Erectile Dysfunction: Embracing the Hard Truth

Diabetes, Regardless of the Type, Follows You Wherever You Go… Even Into the Bedroom!

If you think your diabetes has negatively affected your intimate life, you are not alone. About half of all men and women with diabetes develop some form of sexual complications. Men with diabetes may develop a variety of issues including erectile dysfunction (ED), low testosterone, premature ejaculation, and decreased sex drive. There can also be emotional challenges that negatively impact interest in sexual activity. Let’s face it… living with diabetes can be stressful! It can be awkward discussing sexual issues with your healthcare providers (HCPs), so let’s start getting comfortable and open the discussion now!

If you are unable to achieve or maintain an erection that is firm enough to have sexual intercourse, you have erectile dysfunction (ED). A once-in-a-blue- moon occurrence is nothing to worry about—that is totally normal. But if it becomes an ongoing problem, it is time to seek help. Men with diabetes are three times more likely to develop ED than those who don’t have diabetes. If you have trouble in this area, there are many effective treatment options you can try: oral medications, constriction rings, vacuum pumps, penile suppositories, penile injections, penile implants, and counseling. You might even enjoy Tantric Sex, which focuses more on creating sexually-charged moments than on achieving an orgasm. If you have type 2 diabetes, you can also try the Mediterranean diet, which may reduce your risk of developing ED. Read on to learn more about all of these great options.

Blood Glucose Range

The more you keep your blood sugar level in a healthy range (as determined by your healthcare team), the less likely you are to develop ED. If you already have this problem, improving your glucose management may really help your performance. Work with your health care team to adjust your diabetes care plan. You may need to increase or change your medication, alter your meal plan, increase your level of physical activity, check your blood sugar more often, and lower your stress level. If you take multiple insulin injections, try an insulin pump. When used properly, it can help you meet your blood glucose goals.


You’ve probably seen those commercials on television for Viagra, Levitra, and Cialis, which make everything look so wonderful. He pops the pill, she swoons, and they walk away, arm-in-arm, into the sunset. The real story is far less idyllic as these pills work in only half of all men with diabetes.

I once counseled a patient who tried Viagra several times without any success. Unfortunately, his doctor never asked for an update and he was too shy to complain. That was 10 years ago. During our session, he admitted that he hadn’t been intimate with his wife since then. He just accepted the notion that diabetes was going to steal the joy from his life and he was destined to live without sex. The good news is that a different option worked for him and he and his wife resumed their intimate relationship.

If you try one of these pills, follow the timing directions carefully. Here is a guide to their use, from Intimacy & Diabetes, by Roszler and Rice (ADA):

Most of these pills should not be used if you take any form of nitroglycerin. Side effects include mild flushing, headache, and dizziness. If you notice any change in your vision, contact your doctor. If you already tried them and had no success, don’t give up. You have many other options.

Constriction Rings and Vacuum Pumps

A constriction ring is for men who can achieve an erection but have difficulty keeping it. Think of a balloon. When you blow it up, the air will only stay inside if you pinch or tie the end. The constriction ring puts pressure on the base of the penis, so it holds the blood inside. Constriction rings are inexpensive and easy to use. Just don’t leave one in place for longer than 30 minutes. While wearing a constriction ring, your penis may be a little wobbly at the base, appear a bit bluish in color, and feel cool to the touch.

If you’re a fan of Austin Powers, you probably recall that he often carried a penile vacuum pump. The pump is an amazingly effective tool. It creates a vacuum that draws blood into the penis and then uses a constriction ring or band to hold the blood in place. Vacuum pumps range in price, style, and design. Some are manual and others are battery operated. They work extremely well but take some practice to master. Many pumps come with video instructions. Rather than hiding your vacuum pump, introduce it into your foreplay and share the experience with your partner. You can buy a pump without a prescription, but a doctor-ordered pump may be covered by insurance.

Penile Suppositories and Injections

Penile suppositories and injections relax the blood vessels and muscles in the penis so blood can flow into the area more easily. Insert suppositories 10-15 minutes before intimate activity. An erection should develop within 10-20 minutes. Penile injections create a strong erection within approximately 10-15 minutes and can last up to 1 hour. Be sure to set time aside to learn how to use these options correctly.


Penile implants are an option when other methods are not satisfactory. It is a mechanical device that is implanted and fully concealed within the body through a small incision. It is an outpatient procedure covered by Medicare.

There are two main types of implants. One is made up of semi-rigid cylinders that are surgically inserted into the penis. With this choice, the penis remains semi-rigid at all times. The second type enables a man to have an erection by choice and with no need of other treatments. Typically, the device consists of three pieces: a pump in the scrotum, a reservoir filled with saline in the abdomen, and cylinders that fill the anatomy of the penis. When an erection is desired, manually squeezing the pump will send fluid from the reservoir into the cylinders in the penis to create an erection. This doesn’t interfere with a man’s orgasm or ejaculation and doesn’t affect the urethra. Pressing a button on the pump will allow the fluid in the cylinders to flow back into the reservoir, returning the penis to a flaccid state. An excellent website for more information is www.EDCURE.ORG. If you choose this option, be sure to participate in all education and counseling that is available.

Penile Sleeves

If you are unable to use any of the options above, yet still wish to engage in sexual intercourse, a penile sleeve is a terrific choice. It is a disposable, rigid sleeve that is worn directly over the penis to hold it in a stiff position. Whether the penis becomes erect or remains flaccid, the sleeve enables a man to actively participate in sexual intercourse and can be purchased without a prescription.

Mediterranean Diet

Men with type 2 diabetes who follow the heart-healthy Mediterranean Diet may significantly lower their risk of developing ED. To learn more about this meal planning approach, click here.

Stop Smoking

If you smoke, cut back or quit altogether. Many men find that their ED improves dramatically after they stop smoking. A great reason to quit!

Low Testosterone

If you have type 2 diabetes, you have twice the risk of having a low testosterone level. A low level can cause the following symptoms:

  • Decrease or loss of sex drive
  • Difficulty maintaining an erection
  • Body changes, specifically increased fat and less muscle mass
  • Depressed mood
  • Increased irritability
  • Lack of energy

Low-T Treatments

If your testosterone level is low, don’t worry. It’s extremely easy to treat with a topical gel, patch, dissolving oral tablets, or even injections.

Premature Ejaculation

Men with diabetes have a higher risk of developing premature ejaculation, which means that they ejaculate before or at the very start of intercourse. For a long time, this issue was thought to be caused by emotional issues alone. We now know that there may be a physical component as well, especially if nerves in the pelvic area have become damaged.

There are medications that may help this issue, such as Promescent Delay Spray. Some men also find that taking Viagra or another ED pill helps reduce their performance anxiety and enables them to hold their erection longer. Another option is to meet with a qualified sex therapist who can help you run through a series of start and stop erection exercises to help you improve your performance.

Kegel Exercises… for Men

To help improve your ejaculatory control, try the male version of Kegel exercises. Here’s how:

  1. While you urinate, try to stop or slow down the flow of urine. The muscles you squeeze are the ones you want to tone.
  2. Squeeze those muscles for 2 or 3 seconds then release slowly as you count to five. Some men find it easier to contract these muscles when they lay down.
  3. Gradually build up to squeezing for a total of 5 seconds.
  4. Repeat this exercise 10 times, three times a day.


If you are tempted to try an herbal preparation to treat your sexual issues, be careful. Few, if any herbal products have demonstrated real help for ED. If you have a friend who swears by a certain item, it may work for him because of the “placebo effect.” That is improvement that happens because a person believes a product really works, when it may have little or no effect at all. There are some herbs on the market that may help, but others may be unsafe for you. Also, many just cost a lot and offer little in return. If you wish to try an herbal product, follow these steps:

  • Before you try an herbal product, discuss it with your HCP to see if it’s appropriate and safe for you. Always let your doctor know about the herbal preparations you take. Some may affect your health in unexpected ways. Others must be stopped prior to surgery because they may create healing or bleeding problems.
  • Only take one herbal preparation at a time and watch for negative side effects.
  • Check your blood glucose level often as some herbs may affect your glucose control or alter how your body absorbs your current diabetes medication.
  • If you experience any difficulties, stop using the herb immediately.
  • Try to purchase herbal preparations that have been evaluated by the United States Pharmacopeia (USP). If a label states that the contents are USP- verified, the ingredients listed on the label can be found in the product. For a list of USP-verified products, visit


If your sex life has taken a downturn since diabetes entered your bedroom, don’t give up! Take time to ask your HCP about different treatment options or try some of the options highlighted in this chapter. For additional information, pick up a copy of Intimacy & Diabetes by Roszler and Rice (ADA). It is a fun and helpful book that is filled with expert advice, personal stories, and even contains diabetes friendly recipes that use aphrodisiac ingredients.

  1. Avatar

    Great article for men!! What @ women who struggle?!

  2. Great article and T2D has caused all of these issues. Will come back ad refer to this.

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