Canadian Health Awareness Society : Resources

It is estimated that about 50% of all male diabetic patients who are over 50 years-old experience sexual dysfunction, a condition more commonly referred to as "impotence" (or "erectile dysfunction"). The chance of a diabetic patient experiencing erectile dysfunction is approximately three times that of a non-diabetic. However, the condition is often missed from the diagnosis either because the patient finds the topic too embarrassing to bring up, or because the physician overlooks discussing about or treating the condition due to a heavy workload. In reality, as more knowledge about sexual dysfunction and more treatment options become available, treatment for male diabetic patients experiencing sexual dysfunction is becoming more effective, thus greatly enhancing patients' quality of life.

Throughout his lifetime, any man may experience a number of unsuccessful attempts at sexual intercourse (e.g. difficulty achieving and/or maintaining an erection due to insufficient hardening of the penis, or ejaculating prematurely); however, these unsuccessful attempts do not always indicate impotence (i.e. erectile dysfunction). Erectile dysfunction is defined as the inability to achieve an erection that is adequate for sexual intercourse in over 75% of attempts. Sexual functioning depends on the intricate interaction among our blood vessels, nerves, hormones and emotions. Even if one component of this system becomes disrupted, sexual functioning may be impaired. The use of insulin is not the cause of erectile dysfunction.

Erectile dysfunction in diabetic patients is often caused by complications in the functioning of blood vessels and nerves. Although erectile dysfunction often occurs together with peripheral neuropathy (i.e. disease of the peripheral nerves), it differs from other chronic diabetic complications in that its occurrence is not related to how long the patient has had diabetes. Erectile dysfunction that is triggered by diabetes is similar to organic erectile dysfunction. The condition progresses from a decrease in the firmness and frequency of erection, followed by an erection that is flaccid, and finally to a complete loss of erectile function. Unless a diabetic patient is an alcoholic or smoker, there is no apparent decline in his male hormonal levels. Sexual desire in a diabetic patient does not fade away, but diabetes-induced changes in lifestyle and quality of life, as well as a decrease in self-esteem can create a mental burden on the patient. In other words, a disrupted mental and emotional state overrides the normal physiological functioning of the sexual system, eventually leading to sexual dysfunction.



Diabetes-related erectile dysfunction is caused by disease of the nerves. Impairment of the autonomic nervous system leads to inability of the smooth muscles of the penis to relax. Upon diagnosis, the physician can find out whether the blood vessels and/or nerves give rise to the condition. Besides having an organic (i.e. due to dysfunction of the blood vessels and nerves) and psychological cause, erectile dysfunction may also have a chemical cause due to medications. Some examples are blood-pressure lowering agents, anti-anxiety agents, antidepressants, sedatives and sleeping aids, agents for gastro-intestinal ulcers, female hormonal agents, chemotherapeutic agents, etc. Adjustments in the medications can correct drug-induced sexual dysfunction.

For treatment purposes, it is necessary to differentiate an organic from a psychological cause for erectile dysfunction. For example, when the cause is psychological, the most effective therapy is consultation with health professionals who are familiar with this type of sexual challenges. These professionals may include psychiatrists, clinical psychologists, sex therapists, etc. In most cases where the patient feels nervous about sexual intercourse, talking to these health professionals about his fears and concerns, as well as locating the source of his anxiety can successfully treat his erectile dysfunction. On the other hand, if the condition is a result of chronic diabetic complications, identification of the exact cause via examination of the blood vessels and nerves can help deciding on the appropriate treatment. Treatment options include oral medications, penile injections, penile pumps and surgery (to insert penile prosthetic implants). As for oral medications, which are currently available on the market, have triggered a lot of interest in patients. But one should remain cautious when using these medications. Since diabetics often have diseases of the heart and blood vessels, a thorough assessment by the physician is important before using these medications. No one should start on it before consulting with the physician. If not, the patient might not only lose the fun in sex, but also suffer the undesirable consequences from misuse of medications.

Conclusion : Maintaining mental and emotional well-being, together with good control of blood glucose are the best methods to prevent male sexual dysfunction. Do not hesitate to talk to your physician in order to get advice at the right time. Never believe in advertisements which are full of exaggerating claims, and yet lacking in clinical evidence. If you follow the above suggestions, enjoying a satisfactory sexual life is definitely possible for a diabetic patient.