Men & Diabetes: Talking About A Very Real Issue
By Donna Rice, RN, BSN, CDE
Living with diabetes is a challenge. It is a constant juggle between proper nutrition, medication, exercise and monitoring. Vigilant control is the goal to prevent or retard long term complications. One very troubling complication for men with diabetes is erectile dysfunction, formally referred to as impotence. Yes, we CAN -- and NEED to -- talk about it. It happens to many men. Did you know that 95% of men over the age of 65 have problems initiating or maintaining an erection? This problem affects all men and occurs much more frequently in men with diabetes.
Let's take a look at some of the commonly asked questions about erectile dysfunction. Why does it happen? How do I cope? What can be done about erectile dysfunction?
The physical aspects of erections...Why does it happen?
An erection is caused by a complex series of both physical and psychological events. Sexual stimulation affects the nerves in the brain and the genitals and allows the penis to become engorged with blood. Healthy nerves and blood vessels are needed to begin this process and then to fill the penis with blood. Uncontrolled diabetes of long-standing duration can damage both nerves and blood vessels. When this damage takes place on the nerves and blood vessels of the penis, erectile problems can result. Diabetes is the leading cause of erectile dysfunction in men.
The emotional aspects for men and their partners...How do I cope?
Problems with erections are a devastating blow to a man's ego. It causes very intense emotional turmoil for both the man affected and his partner. Some very common emotions the man may experience are anger, guilt, loneliness and depression. Let's look further into these emotions.
This is a normal response to a loss. You may feel angry that this happened to you. You may feel anger toward your partner or toward your diabetes. Dealing with your anger is essential to your mental health. Communicating with your partner and health care professionals are correct first steps in dealing with this problem.
Guilt is another emotion shared by many men. Some thoughts and feelings expressed are: "I should have watched my diet," "I should have exercised more," or "I should have managed my diabetes better." Remember, it is not your fault. Open communication is essential. You must work with your support team to find your answer.
Loneliness is yet another emotion expressed by many men. You feel isolated with your problem and often stop sharing and stop all forms of intimacy for fear of rejection or failure. When the intimacy comes to a halt, so does the open communication. Realize, there IS hope and there ARE solutions to this problem.
Many men believe "life is over" and that they are "too old and sick" to do anything. Realize that sexual dysfunction is a result of your disease and not you. A sexual relationship is for everyone, the young and the old. Knowing this will help you through this difficult time. There are solutions; you need to seek them out.
What are the answers? Today there are many treatments available to treat dysfunction. Some are pharmacological (being treated with drugs), some are mechanical, and some are surgical. The success of any particular treatment depends on your attitude, your willingness to make it work, and your partner's understanding of the treatment process. Education is the key to success. Let's look at each option very briefly. First and foremost, you must bring your blood glucose level down to a normal range. Good self-management skills are key in preventing the progression of complications and success of your treatment.
Recently several oral medications hit the market which enable men to achieve erections by helping to restore blood flow to the penis. These drugs (Viagra, Levitra, Cialis) have been proven to be very effective in men with diabetes. They have become first line therapy in treating erectile dysfunction. But like any other drug, they can have side effects. Talk to your doctor to see if you are a candidate for one of these drugs. Penile injection therapy requires medication to be injected into the penis to increase blood flow. This therapy is very successful in many men although injections into the penis are often met with fear. The pain associated with these injections, however, is very minimal and the erection obtained is the most natural. As a result, it is the method most often used by men with diabetes.
Mechanical erection devices (vacuum pumps and constriction rings) have been a benchmark in successfully treating dysfunction. They help draw blood into the penis to obtain an erection and then prevent the blood from flowing out with the use of a constriction band. There are many models to choose from. Work with your health care professional to determine which might be best for you. These devices initially may be cumbersome to operate; however, with practice they are better than 90 percent successful.
Penile implants are the surgical approach to treating erectile dysfunction. There are many types and styles to fit the needs of most men. Talk to your urologist (a doctor specializing in sexual dysfunction) to investigate the choice that is right for you. Your physician, diabetes educator and other members of your health care team can provide you most, if not all, of the answers to your questions about erection problems. Many men may benefit from additional counselling and emotional support for dealing with their diabetes and this complication. In contrast, many men choose not to deal with erectile dysfunction and instead look for other means to enjoy their sexuality with their partner. There is an understanding that an erect penis is not the essence of their sexuality. In any case the first step is to communicate with your partner and then with your health care team to better understand your dilemma and to find satisfying solutions. Yes, we CAN talk about it.
Reprinted with permission from Living Well Publications
Date reviewed: February 2005