Diabetes is a common disease of the endocrine system that can occur in patients as either a hereditary or an acquired pathology. It is characterized by either a lack of insulin produced by the pancreas or ineffective use of this hormone in the body. As a result, the patient's body cannot regulate the amount of glucose in the bloodstream, periodically falling into states of hyperglycemia and hypoglycemia (increased or decreased sugar levels).

As of today, more than 370 million people suffer from this disorder, yet only 10% of them have congenital changes (type 1 diabetes). In this case, symptoms of the disorder and sexual dysfunction appear at an earlier age. In the case of sexual dysfunction, nearly half of the cases experience a sharp decrease in the quality of life against the backdrop of an inability to conceive and properly build social relationships.

Causes of Erectile Dysfunction in Diabetes

The occurrence of decreased erection in diabetic patients can be primarily associated not with the patient's age, but with the duration of the disease and the period of impaired carbohydrate metabolism (sugars, glucose). Therefore, patients with type 1 pathology, which occurs in childhood or young age, are most susceptible to complications. There are several theories as to why erectile dysfunction and diabetes are connected:

1. Autonomic Neuropathy

A characteristic complication of the pathology that manifests in 40% of patients with a disease duration of less than 10 years, and in more than 65% of cases when the duration exceeds 10 years. Excess glucose negatively affects the condition of fats, proteins, as well as the myelin sheath surrounding nerve fibers. It disrupts metabolism in nerve cells, alters the mechanism of impulse movement, ability to self-repair, and stimulates the inflammatory process.

Most often, this affects the fibers innervating the feet or arteries, but sometimes the urogenital nerves responsible for the sensitivity and functioning of the sexual organs and urinary tract are also affected, leading to the following problems:

  • Reduced sensitivity leads to decreased sexual pleasure and inability to fully enjoy the process of sexual intercourse. In this case, the mechanism of occurrence of erectile dysfunction in diabetes type 1 or 2 is more psychological.
  • Reduced functional ability leads to insufficient innervation of the muscle fibers responsible for erection.
  • Urination disorders (pain, burning, urinary leakage) also negatively affect a man's sexual desire.

2. Vasculogenic Hypothesis

Microvascular damage to the arteries and veins responsible for blood supply to the sexual organs leads to two possible problems: ischemia and venous leak.

Ischemic damage results from thrombosis and the formation of atherosclerotic plaques on the vascular walls. Insufficient arterial blood reaches the cavernous bodies of the penis, responsible for erection, reducing its rigidity. Venous leak due to damage to the venous walls causes blood to flow out of the cavernous bodies – as a result, the erection quickly subsides, not allowing the completion of sexual intercourse.

3. Psychological Block

Patients with type 1 or type 2 diabetes often have to either take a large number of medications, use special pens for insulin correction, or wear a constant insulin pump for the same purposes. The fact of constant injections or even a small device, often located on the thigh, can embarrass men, making them feel not strong enough to complete sexual intercourse.

Moreover, constant insulin injections due to the physical exertion that sexual activity entails can negatively affect a man's psychological capabilities.

As a result, psychogenic erectile dysfunction develops. Therefore, the answer to the question "can diabetes cause erectile dysfunction?" is definitely yes.

Elimination of Diabetic Erectile Dysfunction

Each patient requires a personalized approach in choosing a treatment method. Given the likelihood of developing specific consequences, the choice of drugs and treatment methods must be justified. Initially, it's necessary to achieve compensation for carbohydrate (glucose) metabolism using insulin or sugar-lowering drugs at an adequate level. After reaching target glucose levels, therapy for the disorder itself is initiated.

Currently, there are several methods of local treatment. However, all these methods have a significant drawback since they are surgical. During them, soft tissues or mucous membranes are traumatized, which is undesirable for patients with type 1 or 2 diabetes and erectile dysfunction due to the high risk of bacterial flora infection.

In addition to surgical intervention, drug therapy is used. According to clinical recommendations, phosphodiesterase type 5 inhibitors are the drugs of choice. However, for some patients with diabetes, despite a fairly extensive list of options for conservative and surgical treatment, these methods do not achieve the desired effect. In such cases, if it's impossible to reverse erectile dysfunction in a patient with diabetes, a radical method of therapy is indicated – phalloendoprosthesis (replacement of the penis with a special prosthesis).