One of the most neglected areas in diabetes education is the topic of men’s sexual health. As a diabetes educator, before each consult I like to ask what topics my patients would like to discuss. Over time I have come to the conclusion that erectile dysfunction (ED) needs discussion but only a very few men bring it up. In the last few minutes of a consult if it is brought to my attention, bam! This is where the questions start! I have made it my policy to bring it up myself because left to the end of a consult there is hardly any time for understanding. As a very important subject we need to discuss erectile dysfunction so every man can have a starting place to approach the topic with his healthcare team. In Part 1 of this two-part series, we are discussing prevention and healthy habits to help control ED.

The National Institutes of Health defines erectile dysfunction (ED) as: “the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. A period of persistence over three months has been suggested as a reasonable clinical guideline.”(1) When men with diabetes grow older, the problem of ED usually develops earlier than in those without diabetes. After age 50 estimates are as much as 50-60 percent of men with diabetes have this problem increasing to as much as 95 percent of men that are over 70 years of age. (2)

9 Prevention and Possible First Steps
Unfortunately, by the time men think about the topic, the window for prevention of ED may be gone. The following are recommended steps to take to prevent ED, but may also be first steps in helping to control ED. Make sure you discuss ED with your healthcare professional and discuss an individualized plan to help with prevention.

1. Stop smoking! If you never did then don’t start. Smoking can lead to narrowing of the arteries which can be a precursor of ED. (3)(4)(5)(6) A meta-analysis study was conducted in 2013 evaluating the risk of ED between smokers vs. non-smokers. The total numbers of participants included in the studies was 28,586. Conclusions included the ED risk was increased by 51 percent for current smokers and 20 percent for ex-smokers compared with men that never smoked. The analysis also showed that when a smoker quits, the risk of ED may decrease. (7)

2. Don’t drink more than two alcoholic drinks per day. More than this can lead to reduction in blood flow and may affect testosterone levels. Proper testosterone levels help sex drive and erections. (4)(5)(6)

Many men are under the impression that a drink can be any size. Standards for the size of a drink are as follows:

- 12 ounces of a beer or wine cooler
- 8 ounces of malt liquor
- 5 ounces of table wine
- 1.5 ounces of 80 proof distilled spirits such as gin, vodka, whiskey, etc. (8)
3. According to a primary report published in the Journal of Sexual Medicine (2009), ED is commonly seen in heroin, amphetamine and Ecstasy users. (9)

4. Have a frank discussion with your physician and pharmacist about all medications you take (prescription and non-prescription). Ask if any have ED side effects and if so, can they be changed. Make sure you take all medications as prescribed. (3)(4) A list of medications that may cause problems can be found in the following Medline Plus publication.

Important: Do not stop or change any medications without consulting with your physician! 

5. Maintain a healthy weight. (3)(4)(5) Losing as little as five percent of body weight when obese can help improve problems with ED. A study involving 31 type 2 obese men with diabetes published in 2011 found that an eight-week low-calorie prescribed diet resulted in rapid reversal of ED in some experiencing a weight loss of five percent. (10)

6. Have a regular exercise routine approved by your healthcare team and stick to it! (3)(4) Ask your physician if you can have a prescription to see a physical therapist to learn proper procedures for pelvic floor exercises. In one study, participants with ED over the age of 20 underwent such therapy for three months. In the group that exercised, over 75 percent of participants showed improvement or regained normal erectile function. Read the study to learn more.

7. Preventing and controlling high blood pressure and limiting sodium intake, will decrease ED (5)(6). People with diabetes are encouraged to follow the recommendations of The American Heart Association and the dietary guidelines for Americans of no more than 1,500mg of sodium per day (12)(13). These recommendations were put in place to help control the increase of blood pressure that happens with aging and to help control increases that have already occurred.

8. Take steps to avoid high cholesterol as it can harden or block arteries all over the body including those needed for sexual function. (6) It is thought that successful treatment of high cholesterol can help to reduce ED. It is also important to note that ED is a risk factor for heart attack and stroke. Men with ED should make sure they ask their physicians to be screened for heart disease. (13)

9. Those with diabetes need to stay under good control. (3)(4) According to Diabetes New Zealand: “Men with type 1 diabetes are more likely to experience impotence at an earlier age (this is because they have usually had diabetes for a longer period of time). Men who have type 2 diabetes (which usually develops in adulthood) may not experience the problem until later in life. If your diabetes is out of control, this can lead to temporary impotence. “(14) Treatment for those with diabetes includes improving blood sugar levels.

As you can see, ways to avoid ED include many healthy habits. Please do not be afraid to talk to your physician about this important issue.

In Part 2 of this series, we discuss ways to help men who suffer with ED, the possible causes and therapies available including hormones, medications, devices, and surgery. Questions to ask your physician are also included to help you become comfortable when talking to your medical team about ED. Read Part 2 here.

Article Referenced Links by Number:

(1) (2) (3) (4) (5)(6) (7) (8) (9) (10) (11(12) (13)(14) 
Written and reviewed by Clara Schneider MS, RD, RN, CDE, LDN - 09/13