It’s not easy to talk about health—especially sexual health—but don’t drop the ball. Speak with your patients about managing diabetes-related problems that could keep them on the sidelines.
OK guys, let’s be honest. Some patients don’t take great care of their health. They walk-off injuries. They may not pay attention to signs that something’s wrong. And the No. 1 reason they don’t go to the doctor? Research shows it’s because they don’t want to hear bad news. But that means they won’t get to hear the good news either. We’ll get to that below.
Men are more likely to get type 2 diabetes at a lower weight than women. One reason is that men store more fat in their bellies—a known risk factor. And more men than women have diabetes that’s undiagnosed; maybe it’s that “don’t want to hear bad news” thing.
Diabetes puts both men and women at greater risk for heart disease, stroke, vision loss, kidney failure, even amputation of a toe, foot, or leg. But some diabetes problems hit guys directly below the belt:
Erectile Dysfunction (ED)
With ED, a man can’t get or keep an erection firm enough for sex. ED is common in middle-aged and older men – as many as 30 million in the United States have it. Men with diabetes are three times more likely to have ED. Getting older doesn’t cause ED, but it does increase your chance of getting it.
First, some facts. Here’s what ED isn’t:
- Occasional trouble having an erection. That really does happen to everyone.
- Less interest in sex. ED happens when a man wants to have sex but can’t have or keep an erection.
- Problems with ejaculation, which can mean a structural problem with the penis.
It’s not uncommon to have trouble getting an erection sometimes, but if it gets worse, happens often, or prevents you from living the life you want, it’s time to get it checked out.
Men who have diabetes are more likely to have heart disease, and ED can be a warning sign of blood vessel problems.
Causes of ED
- Damage from high blood sugar or high blood pressure to nerves and blood vessels needed to have an erection
- Some medicines for high blood pressure, depression, or allergies (don’t stop taking them, but do talk with your doctor to see if you can take a different medicine or lower the dose)
- Treatment for prostate cancer or an enlarged prostate
- Surgery that affects the pelvic area or spinal cord
- Using tobacco or alcohol
- Sleep disorders
It can be tough for patients to talk about ED, but it’s a conversation you need to have with them so they can get treated. The good news is more than 95% of men can be treated successfully.
- Medicine: If there is normal nerve function, patients can take a type of medicine that increases blood flow to the penis. Sometimes these medicines don’t work well for guys with diabetes and should NOT be taken if they’re also taking nitrates for their heart.
- Testosterone: Sometimes having low testosterone (low T) can cause ED. Men with diabetes are twice as likely to have low T than men who don’t have diabetes. Taking testosterone may help them have normal erections or help ED medicine work better.
- Vacuum device: This is a plastic tube that fits over the penis, creating a low-pressure vacuum that causes an erection. An elastic ring is slipped onto the base of the penis to hold blood in and maintain the erection. With training, about 75% of men can get an erection firm enough for sex.
- Injection or suppository: For an immediate erection just before sex, patients can inject a medicine into the side of the penis with a very small needle, or place a tiny pill in the urethra (the tube urine comes out of).
- Implant: A penile implant placed inside the penis by surgery is often recommended if other treatments don’t work. However, if they’re having trouble managing their blood sugar, their chance for infection after surgery is higher and may not be advised.
In addition to ED, nerve damage from diabetes can cause other problems for men, including:
- Overactive bladder (needing to urinate often, urinating often at night, leaking urine)
- Male incontinence (leaking urine)
- Urinary tract infections (UTIs)
- Retrograde ejaculation (semen is released into the bladder)
These problems could mean you need to change how you’re managing your diabetes.