Reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Erectile dysfunction, or ED, is a common sexual health issue that affects around 30 million men in the United States alone.
A wide range of factors can contribute to erectile dysfunction. Sometimes, it’s psychological -- a result of anxiety, discomfort or nervousness about sex.
More often, however, ED is caused by physical health problems, such as obesity, nerve damage or high blood pressure. Unfortunately, diabetes is one of several physical issues that can cause or contribute to ED.
The science is out: Men with diabetes are more likely to experience erectile dysfunction than the average. Diabetes can also affect the age at which you first start to develop ED symptoms, often by a decade or more.
Below, we’ve looked into the link between diabetes and erectile dysfunction. We’ve also covered what you can do to treat ED and improve your sexual performance if you’re affected by type 1 or type 2 diabetes.
Getting an erection might seem simple, but it actually requires a complex process that involves your arteries, nerves, other blood vessels and bodies of soft tissue that make up your penis.
When you feel sexually aroused, your brain sends signals to the nerves surrounding and inside your penis. These nerve signals relax the corpora cavernosa -- a pair of soft, sponge-like bodies of erectile tissue that run throughout the length of your penis.
As blood flows into the corpora cavernosa, pressure builds and your penis becomes larger and firmer, creating an erection. This pressure is maintained by the tunica albuginea -- a membrane that wraps around the corpora cavernosa and holds blood inside the tissue.
This multi-step process happens naturally. After you reach orgasm and ejaculate, the process occurs in reverse as blood flows out from your penis and you enter the refractory period.
Because erections depend on proper nerve function and blood flow, any condition that affects your nerves or vascular system can also potentially affect your ability to get an erection.
For example, diseases and conditions such as atherosclerosis (clogged arteries), hypertension (high blood pressure) and heart and blood vessel disease can contribute to ED by affecting the ability of blood to flow to the tissue inside your penis.
This is where diabetes comes into the picture. Diabetes is closely linked to two issues that can cause erectile dysfunction: heart disease and nerve damage.
Diabetes can contribute to heart disease through blood vessel damage. Over time, high blood sugar levels can damage your blood vessels and contribute to heart disease, affecting the flow of blood throughout your body.
Diabetes can also cause a type of nerve damage called diabetic neuropathy. One form of nerve damage caused by diabetes, called autonomic neuropathy, affect the sex organs. For men, this type of nerve damage causes ED; in women, it can cause vaginal dryness.
Even the non-physical effects of diabetes can affect your erections and sexual performance. For example, if you have diabetes, your risk of developing major depressive disorder is two to three times higher than a person without diabetes.
Depression can affect your sex drive, including by contributing to ED. In fact, depression is one of the most common factors in psychological erectile dysfunction.
In short, diabetes can either cause or contribute to erectile dysfunction in three main ways -- by affecting blood flow to tissue inside your penis, by affecting the function of your nervous system and by potentially contributing to depression.
These three issues mean that men with diabetes have a significantly higher risk of dealing with ED than their peers.
In research published in the journal Clinical Diabetes, researchers found that men with diabetes have a 35 to 75 percent risk of also developing ED, versus just 26 percent of men in the general population.
They were also more likely to develop erectile dysfunction early in life, with the average onset of ED occurring 10 to 15 years earlier in men with diabetes.
Research also suggests that erectile dysfunction is more common in men who’ve been affected by diabetes for a long period of time. Put simply, in older men, the longer you’ve had diabetes, the greater your risk of potentially developing ED.
Read here to learn more about the sexual side effects of diabetes.
Erectile dysfunction can be frustrating to deal with -- something that’s true for men and without diabetes. The good news is that ED is almost always treatable, typically with medication.
Today, a variety of ED medications are available for men with diabetes, many of which are very effective at improving erections and sexual function.
The most widely used ED treatments are oral medications called PDE5 inhibitors. These work by inhibiting the PDE5 enzyme, which is responsible for regulating blood flow to the soft tissue inside your penis.
The most widely used PDE5 inhibitors are sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).
A standard dose of ED medication such as sildenafil can increase the rate of blood flow to your penile tissue, making it easier to develop and maintain an erection if you have diabetes.
ED medications vary in their onset and duration of action. Some medications, such as sildenafil and vardenafil, are ideal for a single night of relief from ED. Others, such as tadalafil, last for up to 36 hours per dose.
Your healthcare provider may prescribe a certain medication based on the severity of your ED, your general health, personal needs and more. Our guide to what you should expect from ED medication goes into more detail on these medications and how they work.
Because ED medications can also have effects on the cardiovascular system, it’s important to speak to your doctor before using any of these drugs to treat diabetes-related ED.
ED medications can also interact with some medications used to treat high blood pressure -- a common issue for people with diabetes -- making it important not to take any ED drugs without first consulting your healthcare provider.
In addition to traditional ED medications, there are alternative treatments available for diabetics, such as injections and vacuum erection devices (VEDs).
These treatment options are often effective, but are less convenient than oral medications. Your healthcare provider may suggest using a device or prescribe an injectable ED medication if you fail to respond to other treatments.
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All four of the oral ED medications treat erectile dysfunction in the same way, meaning there’s no “best” ED medication for diabetics.
However, there are a few differences between ED medications that may make one medication or another the optimal choice for you.
Sildenafil and vardenafil are both relatively short-acting ED medications. Sildenafil is typically effective for up to four hours, while vardenafil provides relief from ED for four to six hours per dose.
Tadalafil, on the other hand, is a longer-lasting medication that can provide relief from ED for up to 36 hours per dose. It’s also available in a reduced dosage for everyday use -- an option we’ve discussed in our guide to daily-use Cialis.
Avanafil, or Stendra, is a fast-acting ED medication that works in as little as 15 minutes. It’s also less likely to cause some side effects than other ED medications.
Since everyone’s needs and preferences are different, there’s no “best” ED medication for every man with diabetes. You may need to try several ED pills before finding one that provides a good combination of effectiveness and tolerable side effects.
Although having diabetes increases your risk of experiencing ED, it doesn’t mean that you can’t enjoy a fulfilling, satisfying sex life.
If you're noticing a link between your diabetes and erectile dysfunction, it’s always best to talk to your healthcare provider. You can also access ED medication online through our platform after a private, online consultation with a licensed healthcare provider.
Interested in learning more about successfully dealing with ED? Our guide to the most common treatments for ED goes into more detail about how you can improve your erections and enjoy a healthy sex life even if you’re prone to severe or persistent erectile dysfunction.