Erectile Dysfunction and Diabetes

Why diabetes and erectile dysfunction are linked

Erectile dysfunction (ED) is common in men with diabetes. Over time, diabetes can affect the small blood vessels and nerves that control erections, and it is also often accompanied by other contributing factors such as high blood pressure, raised cholesterol, obesity, and reduced testosterone.¹

Because of this, ED in a man with diabetes is often multifactorial. Good care looks at the blood flow, the nerves, the hormones, the medications, and the psychological and relationship aspects at the same time.

ED can be an early warning

In men with diabetes, erectile dysfunction can be an early sign of wider cardiovascular disease.² For this reason, assessment usually includes a general health review as well, so that any other risk factors can be managed.

Assessment

Assessment at Urology NSW typically includes:

• A detailed history, including diabetes control, medications, cardiovascular risk factors, and the pattern of erectile difficulty (for example, still waking with erections, or not).
• Physical examination.
• Blood tests including glucose control (HbA1c), lipids, and hormone profile (testosterone, sex hormone-binding globulin, prolactin, and other pituitary hormones where indicated).¹
• Review of current medications, some of which can contribute to ED.
• Discussion of psychological and relationship factors.

Treatment: an individualised approach

There is no one-size-fits-all treatment for diabetic ED. The plan is tailored to each patient's situation, preferences, and other conditions. Treatment usually combines general health optimisation with specific ED therapy.

Foundations

• Glycaemic control – working with the GP or endocrinologist to optimise blood sugar control.
• Cardiovascular risk – managing blood pressure, cholesterol, smoking, and weight.
• Lifestyle – regular physical activity and weight reduction where relevant.¹
• Medication review – identifying any medicines that may be contributing.

Specific ED therapies

• Oral PDE5 inhibitors – usually the first-line medical therapy. They can work well in men with diabetes, though response rates are typically lower than in men without diabetes.¹
• Vacuum pump devices – a non-medication option that can be used alone or in combination with other therapies.
• Intracavernosal injections – often effective when oral therapy is not enough. Training and support is provided by the men's health pharmacist. See Intracavernosal Injections.
• Testosterone replacement – considered only when testosterone is clearly low on repeat testing and symptoms fit, with appropriate monitoring.¹
• Penile prosthesis surgery – a surgical option for men who have not achieved satisfactory results with other treatments.

Working with your other doctors

Because diabetic ED sits at the junction of endocrinology, cardiology and urology, Dr Kooner's clinic coordinates care with the GP, diabetes team, and, where relevant, cardiologist. The aim is a joined-up plan rather than managing each issue in isolation.

How to access care

• Contact Urology NSW to arrange a consultation.
• Request a second opinion if you have already been assessed elsewhere.
• Call the rooms on 02 8382 6980.

See also: Erectile Dysfunction for the general overview of ED assessment and treatment.