Greater Boston Urology Blog

Diabetes and Erectile Dysfunction (ED)

“Bartender, I’d like a martini, three beers, a double shot of insulin, and some Viagra”

This is intended for all the fascinated masses (all five of you, three of whom are probably my family members) and millions of men who have diabetes and erectile dysfunction. Population studies have suggested, and my clinic patients have confirmed, that there are truly millions of men out there suffering from erectile dysfunction, many of whom have diabetes.

Let’s talk about erectile dysfunction first (or as I refer to it “Doc, why can’t I get it up?” question). We shall talk about it first because IT IS IMPORTANT TO MEN! And ultimately that’s why I am here. Erections happen when there is an increase in blood flow to the man’s penis, usually during sexual arousal. Specifically, blood has to fill two sponge-like areas of the penis called corpus cavernosum and stay in that spongy tissue until ejaculation happens. Normally, after ejaculation occurs those spongy areas contract and blood flows out of the penis making it flaccid (soft) again. The more blood that gets to the penis, the better the erection. So what makes blood fill the penis? In very simplified terms, it is under the control of specific nerves that go to the penis (there’s that, along with your hot wife or girlfriend or that girl from the video). If there is not enough blood flow or if the nerves are damaged, the quality of erections will not be the same.

To have a good erection you have to have at least three things: a penis, good blood flow and healthy nerves. If either one of those components is missing or damaged, the erections are not going to be great (i.e., either not hard enough, or not lasting long enough, or both).

Now, what does diabetes do? It damages BOTH nerves AND blood vessels in the body. It does so through high blood sugar levels. Also, the smaller the blood vessels are, the sooner they will be affected by diabetes. Trust me when I tell you: blood vessels that go to the penis are pretty small. You see where this is going, right?  Diabetes may and probably will affect your erections, especially if diabetes is not very well-controlled. This fact is also confirmed by multiple studies showing that ED rates in men with diabetes are two to three times higher than the general population. The onset of ED also tends to occur at a much younger age (some studies suggest 10-15 years earlier) than in men without diabetes.

One more component that has to be present for quality erections (and is also frequently decreased in men with diabetes) is testosterone level. Testosterone is a male hormone which contributes to a healthy sexual function in men including both erection quality and libido (sexual desire). It tends to be lower in men with type 2 diabetes, and seems to be fairly normal in men with type 1 diabetes (we shall discuss it in more detail in one of the upcoming posts).

Bad news: Unfortunately, once erections worsen, it is very difficult (pretty much impossible) to improve them naturally. Vigorous diet, exercise program, and great blood sugar control will not return the erections of your twenties, but what they will do is prevent erections from getting worse. In simplest terms: the healthier you are, the healthier your penis (and erections) will be. So please, please, please (this is three pleases, so you know I really care about the issue) take care of yourself! Take care of your blood sugar and diet, and please exercise! The American Heart Association (AHA) now recommends “at least 30 minutes of aerobic activity at least five days per week” or “at least 25 minutes of vigorous aerobic activity at least three times per week AND muscle-strengthening activity at least two days per week.”

Good news: While there are no “natural” ways to revert worsening erections, there are other means. Yes, I am referring to the medications that help with ED (i.e. Viagra, Cialis, Levitra, Stendra, Staxyn). And if those don’t work, there are other things! By the way, we will talk about those “other things” in the next post.  But you have to talk to your doctor and let us know that it is a problem. Please don’t be embarrassed to bring it up, we are here to help, but we are not mind readers.

GBU specializes in the treatment of ED. For additional information, visit GBU online at or call us at (855) 505-3335.

Natalya Lopushnyan, M.D

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