Erectile dysfunction (ED), also known as impotence, means having trouble getting or maintaining an erection. People with diabetes are about 3.5 times more likely to experience ED, and it can also start at a younger age than it does in people who don’t have diabetes.

People often view erectile dysfunction as a private matter, but ignoring it can take a significant toll on relationships. ED can affect sexual function and even the ability to have children.

Sometimes, ED is a sign that diabetes isn’t well managed. Erectile dysfunction can also be related to medication or other health issues. The good news is that there are many ways to prevent and treat ED — but it starts with sharing your concerns with your healthcare provider.

This article explains how diabetes and ED are connected and discusses lifestyle changes and treatment that can help.

Nerve Damage

High blood glucose (sugar) levels in diabetes can cause diabetic neuropathy (nerve damage), a complication that’s linked to ED. Neuropathy dulls the nerves in the penis, making it more difficult to feel touch or respond to arousal. Nerve damage can also interfere with muscle control, which is needed to produce and maintain an erection.

Up to half of people with diabetes eventually develop diabetic neuropathy, which can range from mild to severe. Diabetic neuropathy usually affects the legs and feet, but it can also harm the urinary tract and digestive system. Common symptoms include tingling, burning, or numbness in the feet and hands.

Your doctor should begin checking for signs of nerve damage soon after you’re diagnosed with type 2 diabetes. However, it’s important to be proactive and let them know if you notice any new symptoms, such as erection problems.

High Blood Sugar and Circulation Problems

Erectile dysfunction is often related to poor circulation. If diabetes isn’t properly managed, blood sugar levels stay high, putting the body under stress. This stress makes blood vessels stiff and narrow, and blood doesn’t flow as well. Without enough blood flow to the penis, getting or keeping an erection becomes difficult.

High blood sugar also causes long-term damage. Over time, poorly controlled diabetes leads to circulation problems throughout the body. This can lead to complications including:

• Vision problems or loss
• Kidney damage
• Nerve damage
• Foot problems that, in some cases, may lead to amputation

These issues happen because different parts of the body stop getting the blood and nutrients they need to stay healthy.

Erectile Dysfunction and Cardiovascular Disease

High blood pressure and high cholesterol levels can also damage blood vessels. Heart-related health conditions are more common in people with diabetes and also raise the risk of erectile dysfunction. As a result, these conditions can happen together.

Fortunately, making healthy choices to help manage diabetes can also protect your heart. For example, eating fewer processed foods and more fiber-rich vegetables can help lower blood sugar, cholesterol, and blood pressure. A registered dietitian can help you learn how food affects your body and come up with an eating plan that works for you.

If a heart-healthy diet and other lifestyle changes aren’t enough, your doctor may recommend medication to help manage high blood pressure or cholesterol.

Other Possible Causes of Erectile Dysfunction

Erectile dysfunction can result from issues unrelated to diabetes, such as prostate or bladder surgery. However, for many people with diabetes, the causes are often connected.

One major factor is insulin, the hormone that helps regulate blood sugar. In type 2 diabetes, the body becomes resistant to insulin — meaning it doesn’t use insulin well — which contributes to high blood sugar. Insulin resistance can also affect hormone levels, including testosterone, a key sex hormone. Research in Diabetes Metabolism Research and Reviews found that about 40 percent of men with type 2 diabetes have low testosterone levels — and within this group, 90 percent have ED.

Mental health plays a role too. Depression is strongly linked to ED, and men with diabetes have double the rate of depression compared to men without diabetes, according to the journal Diabetes/Metabolism Research and Reviews. A 2021 review of multiple studies found that men with both diabetes and depression are six times more likely to experience ED than men with diabetes alone.

ED is also a possible side effect of medications that treat heart disease and depression. If you think your medication may be contributing to ED, talk with your doctor or pharmacist. They may be able to adjust your dose, switch medications, or offer treatment options to manage side effects.

Help for Erectile Dysfunction With Diabetes

High blood sugar is the root cause of many diabetes complications, including erectile dysfunction. Diabetes requires lifelong blood sugar management and an ongoing conversation with your healthcare team. Even if your levels have been steady for several years, your body and health needs can change, so regular blood tests and checkups are important.

Your healthcare provider can also look for other possible causes of ED. For example, if you have low testosterone levels, they may recommend testosterone replacement therapy. To get the most benefit from this approach and lower the risk of side effects, you should also focus on healthy lifestyle changes, such as:

• Not smoking
• Reducing alcohol consumption
• Staying physically active
• Eating nutritious foods

These healthy habits can also help improve ED, diabetes, heart health, and mental well-being.

If you’re experiencing stress or depression, be sure to talk with your doctor. Mental and physical health are deeply connected, and ignoring either one can make matters worse. Taking steps to boost your overall health and well-being can have a big, positive impact on several areas of your life at once.

Other Ways To Treat Erectile Dysfunction

ED is a common condition — and it’s treatable. If ED doesn’t improve with better blood sugar control and healthy lifestyle changes, your doctor may suggest other treatment options.

Oral medications (taken by mouth) for ED work by increasing blood flow to the penis. Some examples are:

• Avanafil (Stendra)
• Sildenafil (Viagra)
• Tadalafil (Cialis)

Other types of ED treatment include:

• Suppositories placed inside the tip of the penis before sex
• Injections into the penis
• Vacuum devices (pumps that help draw blood into the penis)
• Penile implants (surgical devices placed inside the penis)

Each option has benefits and risks. Your healthcare provider can walk you through the details and help you decide which is right for you.

Talk With Others Who Understand

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

How do you feel about talking to your doctor about sexual health? Do you have personal experience with any of the ED treatments discussed above? Share your comments below, or start a conversation by posting on your Activities page.