Physical causes
The following can all contribute to or cause erectile dysfunction (ED):
Blood vessel damage (atherosclerosis – narrowed arteries)
This condition affects blood supply to the penis, therefore affecting the ability to produce an erection.
Nerve damage
Diabetes can damage the nerves that produce an erection. This is known as neuropathy. It may cause a reduction in sensation, making it more difficult to produce an erection.
Surgery
Operations on the prostate, bladder or bowel can result in damage to nerves, causing interference with messages between the brain and the penis, affecting the ability to produce an erection.
Endocrine disorders
Some endocrine glands produce hormones that are important for a normal sex drive. Disorders of these glands, such as the pituitary or thyroid may lead to a loss of sexual interest and function.
Smoking, drugs and alcohol
All of these can affect blood flow to the penis and interfere with messages between the brain and the penis.
Medication
There are different types of medication used by men with diabetes that can also contribute to ED. Many people with diabetes are treated with lipid-lowering medication called statins, and Angiotensin-Converting Enzyme (ACE) inhibitors, which offer protection against kidney damage. Some tablets in these groups can cause impotence, so you should check with your doctor if you think they might be the cause.
Psychological factors
One in four men with diabetes experience erection problems because of emotional factors. If you have erections in the morning but have difficulty producing one when you want to have sex, then the cause may be psychological.
Stress, anxiety, poor self-image caused by lifestyle factors such as weight gain, relationship difficulties, and guilt or anger about your diabetes can all cause of loss of desire or erection problems.
Many men experience periods of erection problems due to these causes at some time in their lives. There is an increasingly recognised link between depression and sexual problems. It is known that people with diabetes are twice as likely to experience depression as people without.
As many as one in three people with diabetes suffer a significant loss in their quality of life due to their depression. Juggling a busy schedule with numerous clinic and doctor appointments can cause extra anxiety. Worrying about problems associated with diabetes such as injection-site disfigurement or fear of an unexpected hypo may indirectly affect your sex life.
All of these worries and emotions are very common and well founded, which is why it is important to seek support.
Reviewed November 2009