by Robert Bittner
For many otherwise healthy men, impotence can be an infrequent
source of embarrassment and mild concern. But for roughly half of all men with
diabetes, impotence is a painful fact of daily life. The cause: diabetic
neuropathy, a nerve disorder that can disrupt the neural pathways responsible
for creating and sustaining an erection.
You\ve got nerves
Neuropathy derails the brain signals that would normally speed along the
nerves from the spinal cord to the erectile tissue of the penis. These nerve
messages normally release nitric oxide, a chemical that relaxes arteries in the
penis, which allows increased blood flow and makes erection possible. Neuropathy
also disrupts the "erection messages" that are sent from the penis to the
brain—for example, during physical stimulation of the penis.
In other words: a communication breakdown. And that means no sex.
According to the National Diabetes Information Clearinghouse, diabetic
neuropathy can occur at any time, although the chances of it developing rise the
longer a person has diabetes. It usually develops over a period of years and
initially shows no symptoms. The risk of neuropathy appears to be more common in
smokers, people over age 40, and those who have had problems controlling their
blood glucose levels. Although research is ongoing, persistently high blood
glucose levels are currently believed to be the main cause of diabetic
neuropathy.
Get a diagnosis
Neuropathy isn't the only cause of impotence in men with diabetes. Many
people who have had diabetes for a long time also have vascular disease, which
may diminish the flow of blood to the penis. In addition, hormonal imbalances,
side effects of medications, and other physical problems unrelated to diabetes
can all lead to impotence.
And the causes of erectile dysfunction go beyond physical well-being.
Psychological stress, too, can be a factor. A 1997 study among Japanese men,
reported in the Swiss journal Urologia Internationalis, revealed that simply
living with diabetes can be stressful enough in itself to affect sexual
performance.
An accurate diagnosis, then, is the first step toward finding a solution.
According to Kenneth Snow, MD, director of the Sexual Function Clinic at Harvard
University's Joslin Diabetes Center, doctors can gather nearly all the initial
diagnostic information through a routine physical exam and a thorough patient
history. Doctors will likely check blood sugar and cholesterol levels and,
sometimes, testosterone levels, in addition to taking pulses throughout the
patient's body to check for signs of vascular problems.
Consider seeing a specialist
In many cases, general practitioners are capable of diagnosing and treating erectile dysfunction in their patients with diabetes. In some cases, however, it may be necessary to consult a specialist. \"I believe patients either need to seek out a specialist or make sure their physician is aware of the range of treatments,\" Dr. Snow says. When choosing a specialist, give preference to one who focuses on sexual dysfunction, not just urology.
Speak up
Patients also need to remember that a doctor is not a mind reader. Unless a
physician has a complete picture of a man's situation—no matter how embarrassing
that picture may be to the patient—he or she will be ill-equipped to recommend a
solution.
What might be perceived as impotence may actually be the result of natural
physical changes that occur as we age. While advanced age does not automatically
lead to sexual dysfunction, many older men find it takes more time or effort to
initiate and complete the act of sex. For example, failing to get an erection at
the sight of a sexual partner may not be impotence at all; it may simply
indicate that he needs more tactile, rather than visual, stimulation to achieve
an erection. Doctors should be willing and knowledgeable enough to probe for
such important details, and patients need to share them.
Treatment options
Treatment begins by addressing the physical factors that may be contributing
to the problem. These include:
- Blood-glucose levels
- Smoking
- Alcohol intake
- Medications and their dosages
- Low testosterone levels
Beyond diabetes-specific concerns, the methods used to treat impotence in the
general population are also effective for men with diabetes.
A Washington State University College of Pharmacy report on "Current and Future
Therapies of Diabetic Neuropathy" summarizes the currently available approaches
for impotence treatment:
- Self-injections of erection-producing agents, such as prostaglandin E1
- Intrapenile doses of prostaglandins (that is, inserting suppository-like
capsules into the urethra)
- Vacuum pumps, which use air pressure to draw blood into the penis
- Permanent surgical implants
- Oral drug therapy – most notably, sildenafil citrate (Viagra)
Not surprisingly, Dr. Snow has seen a clear preference for oral therapy at
his clinic. But for patients who cannot take Viagra (notably, men already taking
nitroglycerin) or who do not want to, Dr. Snow reports that there is no
stand-out runner-up. "Once you get beyond Viagra, people's choice of treatment
is very varied, depending on their own comfort levels and personal life."
Thanks to the variety of treatments available, most men who experience impotence
due to diabetic neuropathy can find a solution that works.
That's something to get excited about.