Earlier this month, Dr. Natalya Lopushnyan discussed erectile dysfunction treatments. Today, she's back to discuss diabetes and ED. (Click here if you'd like to make an appointment with Dr. Lopushnyan or one of our other urologists.)

As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific questions concerning ED.

[Editor's note: This article was reviewed and updated on 9/22/21.]

Here's Dr. Lopushnyan, in her own words…

Population studies have suggested, and my clinic patients have confirmed, that there are truly millions of men out there suffering from erectile dysfunction, many of whom have diabetes.

Let's talk about erectile dysfunction first. Erections happen when there is an increase in blood flow to the man's penis, usually during sexual arousal. Specifically, blood has to fill two sponge-like areas of the penis called corpus cavernosum and stay in that spongy tissue until ejaculation happens.

Normally, after ejaculation occurs, those spongy areas contract and blood flows out of the penis making it flaccid (soft) again. The more blood that gets to the penis, the better the erection is.

What makes blood fill the penis? In very simplified terms, it is under control of specific nerves that go to the penis. If there is not enough blood flow or if the nerves are damaged, the quality of erections will not be the same.

To have a good erection you have to have at least three things: a penis, good blood flow, and healthy nerves. If either one of those components is missing or damaged, the erections are not going to be great (i.e., either not hard enough, or not lasting long enough, or both).

Now, what does diabetes do? It damages nerves AND blood vessels in the body. It does so through high blood sugar levels. Also, the smaller the blood vessels are, the sooner diabetes will affect them. And since blood vessels that go to the penis are very small, you see where this is going, right? 

If you have diabetes, it might (and probably will) affect your erections, especially if the diabetes is not very well controlled. In fact, multiple studies suggest that ED rates in men with diabetes are two to three times higher than the general population. The onset of ED also tends to occur at a much younger age (some studies suggest 10-15 years earlier) than in men without diabetes.

One more component that has to be present for quality erections (and is frequently decreased in men with diabetes) is testosterone level. Testosterone is a male hormone that contributes to a healthy sexual function in men, including both erection quality and libido (sexual desire). It tends to be lower in men with type 2 diabetes, and seems to be fairly normal in men with type 1 diabetes.

OK, now for some good news and bad news.

First, the bad news: unfortunately, once erections worsen, it is very difficult to improve them naturally. Vigorous diet, exercise programs, and great blood-sugar control will not return the erections you experienced in your youth, but what they will do is prevent your erections from getting worse.

In other words, the healthier you are, the healthier your penis (and erections) will be. So make sure you:

• Monitor and take care of your blood sugar
• Watch your diet
• Exercise

The American Heart Association (AHA) recommends at least 30 minutes of aerobic activity at least 5 days per week. (And this number increases if you need to lower your blood pressure and/or cholesterol.)

Now, the good news: while there are no "natural" ways to revert worsening erections, there are other treatment options for erectile dysfunction, such as medications, injections, and penile prostheses.

Bottom line: if you're struggling with ED, whether you have diabetes or not, talk to your urologist. Click here to make an appointment with me, or one of our other fabulous urologists at Greater Boston Urology.