Diabetes and impotence

Impotence means not being able to have or keep an erection for long enough to have sexual intercourse. Approximately one man in 10 over the age of 40 is impotent whether they have diabetes or not. It affects both heterosexual and homosexual men. If you are one of these men, you are not alone. Impotence may affect over 50% of men with diabetes and over 75% of men over the age of 70 with diabetes have some degree of impotence. All men experience failure to achieve an erection at some time in their lives and this problem increases with age for all men. However, there is a wide range of treatments available and many people who can help you.

What causes impotence?

Impotence may have physical or psychological causes or a mixture of the two.

Diabetes can cause damage to the blood supply to your penis and to the nerves that control on erection.
Smoking, drinking too much alcohol and the use of some illegal drugs can be a cause of impotence.
Some medicines used to treat high blood pressure and depression can cause erection problems.
Operations on your bowel, prostate or bladder may also cause impotence by damaging the nerves connected to your penis, as can damage to your spinal cord.
A lack of testosterone, a male sex hormone, can cause loss of interest in sex.
Psychological causes of impotence can include stress, anxiety, depression, marital problems, guilt and fear of failure to perform.

Impotence affects both people in a relationship. You may feel embarrassed, frustrated and guilty. Your partner may feel angry and rejected. Talking to your partner can lead to more understanding about how you both feel about this problem, helps you to improve the situation and decide if you want to take further action.

How do I find professional help?

You should first discuss this with your GP (family doctor) or your diabetes specialist if you have one. They have previous experience in advising about impotence and may be able to help you themselves. If not, you may be referred to a specialist in your area. You can also ask for a referral. You may go to see a urologist (a doctor who specialises in the kidneys, bladder, prostate and genitals), or a physician who perhaps has a particular interest in diabetes, or a sexual therapist/psychologist.

What happens when I am assessed?

It will be helpful if you and your partner can both be involved during your assessment with both of you being prepared to discuss your situation in order to put together a full medical and sexual history. You may have some or all of these tests

Blood tests may be used to check your diabetes control, to check your hormone levels and to see whether there is any disease in the glands that produce hormones such as testosterone.
Tests can also be carried out on your nervous system. These include blood pressure and sweat tests.
You may meet a psychologist to discuss any problems which affect your life in general as well as impotence.
You may have an injection of a drug into your penis to check your responses when you have an erection.

What treatments are available?

Counselling: talking the problem through with an expert counsellor and your partner can help sort things out. Even if the cause of your impotence is physical, your feelings will be affected so counselling is an important part of any treatment. This can also help you to change any habits such as smoking, heavy drinking or drug abuse that will not help your impotence.
Changing medication: a change of drug or an additional prescription to remove the side effects of some medicines may be useful.
Drug therapy: several drugs are used for their effects on impotence, for example Viagra.
Self-injection therapy: you can inject a drug into your penis before intercourse. This increases the blood supply in your penis to produce an erection.
Vacuum therapy: you place a tube (like a rigid condom) over your penis and use a pump to empty the air out of the tube. This causes blood to be drawn into your penis. You place a ring on the base of your penis to maintain an erection during intercourse. This is not usually available on the NHS.
Surgery: occasionally an operation is used to renew the blood supply to your penis or to implant a rod to make your penis erect enough for penetration.

Impotence is now much better understood than in the past. Help is available for you and your partner to find a way round this problem.