Talk to your doctor or diabetes specialist nurse about what the best treatment is for you. It is also important to discuss the choice of treatment with your partner, if you have one.
There is a wide range of treatment options for ED including sex therapy, medication (oral, injection and urethral suppository) and vacuum therapy. Less commonly, surgery may be required. When starting treatment for erection problems, it is also vital that your diabetes and any other linked conditions such as heart disease are well controlled.
Sexual and relationship therapy
This type of therapy is carried out by a sexual and relationship therapist who has had specialised training and will work with you to help you overcome sexual problems. If you have a partner, it may also help to get you and your partner talking, and help ease tension in your relationship.
The therapist is likely to start by finding out about you and the features of your problem, and to listen to you talk about what is going on in your life. Therapists may use a variety of approaches and suggest different strategies for addressing or adjusting to sexual dysfunction.
Therapy could include, for example, exercises such as ‘sensate focusing’, which is a programme of encouraging physical contact with a partner with no intercourse, for a set period of time.
It aims to help couples learn how to touch one another in a sensual, rather than sexual way, in order to remove anxiety about performance and improve communication. Whatever approach is taken, it should be tailored to what you or any partner are comfortable with trying.
In some areas a sexual and relationship therapy clinic may be part of the hospital. You can also speak to your doctor or diabetes specialist nurse about referring you to a clinic or therapist in your area.
Medication
The following medications are available free on the NHS to men with diabetes. You are strongly advised not to buy these tablets over the internet or by mail order.
There are potential risks and side effects associated with each medication, and they should only be prescribed for you after a full consultation with your doctor or diabetes specialist nurse, as some of them may not be suitable when taken in combination with other medications, particularly for heart conditions.
The information below is a summary for each one, and not intended to detail every side effect or substance that should not be taken with it. You should never take more than one medication for ED at the same time.
The tablets Cialis, Viagra and Levitra should not be taken with grapefruit juice, which has the effect of increasing the amount of the medication in the bloodstream. Women should not take any of these medications, as their safety for women has not been tested.
Cialis (tadalafil)
A tablet that should be swallowed at least 30 minutes before anticipated sexual activity. The user should be able to produce an erection with the help of sexual stimulation. The tablet may still work up to 36 hours after being taken, but sexual stimulation is still needed. Side effects can include headache, indigestion, facial flushing, stuffy nose, muscle aches, dizziness and backache.
Viagra (sildenafil)
A tablet that should be swallowed about an hour before anticipated sexual activity. After 25 minutes, the user should be able to produce an erection with the help of sexual stimulation. The tablet may still work up to four hours after being taken, but sexual stimulation is still needed. Viagra may not work as well if taken with food. Side effects can include headache, facial flushing, indigestion and more rarely, effects on vision.
Levitra (vardenafil)
A tablet that should be swallowed about 25–60 minutes before anticipated sexual activity. After 30 minutes, the user should be able to produce an erection with the help of sexual stimulation. The tablet may still work up to four hours after being taken, but sexual stimulation is still needed.
Levitra may not work as well if taken with high fat food or alcohol. Side effects include headache, flushing, runny nose and indigestion.
MUSE (Medicated Urethral System for Erection)
This is a small pellet (roughly the size of a grain of rice) containing the drug alprostadil, that is inserted into the end of the penis (a urethral suppository). An erection usually occurs within 5–10 minutes of insertion and lasts about 30–60 minutes.
MUSE can only be used twice in any 24 hour period, and no more than seven times in any seven day period. Side effects may include pain in the penis, light-headedness, dizziness, fainting, a fast pulse and swelling of the leg veins. It is not advisable to drive a vehicle within one hour after using MUSE.
Self-injection therapy (alprostadil)
This involves injecting a drug into the base of the penis, which produces an erection. The injection is given 5–15 minutes before the erection is wanted. An erection should occur and last about one hour. It should only be used once in a 24 hour period, and no more than three times in any seven day period.
Medical help must be sought if an erection lasts for longer than 3–4 hours. Side effects can include bruising. Complications such as infection and scarring are rare. Your doctor will show you how to inject the penis.
Mechanical treatments
Penis vaccum pumps
This is a cylinder that fits over the penis, with a manual or motorised pump to provide suction, which induces blood flow and produces an erection. The erection is maintained by applying a constriction ring around the base of the penis to stop the blood flowing away.
The ring may be left in place for up to 30 minutes and will keep the erection going until it is removed. Side effects can include discomfort and bruising. Vacuum therapy can be used repeatedly if one hour rests are taken between uses. Vacuum therapy should not be used if taking blood thinning medication, as this can result in excessive bruising. There are various types of pumps available that your doctor can tell you about.
Surgical penile implants
This is a semi-rigid or inflatable implant that is surgically fitted inside the penis. A semi rigid implant creates a permanent erection that is bent into position as needed, and concealed under clothing when not needed.
An inflatable implant produces an erection when fluid (saline) is pumped from a reservoir implanted in the lower abdomen. Because the surgery alters the penis permanently and ends all possibility of a natural erection, most specialists would not normally consider this treatment unless all other methods have failed.
Reviewed November 2009