When Your Penis Stops Working
Diabetes and erectile dysfunction
Ben shifted in his seat.
He seemed uncomfortable.
I’d been seeing 26-year-old Ben in my diabetes clinic for a couple of years. He was diagnosed with type 1 diabetes at age 8. Generally, Ben would waltz into my room, head held high, telling me some wild story about his latest night on the town or showing me his newest tattoo or piercing.
But today seemed a little different. For starters he’d called earlier in the week to schedule this extra appointment and secondly, he avoided my eye contact as we walked into the consulting room. I knew that something was worrying him.
We started off by having the usual chit-chat,but I could tell he was not his usual confident self. There were a few long pauses in our conversations and I tried to let the silence motivate him to get whatever it was, off his chest. No luck. Our appointment was nearly at its end when Ben suddenly and somewhat dramatically blurted out
“My penis doesn’t work!”
Wowsers! That’s sort of an awkward thing to quietly discuss with your partner, let alone blurt out loudly in an ‘out of context’ moment, like pus being squeezed out of an unwilling pimple.
Whilst Ben looked towards the ground and shuffled his feet around a little as his cheeks flushed, I was glad that he’d been able to ‘rip off the bandaid.’ so to speak. His body couldn’t hide the internal embarrassment he felt in bringing up the issue. He briefly looked up at me before his eyes darted back towards the floor. He took a deep breath before quietly and cautiously saying;
“I’m having trouble getting and keeping an erection”
Needless to say, Ben’s attempt to divulge his worries landed much better for him second time round.
Erectile dysfunction — what is it?
Erectile dysfunction, let’s call it ED for short, is, put simply, the medical term used to define the inability to get or maintain an erection that is hard enough for sexual activity. Whilst ED is not talked about a lot, is quite common and according to one study, impacts about one in three men over the age of 40.
Now, firstly we must remember that there are a number of reasons why a man may have difficulty getting or keeping an erection. Depression, stress, fatigue or alcohol intake can be the culprit. We’ve possibly all either experienced or been on the receiving end of ‘whiskey dick’, whereby a night of alcohol infused passion has been foiled by an uncooked wiener.
There are also some medications, such as those used to treat high blood pressure, heart burn, stomach ulcers or depression, that can cause ED. Whatever the reason, it is important to ensure the underlying cause of ED is ascertained so it can be treated or managed appropriately.
What’s ED got to do with diabetes?
Unfortunately, any form of diabetes, such as type 1 and type 2 diabetes, increases the risk of a man developing ED, with some studies suggesting that more than 50% of men with diabetes will develop ED within 10 years of having diabetes and men with diabetes being 3.5 times more likely to have ED than men without diabetes.
But why is this?
Firstly, elevated blood glucose levels cause damage to blood vessels. When blood vessels become damaged, they begin to narrow and can become blocked.
The penis needs adequate blood flow to achieve and maintain an erection. Blood fills the empty spaces of the corpus cavernosum, which is spongy erectile tissue. If the blood vessels are damaged then this can impact blood flow to the penis, reducing the pressure and thus expansion.
Elevated blood glucose levels can also cause damage to the nerves. This is called neuropathy. Nerves are located all throughout the body and are responsible for sending messages between the brain and other parts of the body. This means that nerves are the things that allow the brain to tell the penis “it’s go time”. If the nerves that control sexual stimulation and response are damaged, this can result in ED.
Both blood vessel and nerve damage as a result of elevated blood glucose levels occur over time. There can be instances where a man has difficulty getting or maintaining an erection due to an acute low or high blood glucose level. For example, in Ben’s case, we ascertained that he only had trouble getting an erection when his blood glucose level was above a certain level. Knowing this definitely gave Ben a strong motivator to aim to keep his blood glucose levels within his target range, with better blood glucose control being evidenced to improve erections.
Interestingly, when sexually aroused a chemical called nitric oxide is released into the blood. This chemical tells the muscles and blood vessels in the penis to relax, promoting increased blood flow to the penis and thus an erection. When blood glucose levels are elevated less nitric oxide is produced, which can result in reduced blood flow to the penis.
Further, studies have identified that men with diabetes also have lower levels of testosterone than men without diabetes. Lower levels of testosterone can reduce libido and thus impact on sexual function.
Can it be treated?
There are a number of treatment options, such as medications, that can assist ED. Treatment does also rely heavily on lifestyle and good blood glucose control, so below are a few suggestions to both reduce the risk of developing ED and prevent further blood vessel and nerve damage when living with diabetes.
Firstly, aim to have good blood glucose control. Talk to your doctor or diabetes health care team to ensure your current treatment and diabetes management is appropriate.
Secondly, stop smoking. Like elevated blood glucose levels, smoking can also damage blood vessels through elevating blood pressure and can therefore increase the risk of developing ED.
Thirdly, cut back on the alcohol. We’ve mentioned the old ‘whiskey dick’, but drinking more than just two standard drinks per day can damage the blood vessels that contribute to ED.
Fourthly, sleep well. Being tired is often my excuse to keep my husband away. Fatigue can play a big role in sexual dysfunction so try to consistently get enough sleep to reduce your risk of ED.
Fifthly, engage in regular physical activity and eat well. Try to be active for 30 minutes a day, at least 5 days a week. Exercise improves cardiovascular fitness and increases blood circulation, reduces blood glucose levels, improves mood and can aid in weight loss, which in itself can improve sexual function. Eating a healthy diet also benefits cardiovascular health, can reduce blood glucose levels and improve weight.
Finally, check your emotional health. As mentioned earlier, depression and stress can be a cause of ED. It is well known that having a chronic illness such as diabetes increases the risk of developing depression and anxiety. Meditation, yoga and talking to a counselor, your doctor or psychologist may help to manage your emotional and psychological health.
Remember, prevention is king
Treatment and management of ED can only occur by firstly deciphering and tackling the underlying cause of the condition. Talking to a doctor or diabetes healthcare professional is the first step to ensuring you can enjoy and maintain a good roll in the hay.
Ben has boisterously reported back on his personal ‘growth’ and advancements in his errmm… ‘life’ since making some changes to his lifestyle and seeing improvements in his blood glucose management.
It’s nice to see that Ben has ‘risen’ to the occasion.
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