Men with diabetes are two to three times more likely to have erectile dysfunction (ED) than those without diabetes. In fact, some studies show that ED may be the first manifestation. Erectile dysfunction is a condition in which a man is unable to maintain an erection.
The trigger of an erection can be physical or psychological. It can also be stimulated by physical contact to the nerves that collect the sensitivity of the penis. This will lead to a reaction from other nerves whose function is to give orders, in this case, to begin an erection.
The orders given by these nerves are vasodilation. Thus, it increases the caliber of the arteries that reach the penis (mainly the cavernous artery), having more blood reaching the area. The cavernous artery runs through the interior of the corpora cavernosa, which swell when they get more blood. Parallel to this process it’s also developing the vasoconstriction of the deep veins of the penis. The veins partially close and the blood that has reached the penis is unable to leave it. Thus, it accumulates inside.
In the long term there are two problems that diabetes causes in the body: neuropathy and angiopathy. Both problems affects directly the erection, the first in relation to the injury of small nerves and the second in relation to the injury of small blood vessels.
Neuropathy is a long-term complication of poorly controlled diabetes. The destruction of nerves occurs due to exposure to high glucose levels. It is mostly a consequence of constant abrupt changes in blood glucose levels. Once the nerves are destroyed, in this case those related to the penis, the latter ceases to have sensitivity. Therefore, it stops responding to sexual stimuli. In the end the patient cannot start the erection or cannot maintain it.
The second major long-term complication of diabetes is angiopathy. It damages blood vessels as results from exposure to high glucose levels. Also by constant abrupt changes in blood glucose. However, in this case the blood vessels are not simply destroyed. What happens is that the endothelium (the innermost cell layer of the vessels, in contact with the blood) begins to proliferate. Thus, more and more cells appear “stuck” inside the vessel. It diminishes its caliber and with it the capacity of passage of blood through it. In this way, when angiopathy occurs in the cavernous artery less blood reaches the corpora cavernosa. It is then when it appears difficult to generate or maintain an erection.
Another male sexual problem that frequently causes poorly controlled diabetes is retrograde ejaculation. This occurs because the damaged nervstimulate the urethral sphincter. This is responsible for letting go, or not, both urine and semen through the urethral orifice. Due to this erroneous stimulation, when ejaculating the sphincter is closed. In this way the semen, unable to go outside, goes to the bladder. Later, urinating eliminates both urine and semen.
The best prevention that exists is the adequate control of the glycemia of the diabetic patient. In this way there will not be, or will be less, the damage produced in the blood vessels and nerves of the person. As for the treatment once the erectile dysfunction has appeared, the famous Viagra could be administered, whose active principle is sildenafil. Also other inhibitors of phosphodiesterase-5.