The nerves and blood vessels in your penis are damaged by high blood sugars just like the rest of your body. 

Let’s take a look at the connection between erectile dysfunction and diabetes.

What is erectile dysfunction?

In the United States, an estimated 18 million men, or about 15% of adult males, struggle with “erectile dysfunction” or “ED”, according to the Diabetes Research & Wellness Foundation (DRWF).

You have erectile dysfunction if you struggle to get and sustain an erection, or the degree of your erection isn’t firm enough to engage in sexual activity.

The DRWF estimates that 50 percent of men with diabetes have ED. Men with diabetes also tend to develop ED as much as 10 to 15 years earlier in life compared to men without diabetes.

It’s important to keep in mind that you can have erectile dysfunction completely unrelated to your diabetes. ED can stem from issues in your nervous system, vascular system, or endocrine system.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, potential causes of erectile dysfunction include:

• Obesity
• Heart disease 
• Type 2 diabetes
• Lifestyle choices: Alcoholism, smoking cigarettes, lack of exercise, drug use 
• Atherosclerosis
• High blood pressure
• Chronic kidney disease
• Chronic illnesses: Multiple sclerosis, Peyronie’s disease, Parkinson’s disease
• A side-effect of surgery and treatments for prostate or bladder cancer
• Physical injuries to the penis, spinal cord, etc.
• Psychological issues: depression, anxiety, low self-esteem

• Medications for blood pressure, cancer, antidepressants, etc.

Sometimes pinpointing the cause of a patient’s ED is simple, and sometimes it takes further investigation, testing, and reviewing your overall health history.

How high blood sugars lead to ED

To understand when and why erectile dysfunction can be caused by diabetes, it’s important to first understand how a healthy penis normally functions.

A healthy erection relies on several details:

• Brain sending signal of arousal
• Nerve-endings responding to signal
• Blood vessels release nitric oxide
• Blood flow increases to create an erection

The signal from the brain and the response by the nerve-endings is the easy part. But the eventual erection relies heavily on increased blood flow to the penis. That blood flow is a direct result of nitric oxide. 

Nitric oxide is the most critical component of an erection. It communicates with the smooth muscles within your penis to relax which allows more blood to flow into the shaft of your penis. 

“As the blood flow increases, the pressure within the spongy tissue increases and the penis expands,” explains the DRWF. “As the pressure in the penis increases, the veins that drain blood out of the penis are compressed—trapping the blood within the penis—and an erection is achieved.”

Without enough nitric oxide released from your blood vessels, blood flow will be limited, and this will lower your ability to get and sustain an erection.

If your blood vessels aren’t healthy, your ability to achieve and sustain an erection will be limited.

This is where diabetes comes in.

High blood sugars damage blood vessels and nerve endings 

Chronically high blood sugar levels will damage blood vessels throughout your entire body — including your penis. The more damage those blood vessels incur, the less nitric oxide they will release, and this leads to decreased blood flow to your penis.

Chronically high blood sugars will also damage your nerve endings, which are located throughout your entire body. 

It is likely that if you have nerve damage in your fingers and toes (neuropathy), you will also have nerve damage in your penis.

The nerve endings in your penis are what provide the physical pleasure of sex. In men, the nerve endings are focused primarily on the frenulum of your penis. You’ll find the frenulum on the extra area of skin right below the head of your penis, on the interior side of the shaft. 

You also have nerve endings through the entire head of your penis, and the shaft, but the majority are focused within the frenulum.

Nerve damage in this part of your body can prevent you from actually feeling the physical sensations of sex that lead to an orgasm and ejaculation. This means that even if you’re able to increase blood flow with pharmaceutical help, you may still struggle to ejaculate if the nerves are too damaged to sense pleasure.

Treating and managing erectile dysfunction

Treating and managing ED can be a combination of methods, but if you’re living with diabetes there’s absolutely no way around focusing first on your blood glucose management.

Work with your healthcare team to lower your blood sugar levels.

This is a no-brainer. No pharmaceutical aid will compensate for the ongoing damage to the nerve endings and blood vessels in your penis if you do not lower your blood sugar levels.

• You may have to increase your current diabetes medications or try a new medication. 
• You may have to get and use a gym membership or walk for 30 minutes every other day on your lunch break. 
• You may have to improve what you eat — without having to go crazy following any strict diets. Simply striving for two healthier meals each day can have a big impact!

Work with your healthcare team ASAP to start tackling those blood sugar levels. Diabetes isn’t random — it’s a constant balancing act between insulin (self-made or injected), activity, food, and hormones. Finding the right balance to achieve healthier blood sugars takes time. Don’t give up!

What about medications and devices?

Yes, there are medications that can increase blood flow and your ability to sustain an erection.

Viagra, Cialis, and Levitra are designed to increase blood flow in the penis when you are sexually aroused. But they won’t overcome nerve damage that robs you from feeling aroused and they can be dangerous for some with pre-existing conditions, including:

• Alpha-blockers for blood pressure and prostate issues
• Nitrate medication for a history of heart attacks or chest pain
• A history of heart attacks or stroke within 6 months
• Diseases including kidney and liver disease

Talk to your healthcare team about penile suppositories, injections or vacuum devices. Surgical implants are also available but they are not an easy fix or simple solution.

At the end of the day, if you live with diabetes and your blood sugars are consistently high, with A1c levels above 8.0 percent, it will likely impact your ability to fully enjoy your sex life!