What is erectile dysfunction?

Erectile dysfunction (ED) is not being able to achieve or maintain an erection long enough for sexual intercourse.

Most men experience this at some point in their lives and it becomes more common with increasing age.

You are not alone:

• approximately one in 10 men over the age of 40 has ED, whether they have diabetes or not
• ED may affect more than half of men with diabetes
• more than 75 per cent of men over the age of 70 who have diabetes experience some degree of ED.

There are a range of treatments available that may help.

What causes erectile dysfunction?

ED can have physical, hormonal or psychological causes. Sometimes more than one cause may be involved.

Common causes include:

• diabetes. Long-term effects of diabetes can damage the blood vessels that supply the penis and the nerves involved in achieving an erection
• smoking, excessive alcohol intake and the use of some illegal drugs
• some medications, including certain medicines used to treat high blood pressure and depression
• surgery involving the bowel, prostate, bladder or spine, which may damage nerves connected to the penis
• spinal cord damage
• low levels of the hormone testosterone
• psychological factors, such as stress, anxiety, depression, relationship difficulties, guilt or fear of sexual failure.

ED can affect both people in a relationship.

You may feel embarrassed, frustrated or anxious. Your partner may feel rejected or concerned.

Talking openly with your partner can improve understanding about how you both feel about this issue.

ED can also be a strong indicator of cardiovascular disease. It is important to discuss this with your doctor.

Getting professional help

You should first discuss ED with your GP or a member of the diabetes team.

They can advise you about possible causes and discuss treatment options.

If appropriate, you may be referred to a specialist for further assessment.

What assessments may be needed?

It may be helpful for your partner to be involved in your assessment, if appropriate.

You should be prepared to discuss the situation openly with the healthcare professional.

Investigations may include:

• blood tests to assess diabetes control, kidney function and testosterone levels
• tests of the nervous system, including blood pressure and sweat tests
• an injection of drugs into the penis
• referral for counselling.

What treatments are available?

Changing medication

Changing current medication, or prescribing additional medication to reduce side effects, may sometimes help.

Drug therapy

Certain medications used to treat ED are available on the NHS for men with diabetes.

These medications may not be suitable for everyone, so you should always discuss them with your doctor.

Self-injection therapy

This involves injecting medication into the penis before sexual intercourse.

The medication increases the blood supply to the penis and helps achieve an erection.

Vacuum therapy

Vacuum therapy is an effective way of achieving an erection.

A tube is placed over the penis and a pump is used to remove the air from the tube. This draws blood into the penis.

A ring is then placed at the base of the penis to help maintain the erection during sexual intercourse.

Vacuum therapy is only available on the NHS for people who meet specific criteria.

Devices can also be purchased privately from specialist suppliers.

Surgery

In some circumstances, surgery may be considered.

This may include procedures to improve blood flow to the penis or the insertion of a stent or rod.

Further information and support

Sexual Advice Association

Right Angle
224 Building 3
Chiswick Park
566 Chiswick High Road
London
W4 5YA

Website: Sexual Advice Association