To understand how diabetes leads to Erectile Dysfunction (ED), you first have to understand how erections work. Getting an erection is really a complicated process.
Anatomy of an Erection
In the shaft of the penis there are two side-by-side chambers of spongy tissue called the corpora cavernosa. They’re mainly responsible for erections. Just below them is another chamber called the corpus spongiosum. The urethra, which carries semen and urine, runs through the center of it.
The corpora cavernosa are made of small arteries and veins, smooth muscle fiber, and empty spaces. The chambers are wrapped in a sheath of thin tissue.
When you get an erection, nerve signals from your brain or from the nerve endings in your penis cause the smooth muscle of the chambers to relax and arteries to dilate, or open wider. This allows a rush of blood to fill the empty spaces.
The pressure of blood flow causes the sheath of tissue around the chambers to press on veins that normally drain blood out of the penis. That traps blood in the penis. As more blood flows in, the penis expands and stiffens, and you have an erection.
When the excitement ends, the smooth muscle contracts again, taking pressure off the veins and allowing blood to flow back out of the penis.
Diabetes: A Perfect Storm for Erectile Dysfunction
Many common problems related to diabetes all come together to cause erectile dysfunction. That’s why various studies show that 35% to 75% of men with diabetes will develop some degree of erectile dysfunction. If you are having difficulty getting erections, there may be a number of things going on in your body.
Nitric oxide is a chemical released into the bloodstream by the lining of blood vessels. It acts as a kind of chemical messenger that tells the smooth muscles and arteries in the penis to relax and let in blood.
High blood sugar, which must be managed carefully if you have diabetes, causes blood vessel and nerve damage that affects many processes in the body. Sexual response is one of them. Damage to the blood vessels blocks the release of nitric oxide. A lack of nitric oxide results in constricted blood vessels and reduces blood flow to the penis.
What’s more, according to the American Diabetes Association, 73% of adults with diabetes have high blood pressure or take blood pressure medication. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow.
High cholesterol is also common in people with diabetes. LDL cholesterol, or what’s called “bad” cholesterol, can interfere with the ability of blood vessels to dilate. High cholesterol levels result in fatty deposits in artery walls. This buildup of fatty deposit can reduce blood flow.
Some of the choices that men with diabetes make also feed into this “perfect storm.” Smoking, especially. Smoking by itself reduces blood flow all through the body.
Last but not least, feeling badly about your health can lead to erectile dysfunction. For most men, erectile dysfunction is mainly a physical problem, but the mind always plays some part in sexual arousal.
Although having diabetes means that you may encounter problems with your sexual functioning, you really can turn it around. By living a healthy lifestyle and working with your doctor, you can get your diabetes under control and treat erectile dysfunction if it becomes a problem for you.
If you have diabetes and it has caused erectile dysfunction (ED), you still have every reason to be optimistic about the future and a healthy sex life. There are many proven treatments you can try.
A doctor’s first choice for treating erectile dysfunction is usually one of the pills called PDE5 inhibitors. First there was Viagra. Now there’s also Levitra and Cialis. All three drugs work in similar ways. They don’t increase sexual desire. They make it physically possible to get an erection when you are aroused.
No one of them has been proven to work better than the others, although there can be a different individual response. But the time they take to start working and the duration of their effects vary. That’s something you may want to consider based on your sexual habits. For example, does spontaneity matter to you, or do you usually plan sex ahead of time?
Viagra starts working in about 15 to 30 minutes and its effects last about four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours. Cialis starts working in about 30 to 60 minutes and lasts as long as 36 hours. Take note that Viagra is most affected by slow absorption if you take it after a meal.
These drugs are not good for every man. Men who take nitrate drugs for chest pain or alpha blockers for high blood pressure or prostate problems shouldn’t take Cialis, Levitra or Viagra. Other reasons why you may not be able to take these drugs include:
- High blood pressure that isn’t under control
- Very low blood pressure
- A heart attack or stroke in the past six months
- Kidney or liver disease
- Retinitis pigmentosa (an eye disease)
Other Treatments for Erectile Dysfunction
If erectile dysfunction pills are out of the question, or if they haven’t worked for you, don’t worry. There are other good options.
Alprostadil is another drug for erectile dysfunction. However, it’s not a pill. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. It widens blood vessels and relaxes smooth muscle tissue in the penis, allowing blood to fill the spongy tissue that makes the penis erect.
Injections directly into the penis are another way to deliver alprostadil. Phentolamine and papaverine are additional drugs that are injected into the penis to treat erection problems. When injecting these drugs there is some risk that your erection may last too long, a condition that can require medical treatment.
Next, you may want to try a vacuum device, or “penis pump.” This is typically a clear plastic cylinder with a bulb or plunger and a constriction band.
You put your penis in the cylinder and start pumping. The suction creates a vacuum, so blood rushes in to fill the spaces in the spongy tissue of the penis, creating an erection. The erection lasts only as long as the blood stays in, so you slide the band down around the base of your penis, trapping the blood. It’s safe to keep the band on for up to 30 minutes.
Alternative Treatments for Erectile Dysfunction
Currently, no herb or supplements have been proven to help with erectile dysfunction. Herbs and supplements that some people believe are helpful include:
- Horny goat weed
- Ginkgo biloba
- Muira puama
Before trying any alternative treatment, be sure to ask your doctor about it first. Herbs and supplements, whether they help with erectile dysfunction or not, have real effects on the body. They could cause dangerous reactions with other medicines you might be taking.
Every Tuesday and Thursday from 10 a.m. till noon, you can come to the Philipsburg Pharmacy for a free Diabetes and Blood-pressure check-up.