Dr Aidin Rawshani

Erectile dysfunction (impotence) in diabetes


Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction, which is also called impotence, means that one is unable to obtain or maintain an erection. This is a common condition that affects many men during life. The condition is especially common among people with diabetes. Erectile dysfunction can be a very troublesome condition that adversely affects the quality of life. Not being able to conduct a sexual intercourse has a negative effect on the condition. Risk factors for erectile dysfunction are actually the same as for cardiovascular diseases, namely overweight, hypodynamia, smoking, high blood lipids (cholesterol) and metabolic disorders (metabolic syndrome). Therefore, it is not so surprising that people with diabetes more often suffer from erectile dysfunction. Today there are several good treatment options.

What symptoms are seen in erectile dysfunction?

  • One can not get an erection, despite sexual stimulation.
  • One can not maintain an erection during sexual intercourse.

Symptoms vary depending on the cause of the impotence. In some cases, impotence is psychological, which means, for example, you can get an erection when masturbating but not when you are with a partner. However, for people with diabetes, erectile dysfunction is usually due to changes in the vessels that go to the penis. That kind of erectile dysfunction is a more persistent problem.

Why do you get erectile dysfunction?

There are many different reasons for getting erectile dysfunction. Below are listed the most common reasons.

  • The most common cause of erectile dysfunction among people with diabetes is that blood flow to the penis is impaired due to vascular disease. The older you are and the longer you have diabetes, the more pronounced such vascular changes are. People with high blood pressure, smokers, high cholesterol, overweight and physical inactivity have the highest risk of erectile dysfunction.
  • Too high intake of alcohol or other drugs also leads to lower ability to get an erective.
  • Stroke, Parkinson’s disease and other neurological diseases can also be impair the ability to get an erection.
  • Some drugs cause erectile dysfunction as a side effect. These drugs include antidepressants, beta-blockers and diuretics. The latter two are common among people with diabetes.
  • Erectile dysfunction can be caused by a lack of certain hormones, such as testosterone. This is likely a less common cause of erectile dysfunction.
  • Stress, depression, anxiety and psychosocial problems can also cause erectile dysfunction.
  • Prostate cancer and surgery in the prostate and urinary system can cause erectile dysfunction.

Is the sex drive affected by erectile dysfunction?

In the vast majority of cases, the sex drive is not affected. Men with erectile dysfunction usually have the sex drive preserved. Therefore, it is important to correct impotence.

Dare to talk about erectile dysfunction!

Your caregiver is no stranger to discuss erectile dysfunction. It is extremely important that you dare to address this topic, which can be difficult for many. It can be difficult to accept that you have erectile dysfunction and for many people the topic of conversation is difficult.

  • You must have the courage to talk about your problems in order for your healthcare provider to help you.
  • Get help from your healthcare provider to investigate the cause of your problems. As can be seen above, there are many causes of erectile dysfunction and it is important to determine exactly what cause you have before starting treatment.
  • Do not be afraid to discuss emotional or personal topics with your caregiver. Ask your caregiver to review your medicines to evaluate whether any of these may have caused impotence.
  • Ask what treatment options are available.

Diabetes and erectile dysfunction

People with type 2 diabetes often have several risk factors for cardiovascular disease. Overweight, smoking, high blood pressure, high blood lipids (cholesterol) and physical inactivity are common. These risk factors cause not only cardiovascular disease, but also erectile dysfunction. In fact, erectile dysfunction can be seen as a warning flag for those who have diabetes. The condition testifies to a negative impact on your vessels.

People with type 1 diabetes also suffer erectile dysfunction because their vessels and nerves may be damaged by high blood sugar.

How to treat erectile dysfunction?

Treatment of erectile dysfunction depends on the cause of the symptoms. For people with diabetes, the cause is most often changes in the blood vessels that go to the penis. At the present time, there is no drug that can repair vascular changes. However, one can still improve blood flow through the following measures:

  1. Lose Weight
  2. Lower your stress
  3. Stop smoking
  4. Drink less alcohol, or stop drinking regularly
  5. Exercise regularly

All of the above leads to getting a better blood flow, even in the penis. In addition to these lifestyle changes, there are a number of treatment options.

Drugs that dilate the blood vessels of the penis (PDE5 inhibitors)

There are drugs that can widen the blood vessels of the penis. These drugs are called PDE5 inhibitors. They are well-known medicines used by many Swedes. The most famous PDE5 inhibitors are:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
  • Avanafil (Spedra)

All of these dilate the blood vessels in the penis so that you can get an erection. One tablet (dosage is determined by your doctor) is taken 1 hour before sex. Tadalafil has an effect lasting up to 36 hours. Others have an effect lasting about 10 hours.


Alprostadil is a hormone that stimulates blood flow in the penis. This medicine is usually only given if the PDE5 inhibitors have not been assisted or if the PDE5 inhibitors are unsuitable for medical reasons. There are several different ways to use alprostadil:

  • Alprostadil can be injected (by syringe) into the penis.
  • Alprostadil is available as tablets to be taken into the urethra.
  • Alprostadil is available as a cream, which is applied to the urethra.

The effect of alprostadil usually comes within 15 minutes. It is you and your doctor who decide which way of alprostadil is best for you.

Vacuum pump

There are medical vacuum pumps that are used to force blood into the penis. These work by inserting the penis into a plastic container and then pumping air out of the container so that the penis dilates and fills with blood. Then take the penis out of the plastic container and finally attach a rubber band to the base of the penis. The rubber band prevents blood from flowing out of the penis. You get to wear the rubber band for 30 minutes. Subsequently, there is a risk of oxygen starvation of the penis.

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