Why Can Diabetes Cause Erectile Dysfunction?

Diabetes in America

According to the Centers for Disease Control and Prevention, 14% of men have diabetes, and 27% of men over 65 have diabetes. African American, Asian, and Hispanic men have higher rates compared to Caucasian men. The Southeastern United States has higher rates compared to other areas, and overall rates of diagnosis are steadily increasing over time. Besides affecting energy, eyesight, heart health, kidney function and many other important health factors, diabetes also affects life in the bedroom.
Most doctors will talk to their diabetic patients about controlling their sugar, getting their eyes checked, exercising, and staying healthy for their hearts. They may talk about a medication to protect their kidneys. But they probably won’t talk to you about intimacy.

It’s because we know that your favorite organ is connected to your most important organ (and no, they aren’t the same thing)

Diabetes and ED – the (un)Happy Couple

According to several studies, more than 50% of men with diabetes have erectile dysfunction. Sometimes, ED is the first sign that something bigger might be going on. Urologists ask you strange questions in general (how else would I have found out that he put an earthworm inside his penis…) but when we start asking you about exercise, walking flights of stairs, and chest pain, it’s because we know that your favorite organ is connected to your most important organ (and no, they aren’t the same thing).
Diabetes is not just a blood sugar problem. Urologists know diabetes as a disease of small blood vessels – the blood vessels that supply that all-important organ in your pelvis. These small blood vessels also supply the nerves necessary for good erections. Not only does diabetes affect blood vessels, but it also causes erectile dysfunction by affecting several different molecular pathways. Diabetics have higher levels of free radicals and decreased levels of cGMP.

cGMP is necessary for helping relax the smooth muscle tissue in the penis. This relaxation allows the penile chambers to fill with blood resulting in an erection. Not only is your body now fighting against (at least) three levels of pathophysiological changes to achieve an erection – decreased blood flow, damaged nerves, and molecular pathway disruption – now you’re thinking about it, and worrying about it, and so is your partner. Now we have the fourth causal component – the psychological part of erectile dysfunction.

The Break-Up

The first step for diabetic patients to improve their erections is to focus on their overall health. This means to lose weight, control your blood sugar, work on increasing your physical activity, quit smoking and excessive alcohol consumption (if you do these things), and eat better. Improving your overall health will always improve your sexual health. And get your partner involved. I always ask my patients – male and female – to bring their partners in to their clinic visits when we’re talking about sex. Your sex life is yours – and I’m here to help you meet your goals – whatever they are (trust me, I’ve heard it).

When the Break-Up Needs a Wing Man

The next step will be medications. PDE5 inhibitors – or the little blue pill. Viagra® (sildenafil), Cialis® (tadalafil), Levitra® (vardenafil), any of these are usually, but not always the next step. These oral medications require nerve stimulation and adequate blood flow. If damaged by diabetes the pills may not be an effective treatment. However, the majority of diabetics who fail oral medications for ED can achieve success with intracavernosal injections. Talk to your Urologist about what works best for you. Many diabetic patients move forward with surgery – penile implants – as the complex nature of their disease means the medications may not be as effective as they want, or they may only be effective for a short amount of time.

From a doctor who’s been there, seen that, and fixed it – don’t let diabetes keep you out of the bedroom

What is most important is that you find a doctor to talk to about you and your partner’s goals. Intimacy – in whatever form you desire – does not have to end with a diagnosis of diabetes. You may need a little help getting there, but leave that to us. Sex shouldn’t stop with age or with diabetes. Erectile dysfunction might be new to you, but it isn’t to us. Find a Urologist in your area and bring intimacy back into your life.
From a Doctor who’s been there, seen that, and fixed it – don’t let diabetes keep you out of the bedroom. Do your part, and for the part that you need some help with, talk to your Urologist about getting that help.

Key points:

  1. At least 1:2 men with diabetes have erectile dysfunction
  2. Diabetes affects many different pathways for erections – blood vessels, nerves, and neurotransmitters
  3. There are several different treatment options available
  4. You can have diabetes and have great sex again


Lael Stieglitz MD

Lael Stieglitz, MD, MPH

Baptist MD Anderson Cancer Center
1301 Palm Avenue
Jacksonville, FL 32207
Phone: (904) 389-3993
Website: BaptistJax.com/DrLaelStieglitz