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Diabetes and Sex – Male Dysfunction

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Updated November 23, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

For men with diabetes, sexual problems can be all too common. The National Institutes of Health states that erectile dysfunction can range from 20% to as high as 75% of men with diabetes. Men who have diabetes are two to three times more likely to have this problem. Men can also experience problems with ejaculation.

We all encounter change in sexual function as we age. However, men with diabetes may start to experience problems at a younger age and with more severity due to small blood vessel and nerve damage caused by poor control of diabetes. Problems can appear as much as 10-15 years earlier than can be expected for men without diabetes. In fact, erectile dysfunction in men younger than 45 years old can be a sign of diabetes or indicate a high risk for developing diabetes in the future.

Causes

Causes of erectile dysfunction include damage to nerves and small blood vessels, medications, alcohol abuse, smoking, high blood pressure, kidney disease, and psychological or emotional problems. Medications than can cause erectile dysfunction are those for blood pressure and depression.

Recent studies have shown a strong relation between sexual dysfunction with low testosterone and abdominal obesity, metabolic syndrome, and type 2 diabetes.

Risk is increased for erectile dysfunction with high blood pressure, abnormal blood fat levels, urinary problems, heart disease, advanced age, high body mass index, and smoking.

Men may also experience difficulty with ejaculation, particularly a problem called retrograde ejaculation. They may notice less semen being discharged. This may be due to a condition where semen enters the bladder instead of exiting the penis as it should. This is caused by improper functioning of the internal sphincter muscles responsible for opening and closing bodily passages. Nerve damage can be the culprit. This condition should not cause harm but it can cause problems with fertility.

Causes of retrograde ejaculation include nerve damage, medications, and prostate surgery.

Male Sexual Problems Due to Diabetes

  • Decreased libido
  • Erectile dysfunction
  • Problems with ejaculation
  • Orgasmic dysfunction

How to Lower Risk

  • Good diabetes management and blood sugar level control
  • Healthy diet and exercise
  • Keep abdominal fat within normal limits

When you maintain good control of diabetes, you lower the risk for nerve and small vessel damage. Sexual response happens due to involuntary nerve signals, also known as autonomic nerve signals, and blood flow being directed to sexual organs.

You make a conscious decision to move your legs to walk, but you cannot control your sexual organs the same way or consciously tell your blood to flow to a certain area. Therefore, it is important to keep your nervous and circulatory system in the best shape possible and functioning normally. High blood sugar levels can damage both of these systems and cause problems with sex.

What to Do

Talk to your doctor. Your lifestyle, diabetes control, and past medical history will be evaluated as well as the nature of your sexual problems. Expect a physical exam including laboratory tests. Your urine may be tested to look for the presence of semen which may indicate retrograde ejaculation.

Your emotional health should also be addressed. Let your doctor know if you have been depressed or have been experiencing stressful life changes.

Treatment

If you have excess abdominal fat, try diet and exercise to lose it. Good diabetes management will help with sexual health.

Treatments for erectile dysfunction include medications to help increase blood flow to the penis, a vacuum pump, penile injections, pellets or suppositories placed into the urethra, and surgery. Surgery is usually the last treatment should others fail. Your healthcare provider will assess the best treatment for your situation and alert you to the pros and cons of these treatments. Counseling may be helpful to reduce stress. Seek out emotional and psychological support.

Treatment for retrograde ejaculation includes medication to strengthen the sphincter muscle in the bladder. If fertility is an issue, a urologist with experience in fertility treatments may be able to help by obtaining semen from the urine to use for artificial insemination.



Sources:

Sexual and Urologic Problems of Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Accessed: 09/10/2011 http://diabetes.niddk.nih.gov/dm/pubs/sup/

Wang MD, Christina; Jackson MD, Graham; Jones MD, T. Hugh; Matsumoto MD, Alvin M; Nehra MD, Ajay; Perelman PHD, Michael A; Swerdloff MD, Ronald S; Traish PHD, Abdul; Zitzman MD, Michael; and Cunningham MD, Glenn. Low Testosterone Associated With Obesity and the Metabolic Syndrome Contributes of Sexual Dysfunction and Cardiovascular Disease Risk in Men with Type 2 Diabetes. Diabetes Care 2011 34(7):1669-1675

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