DIABETES AND SEX
often referred to as impotence,
is the persistent inability to achieve and
maintain an erection sufficient to complete sexual intercourse.
At some time or another, most men experience erection problems,
but for some, impotence is a chronic problem. As many as
10% of the male population and 35% of men over 60 may
have erectile dysfunction. As many as
40 to 50% of men with diabetes may develop ED.
Erection occurs when
blood is pumped into the penis. The more blood that fills the
penis, the firmer the erection. Failure to achieve erection
results when the penis does not fill or empty appropriately.
The penis has two
chambers called the corpora cavernosa. These chambers run the
length of the penis and are filled with a spongy tissue which
contains smooth muscles, fibrous tissues, spaces, veins and
arteries. The corpora cavernosa are surrounded by a membrane
called the tunica albuginea. The urethra, which is the pathway
for both urine and semen, runs along the underside of the
Erection begins when a
man receives sensory and mental stimulation. Impulses from the
brain and nerves around the penis cause the muscles of the
corpora cavernosa to relax, allowing blood to flow in and fill
the open spaces. This blood creates pressure in the corpora
cavernosa, which makes the penis expand. By helping to trap the
blood in the corpora cavernosa, the tunica albuginea sustains
the erection. Erection is reversed when the muscles in the penis
contract, stopping the blood from flowing in and opening the
channels that allow the blood to flow out.
There are different
levels of erectile dysfunction:
• A total
inability to achieve erection
irregular ability to achieve erection
erections -- an inability to maintain erections
ED is a treatable
What Causes Erectile Dysfunction?
problems may have a big part to play in creating ED,
there are often physical causes too.
Vessel (Vascular) Disease
Medication pills for high blood pressure, heart medications,
antidepressants, tranquilizers and sedatives
Speak with your endocrinologist. Do not be
embarrassed. A number of tests may be performed to help your
doctor come to a diagnosis. These may include blood and urine
testosterone and prolactin,
liver and kidney
test, and other specialised
Treatments for ED
• Motivation: Men need to evaluate honestly
what is motivating them and to understand their expectations
about treatment. Unrealistic expectations can sabotage the
success of any treatment method. Patients also have to be
committed to the treatment option they select, and be sure that
they are willing to do what is necessary to make the chosen
course of treatment successful.
• Willingness to Adapt: All impotence
treatments require active participation by the patient. Men have
to be willing to learn new techniques and adapt for impotence
treatment to succeed.
• Partner's Attitude: Impotence has rightly
been called a couple's problem, for a variety of reasons. For
instance, some treatments may require a man's partner to
administer a medication. And since partners often experience
similar emotional responses to impotence, some couples find that
counseling can help them reestablish a mutually satisfying
sexual relationship. Either way, a partner's involvement in and
commitment to treatment definitely supports a man's recovery. In
fact, most partners of men with erectile dysfunction want to be
involved in the treatment process.
Hormone Replacement Therapy
therapy can be used to treat men with hormone deficiencies.
Testosterone treatment is not appropriate for men who have been
diagnosed with prostate cancer, and is usually not necessary
after bladder surgery because testosterone levels are normal.
There are several
different treatments for impotence which involve taking a
prescription medication orally (through the mouth, usually as a
pill). Each of these treatments has advantages and
disadvantages. In general, the main advantages of oral
medications are that they are easy to self-adminster, and
require no surgical procedures. These include Viagra,
Cialis and Levitra. These drugs can be
safely used but only with a doctor's advice.
Another treatment option
is the penile prosthesis, a device that is surgically implanted
inside the body. Implants are most successful for men who can
ejaculate and have orgasms even though they can't achieve
Vascular Reconstructive Surgery
A very small percentage
of men may be candidates for some kind of reconstructive surgery
to improve penile blood flow, including revascularization and
venous ligation. Vascular
reconstructive surgery is a technical and relatively expensive