Diabetes: Is Impotence Inevitable?

If you're a man with diabetes, you may worry about its association with impotence. While it's true that disease may contribute to impotence in some diabetic men, the good news is that there are plenty of effective treatments out there to help you get your sex life back on track.

Diabetes "messes with the nerves and blood vessels in general," explains Matthew Weissman, MD, medical director of the Ryan-NENA Community Health Center in New York City. "And it messes up those that you need to get an erection."

Impotence in diabetics is often due either to nerve damage or to vascular insufficiency (problems with the blood vessels), says Carlos R. Hamilton, Jr., MD, endocrinologist and professor of internal medicine at the University of Texas Health Science Center in Houston, Texas.

"It happens over time and certainly not immediately," Hamilton says. "The longer you have had diabetes, the more likely you are to have impotence."

It's estimated that 6 percent of diabetic men between the ages of 20 and 24 have impotence and that 52 percent of diabetic men ages 55 to 59 have impotence, Weissman says.

Nerve and blood vessel damage aren't the only reasons some diabetic men experience impotence. Individuals with diabetes generally tend to be more depressed than non-diabetics, Weissman explains. "And sexual functioning is a combination of having your mind working in a way that lets you respond to stimuli appropriately," he says. "And in addition to this, the nerves must work and the blood flow must be working."

While impotence is more likely to occur in men with poor blood sugar control, there's not much evidence that getting into better blood sugar control will make the impotence disappear, Weissman says. It is more likely to occur in men who've had diabetes for a long time, who are older, and who have other diabetic complications.

One caveat: Keep in mind that if you have impotence, you're also at an increased risk for heart disease, Weissman says. "If you are having trouble with blood flow in the penis, then it follows that you would be having trouble with blood flow in the heart," he says. He cautions to be sure to discuss erection problems with your doctor, who'll monitor you for potential heart problems.

If you think that you are getting erectile dysfunction (ED), don't panic. Here's what's available to help you.

  • Viagra or a similar medication may be prescribed, as long as the person doesn't have heart disease or is not taking any medications that might contraindicate its usage, Hamilton says. "And Viagra is a pretty effective medicine," he notes. Weissman notes that Viagra is often the first line treatment for impotence in diabetic men.
  • If there's a depression component with the impotence, counseling and antidepressants may help, Weissman says.
  • An inflatable penile implant, or pump, is available if Viagra fails, he notes. "There also are pills and injections that you can put directly inside the penis," Weissman explains. "You need to be evaluated by a doctor to figure out what's right for you. But if you try Viagra and it doesn't work, there are lots of other options."