in the UK are living with diabetes, 90% of which have type 2 according to Diabetes UK. While the physical and psychological effects are well known, many don’t realise the effect it has on your sexual health.

How does diabetes cause erectile dysfunction?

Erectile function relies on several systems to function properly: your cardiovascular system, your nervous system, and your endocrine system.

Diabetes affects all of these extensively, meaning it can result in impotence in several ways. In fact, men with diabetes are three times more likely to develop erectile dysfunction.

Cardiovascular disease

The main way that diabetes causes ED is by damaging your blood vessels. To get and maintain an erection, the penis requires healthy blood flow so that the soft tissues can trap the blood in the penis to get hard.

High blood sugar levels for an extended period of time reduces the elasticity of blood vessels, narrowing them over time. It also causes atherosclerosis, as the damage allows fatty substances to build up in the arteries and block them. Both of these actions combined limit blood flow.

Diabetes also causes conditions that are fellow risk factors for ED, such as high cholesterol, high blood pressure (hypertension) and coronary heart disease. It also results in metabolic syndrome, the medical term for someone who has high blood pressure, diabetes and is overweight.

All of these factors combined result in poor heart health, which is one of the most common causes of ED in diabetic men.

Nerve damage

Another complication of diabetes is known as diabetic neuropathy. This happens because high blood glucose levels damage the blood vessels that supply the nerves. Over time, this prevents essential nutrients from reaching the nerves and this damages and kills the nerve fibres.

This complication most notably affects the nerves in your feet. However, it also affects motor and autonomic functions (e.g. bladder control, heartbeat, sweating and stomach emptying).

Erectile function is another autonomic process that is affected by neuropathy. This is because an erection, when you’re aroused, requires neural signals from the central nervous system (the brain and spinal cord) to reach the pelvic and penile nerves.

Low testosterone

Low testosterone levels, a condition known as hypogonadism, are common in men who have metabolic syndrome or heart disease. The condition also has a high prevalence in those with type 2 diabetes, with up to 50% suffering from low testosterone levels.

“50% of men with type 2 diabetes have low testosterone”

One of the main reasons researchers believe this happens is because fat tissue, especially around the stomach, causes more testosterone to be converted into oestrogen. Additional research has found that this relationship goes both ways, as low testosterone also increases visceral body fat levels, which leads to insulin resistance and an increased risk of developing type 2 diabetes.

This is another contributing factor to ED. Testosterone is the main male hormone and is largely responsible for sexual function, including ejaculation, sexual desire and orgasm. Research has also found it to be an important component in erectile function, meaning low testosterone could be linked to erectile dysfunction.

While it is not a common cause of ED, as many men who have low testosterone do not have ED, it could be a potential risk factor for some. You should consult your doctor if you’re concerned you have low testosterone.

Mental health

Living with a diagnosis, symptoms and treatment in those with a chronic condition puts a significant toll on your mental health. This is no less true for diabetics, with a 30% prevalence of depressive symptoms and 40 - 55% prevalence of anxiety symptoms in those with diabetes.

This can result in psychological erectile dysfunction. Negative emotions can affect your blood vessels and your nervous system. Studies have also shown that certain changes in hormones that cause stress or depression can significantly influence your erectile health. Moreover, many men have unhealthy habits that they use to cope with their emotions, such as drinking more, smoking or overeating - all of which are linked to ED.

Men with diabetes can also struggle with sexual performance anxiety (SPA) due to body image or performance issues. This is a leading cause of psychological ED in men and can be difficult to overcome.

How do you manage erectile dysfunction and diabetes?

Lifestyle changes

Simple changes to your lifestyle will significantly improve your blood sugar levels:

• eating a low-calorie, balanced diet
• regular light exercise
• weight loss - this can also improve your confidence
• quitting smoking
• avoiding alcohol

Alongside managing your diabetes, this will help improve your erections.

Medication

It’s also important to take your diabetes medicines correctly, whether you need to take insulin or tablets, to keep your blood sugar under control.

If you’re struggling with ED as well, you should consult your doctor on what oral medications you can take. PDE-5 inhibitors, such as Viagra and Cialis, are a group of ED treatments that have few side effects and are safe to take for most men with diabetes.

You should still consult your doctor before taking any treatment. They know your medical history, and they can check what's safe for you to take. However, there are plenty of non-medicated treatment options for those who cannot take traditional ED meds.

Main takeaways

• Type 2 diabetes causes ED as it damages the blood vessels and nerves.
• It also lowers your testosterone levels and impacts your mental health - both of which are linked to ED.
• Managing your diabetes, losing weight and using ED treatments will all significantly improve your symptoms.