When the cap fits
I’ll keep wearing the physician’s hat for a little longer. There are a number of possible causes of erectile dysfunction (ED) to work our way through, giving us a fair chance to review all the most common.
I suppose I’m coming to Diabetes slightly later than I should. Erectile Dysfunction is quite a common early symptom of Type 2 Diabetes, cardiovascular disease or both. If you check through the literature, you’ll find that about 12% of patients who are later confirmed as diabetic first appear in the consulting rooms complaining of ED. Putting the cart before the horse, the evidence is that treating ED in cardiovascular patients who are also diabetic significantly reduces the mortality rate. So some good can come out of treating ED, usually with Viagra, Cialis or Levitra although, given that these drugs may not always be allowed as treatment, it is better to prevent the onset of the Diabetes if at all possible, say, by reducing excess weight.
A few years back, the Massachusetts Male Aging Study (MMAS) of men aged between forty and seventy years found that 28% of men with diabetes had ED — about three times the incidence in the general population. Averaging out the later surveys over the age range, ED develops between ten and fifteen years earlier in men with diabetes. Above the age of 50 years, between 50-60% of men with diabetes will have difficulties with an erection. Above 70 years, it is almost certain that diabetic men will have some difficulty with erectile function.
The cause of ED in diabetic men usually has both organic and psychological elements. Even if the first cause is not psychological, the onset of organic ED almost inevitably produces serious performance anxiety and, if not treated, depression. The combination inevitably affects the libido and this reinforces the disability.
Vascular disease with decreased flow of blood into the penis through arterial narrowing, hardening and closure, high blood pressure, peripheral nerve damage, hormonal problems, say, because of decreased gonadal function, and obesity are all more common in diabetic men and each one may be the cause of your ED. An increasing body of research indicates that half of all ED cases in diabetic men over 50 years are caused by arteriosclerotic disease resulting in a thickening, hardening and loss of elasticity in the arterial walls.
So that leaves us with the question of how we treat both the ED and the diabetes.
- Good control over the level of blood sugar can prevent the nerve and blood vessel damage that leads to ED.
- Many of the medications used to treat high blood pressure and depression may cause ED. Sometimes, a simple change can restore function.
- Smoking and other uses of tobacco, (a) constrict and may block your blood vessels; and (b) can also reduce nitric oxide levels, both of which which may limit the flow of blood into your penis.
- Drinking too much alcohol can damage your blood vessels and make ED more likely.
- Performance anxiety and depression can cause ED. To keep your stress levels under control, you should review your current tasks, and set more reasonable goals and deadlines.
- Regular physical exercise can keep your arteries clear and boost your stamina. If you lack motivation, do not stay solitary. Join a club or gym.
- If you sleep well, you are less likely to suffer from ED.
As your physician, I can also consider Viagra, Cialis or Levitra, but these drugs are not safe if you are taking nitrates to treat heart disease or alpha blockers to treat high blood pressure or prostate enlargement This takes us into new territory for these articles. The vacuum constriction device works no matter what the cause of the ED. If you find the idea of using this piece of equipment off-putting, there is the possibility of intracavernosal injections to the penis to help stimulate an erection. Surgery and penile prostheses implantation are highly successful, but there are greater risks of infection when operating on diabetic men.
Thus, there are well-established systems for treating both diabetes and ED. There is no need to suffer in silence. Your sex life can be restored in most cases, albeit that sometimes, you cannot rely on a simple pill to solve the problems.