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Men with diabetes are twice as likely to have trouble getting or keeping an erection (what doctors call erectile dysfunction) as men without this problem. That makes diabetes one of the most common causes of erectile dysfunction. Diabetic men also tend to confront this problem at younger ages than men in the general population.

Among men with diabetes, erectile dysfunction usually develops gradually over a period of months or years. At first, an erection may not be as rigid as it once was or might not last as long as it once did. Sometimes erectile dysfunction is the first sign that a man has diabetes.

Diabetes can cause erectile dysfunction in at least two ways: it can harm the nerves that instruct the arteries in the penis to dilate, and it can restrict blood flow to the penis by damaging blood vessels. People with diabetes often have high blood pressure, high cholesterol, and high blood sugar—all conditions that can further harm blood vessels and interfere with adequate blood flow.

Although both type 1 and type 2 diabetes increase the risk for developing erection problems, studies in animals suggest that the pathway to erectile dysfunction may differ depending on which type of diabetes a man has. If this proves true in human studies, it could be a step toward better-tailored treatments.

Carefully controlling blood sugar can help prevent the blood vessel and nerve damage that contribute to erectile dysfunction. One study of men with diabetes and erection problems found that the worse their blood sugar control, the more their sex lives suffered.

Many men with diabetes can benefit from Viagra and related drugs. Other therapies for ED also work well in men with diabetes. These include drugs that can be injected into the side of the penis or placed in its opening, devices that use a vacuum to pull blood into the penis, and inflatable prostheses that are implanted in the penis.

High blood pressure and erections

Men with erectile dysfunction are about 38% more likely to have high blood pressure than men without erectile dysfunction, according to a study that examined the medical records of almost 2 million men. This study also showed that erectile dysfunction often occurs in men who smoke or are overweight—both common risk factors for high blood pressure. In fact, erectile dysfunction is sometimes a man's first warning sign that he has high blood pressure or heart disease.

One thing complicating the connection between high blood pressure and erection problems is that the use of some medications to control high blood pressure—especially beta blockers—has been linked to erectile dysfunction. It is possible that these drugs somehow affect the nervous system or blood flow in ways that are good for heart arteries but bad for blood flow to the penis. It is also possible the effect may be at least partly psychological. When erectile dysfunction occurs after a man starts taking a new medication, it's possible that fears about his health, rather than the medication itself, are triggering the problem.

In addition, being aware of possible side effects has been shown to make people more likely to recognize effects as abnormal. One study looked at men newly diagnosed with heart disease—but without erectile dysfunction—who started taking the beta blocker atenolol (Tenormin). Among those who were told about the drug's possible sexual side effects, almost one-third reported having problems getting or keeping an erection after having taking the atenolol for a while. In contrast, only 3% of men who were not told the drug's name or its side effects said they had experienced erectile dysfunction while taking it.

Although any blood pressure medications could conceivably cause erectile dysfunction, the problem seems to be greater with diuretics and beta blockers than with ACE inhibitors. If you experience erectile dysfunction shortly after starting treatment with any of these drugs, ask your doctor if you can try a different medication.

Last Annual Review Date: 2011-12-05 Copyright: Harvard Health Publications

Reference: Diabetes section on Better Medicine

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