For men with diabetes, sexual health involves three main issues: impotence, birth control, and safe sex. Because the mention of impotence alone is enough to evoke fear and worry, it's important to know that it's a common problem not just for men with diabetes.
The fact is, fear and lack of knowledge may stop you from dealing with this common problem. If you worry about impotence, facing your fears may be the best thing you can do to change and improve your life.
First, know that you are not alone. About 1 million men in this country have impotence. The number could really be much higher, because many men may keep the problem a secret. Men who have diabetes have a special reason to learn about impotence. It occurs among 50 to 60 percent of all men with diabetes over the age of 50.
Let's be clear about what impotence is. Impotence means that all or most of the time, the penis fails to get or stay hard enough for sex. You can't have or keep an erection. Impotence is not an occasional failure of erection. It is not premature ejaculation, decrease in sexual desire, or failure of ejaculation or orgasm. However, all of these can happen with impotence.
Causes of Impotence
Impotence has many causes perhaps 100 or more. Any one of them can affect a man with diabetes. The most common causes of impotence in men with diabetes are physical problems like blood vessel disease and nerve disease.
If you have either of these side effects of diabetes, you may have to deal with impotence at some time. But there are tests to find the cause of the problem, and there are treatments for nearly all men who want them.
Impotence is either a psychological or a physical problem. Your doctor will try to find out which kind of problem is causing your symptoms. It may be hard to decide where the problem lies, because sex requires that the mind and body work together.
Sexual desire begins in the brain and results in responses in the nervous system and blood vessels that cause an erection. The male sex hormone testosterone also plays a major role both in sexual desire and in being able to have an erection.
You may be worried or stressed, so your brain is not alert to the signals of the testosterone hormone. Or your body may not be able to make testosterone or may make so little that your brain doesn't get the message. You may have nerve damage. If the nerves to the penis are damaged, they may not be able to send signals. Nerve damage can also limit blood flow. This can prevent an erection.
Psychological impotence often starts suddenly. It can be caused by fear, worry, anger, or sadness. It often focuses on one person or event. Men hear so much about impotence and diabetes that they may expect it to happen. The very fear of impotence can be enough to cause the problem. Once a problem occurs, fear of failure can add worry.
Diagnosis
Healthy men have erections at night while they sleep. Doctors use this fact to diagnose psychological impotence. Your doctor may suggest that you place a gauge (in the past a band of postage stamps was used) around the penis. When normal erections occur during sleep, this gauge will break.
If you find you have erections during the night, this means that your body is working. In this case, impotence may be a psychological issue. Your doctor may suggest that you have more tests in which your erection can be measured precisely.
In contrast, physical impotence most often comes on slowly and gets worse as time goes by. Early symptoms of physical impotence include a less rigid penis and fewer erections. Over time, a man with physical impotence will not be able to have erections.
The Diabetes Connection
Impotence in men with diabetes can be due to side effects from diabetes. Nerve disease is a common cause. When nerves are damaged, small blood vessels don't relax. This stops the blood vessels from growing larger with the flow of blood that makes the penis erect.
Your doctor may decide that the nerves in your penis need to be checked. If so, your doctor will likely refer you to a doctor who treats nerve problems or to a testing centre. The test consists of a mild electrical current that travels in the nerves in your penis and measures their ability to function.
Blood vessel damage is another diabetes-related cause of impotence. One test for blood vessel damage measures the blood pressure in the penis and compares it with the blood pressure in the arm.
Another test involves a shot of a drug or a mixture of drugs into the penis. The doctor injects the drug so that it will bypass your nerves. If you then have an erection, damaged blood vessels are not the problem. If you don't have an erection or your response is limited, then it shows that larger blood vessels may be blocked.
Your doctor can also use an ultrasound scanner or a process called angiography to find out if blockage of the larger blood vessels in the penis is the problem. In angiography, the doctor injects tracking dye into the penis. This allows the doctor to see if blood is flowing freely through the vessels.
About 10 to 15 percent of men with impotence are troubled by a lack of testosterone. Doctors can measure the level of the hormone to find out if this is the problem.
Some common medications can cause impotence. Drugs used to treat high blood pressure, anxiety, depression, and peptic ulcers can cause impotence. If you have signs of impotence and take drugs for any of these problems, let your doctor know. Do not stop taking your medication without telling your doctor.
Drinking too much alcohol can also cause problems with impotence. And smoking is never a good idea for anyone with diabetes. Smoking makes blood vessel damage worse. It also slows down blood flow.
Treatment
For men with diabetes, the first step to reduce your risk of impotence is good blood glucose control. Ask your doctor how you can improve your blood glucose levels. Good diabetes control can help you avoid diabetic nerve and blood vessel disease and kidney disease.
If you have signs of impotence, talk to your doctor. This is an important problem that will affect your quality of life. Ask your doctor for advice about all the treatment options and for the names of specialists, if needed.
For impotence that stems from a psychological issue, or if a fear of impotence is affecting your sex life, you may want to work with a therapist who has helped others with sexual issues.
For impotence caused by physical problems, there are a range of treatment choices. It is important to choose an option that suits your and your partner's needs and desires.
One method for treating impotence is to inject drugs into the penis. Papaverine and phentolamine are most often used. An erection caused by a shot lasts about 30 minutes to an hour. Side effects may include bruising and prolonged erection.
Another treatment involves using a vacuum pump to create an erection. A container is placed around the penis. The pump pulls air out of the container. The vacuum that is created causes blood flow to the penis, which results in an erection.
To keep the erection, you remove the container and put a rubber band around the base of the penis. This works for about 20 minutes. If you keep the rubber band on longer, you may bruise the penis.
Other options include devices that a doctor implants surgically in the penis. For this, you need to see a urologist with special knowledge about implants. Be sure to ask about risks, such as infection or the need for further surgery if the device breaks or fails to work.
If lack of testosterone is the problem, you can take hormone shots. You'll need them about every three or four weeks.
Because impotence is complex and can have more than one cause, you may be helped most by a program that involves several forms of therapy.
You may also choose to have no treatment. All the options for treating impotence have risks or drawbacks that you may not wish to accept. Some men and their partners choose to live with impotence and express their sexuality without any of these treatments.
Birth Control and Safe Sex
The goal of birth control is to prevent pregnancy. The goal of safe sex is to prevent the spread of sexually transmitted diseases. There are a number of choices of protection for sexually active men and their partners.
Condom.
A condom, or rubber, is a thin piece of rubber placed over the penis before sex. Used correctly, it prevents semen from entering your partner. It should be carefully removed soon after sex.
Using a condom can help protect against sexually transmitted diseases. Of course, no type of birth control will stop sexual disease. But wearing a condom lowers your chances of getting a sexual disease. A condom is the only form of birth control that can also help prevent the spread of AIDS, a fatal illness. You can get AIDS through sex with an infected partner. Correct use of a condom lowers your chances of getting AIDS.
Other forms of birth control.
You can discuss other methods of birth control with your partner. Oral contraceptives (birth control pills), a diaphragm with spermicidal jelly, and an intrauterine device are choices to consider. Some men choose to have a vasectomy, a simple operation that stops them from releasing sperm. If a man can't emit sperm, he can't make his partner pregnant. A man who has a vasectomy emits semen with no sperm.
Although your sex life is a private matter, don't suffer in silence. Discuss problems or worries with your doctor. Treating sexual issues is an important part of health care. Diabetes does not have to threaten your sexual health.
The fact is, fear and lack of knowledge may stop you from dealing with this common problem. If you worry about impotence, facing your fears may be the best thing you can do to change and improve your life.
First, know that you are not alone. About 1 million men in this country have impotence. The number could really be much higher, because many men may keep the problem a secret. Men who have diabetes have a special reason to learn about impotence. It occurs among 50 to 60 percent of all men with diabetes over the age of 50.
Let's be clear about what impotence is. Impotence means that all or most of the time, the penis fails to get or stay hard enough for sex. You can't have or keep an erection. Impotence is not an occasional failure of erection. It is not premature ejaculation, decrease in sexual desire, or failure of ejaculation or orgasm. However, all of these can happen with impotence.
Causes of Impotence
Impotence has many causes perhaps 100 or more. Any one of them can affect a man with diabetes. The most common causes of impotence in men with diabetes are physical problems like blood vessel disease and nerve disease.
If you have either of these side effects of diabetes, you may have to deal with impotence at some time. But there are tests to find the cause of the problem, and there are treatments for nearly all men who want them.
Impotence is either a psychological or a physical problem. Your doctor will try to find out which kind of problem is causing your symptoms. It may be hard to decide where the problem lies, because sex requires that the mind and body work together.
Sexual desire begins in the brain and results in responses in the nervous system and blood vessels that cause an erection. The male sex hormone testosterone also plays a major role both in sexual desire and in being able to have an erection.
You may be worried or stressed, so your brain is not alert to the signals of the testosterone hormone. Or your body may not be able to make testosterone or may make so little that your brain doesn't get the message. You may have nerve damage. If the nerves to the penis are damaged, they may not be able to send signals. Nerve damage can also limit blood flow. This can prevent an erection.
Psychological impotence often starts suddenly. It can be caused by fear, worry, anger, or sadness. It often focuses on one person or event. Men hear so much about impotence and diabetes that they may expect it to happen. The very fear of impotence can be enough to cause the problem. Once a problem occurs, fear of failure can add worry.
Diagnosis
Healthy men have erections at night while they sleep. Doctors use this fact to diagnose psychological impotence. Your doctor may suggest that you place a gauge (in the past a band of postage stamps was used) around the penis. When normal erections occur during sleep, this gauge will break.
If you find you have erections during the night, this means that your body is working. In this case, impotence may be a psychological issue. Your doctor may suggest that you have more tests in which your erection can be measured precisely.
In contrast, physical impotence most often comes on slowly and gets worse as time goes by. Early symptoms of physical impotence include a less rigid penis and fewer erections. Over time, a man with physical impotence will not be able to have erections.
The Diabetes Connection
Impotence in men with diabetes can be due to side effects from diabetes. Nerve disease is a common cause. When nerves are damaged, small blood vessels don't relax. This stops the blood vessels from growing larger with the flow of blood that makes the penis erect.
Your doctor may decide that the nerves in your penis need to be checked. If so, your doctor will likely refer you to a doctor who treats nerve problems or to a testing centre. The test consists of a mild electrical current that travels in the nerves in your penis and measures their ability to function.
Blood vessel damage is another diabetes-related cause of impotence. One test for blood vessel damage measures the blood pressure in the penis and compares it with the blood pressure in the arm.
Another test involves a shot of a drug or a mixture of drugs into the penis. The doctor injects the drug so that it will bypass your nerves. If you then have an erection, damaged blood vessels are not the problem. If you don't have an erection or your response is limited, then it shows that larger blood vessels may be blocked.
Your doctor can also use an ultrasound scanner or a process called angiography to find out if blockage of the larger blood vessels in the penis is the problem. In angiography, the doctor injects tracking dye into the penis. This allows the doctor to see if blood is flowing freely through the vessels.
About 10 to 15 percent of men with impotence are troubled by a lack of testosterone. Doctors can measure the level of the hormone to find out if this is the problem.
Some common medications can cause impotence. Drugs used to treat high blood pressure, anxiety, depression, and peptic ulcers can cause impotence. If you have signs of impotence and take drugs for any of these problems, let your doctor know. Do not stop taking your medication without telling your doctor.
Drinking too much alcohol can also cause problems with impotence. And smoking is never a good idea for anyone with diabetes. Smoking makes blood vessel damage worse. It also slows down blood flow.
Treatment
For men with diabetes, the first step to reduce your risk of impotence is good blood glucose control. Ask your doctor how you can improve your blood glucose levels. Good diabetes control can help you avoid diabetic nerve and blood vessel disease and kidney disease.
If you have signs of impotence, talk to your doctor. This is an important problem that will affect your quality of life. Ask your doctor for advice about all the treatment options and for the names of specialists, if needed.
For impotence that stems from a psychological issue, or if a fear of impotence is affecting your sex life, you may want to work with a therapist who has helped others with sexual issues.
For impotence caused by physical problems, there are a range of treatment choices. It is important to choose an option that suits your and your partner's needs and desires.
One method for treating impotence is to inject drugs into the penis. Papaverine and phentolamine are most often used. An erection caused by a shot lasts about 30 minutes to an hour. Side effects may include bruising and prolonged erection.
Another treatment involves using a vacuum pump to create an erection. A container is placed around the penis. The pump pulls air out of the container. The vacuum that is created causes blood flow to the penis, which results in an erection.
To keep the erection, you remove the container and put a rubber band around the base of the penis. This works for about 20 minutes. If you keep the rubber band on longer, you may bruise the penis.
Other options include devices that a doctor implants surgically in the penis. For this, you need to see a urologist with special knowledge about implants. Be sure to ask about risks, such as infection or the need for further surgery if the device breaks or fails to work.
If lack of testosterone is the problem, you can take hormone shots. You'll need them about every three or four weeks.
Because impotence is complex and can have more than one cause, you may be helped most by a program that involves several forms of therapy.
You may also choose to have no treatment. All the options for treating impotence have risks or drawbacks that you may not wish to accept. Some men and their partners choose to live with impotence and express their sexuality without any of these treatments.
Birth Control and Safe Sex
The goal of birth control is to prevent pregnancy. The goal of safe sex is to prevent the spread of sexually transmitted diseases. There are a number of choices of protection for sexually active men and their partners.
A condom, or rubber, is a thin piece of rubber placed over the penis before sex. Used correctly, it prevents semen from entering your partner. It should be carefully removed soon after sex.
Using a condom can help protect against sexually transmitted diseases. Of course, no type of birth control will stop sexual disease. But wearing a condom lowers your chances of getting a sexual disease. A condom is the only form of birth control that can also help prevent the spread of AIDS, a fatal illness. You can get AIDS through sex with an infected partner. Correct use of a condom lowers your chances of getting AIDS.
You can discuss other methods of birth control with your partner. Oral contraceptives (birth control pills), a diaphragm with spermicidal jelly, and an intrauterine device are choices to consider. Some men choose to have a vasectomy, a simple operation that stops them from releasing sperm. If a man can't emit sperm, he can't make his partner pregnant. A man who has a vasectomy emits semen with no sperm.
Although your sex life is a private matter, don't suffer in silence. Discuss problems or worries with your doctor. Treating sexual issues is an important part of health care. Diabetes does not have to threaten your sexual health.
