Erectile dysfunction dates back to 2000 B.C.and was even set down on Egyptian papyrus. There is perhaps no other condition that can humble a man more than the inability to perform the sexual act when the need arises. The term erectile dysfunction (ED), formerly called impotence, covers a range of disorders, but usually refers to the inability to obtain or maintain an adequate erection for satisfactory sexual activity. This may mean complete inability to attain erection necessary for penetration or merely unable to maintain erection in order to achieve orgasm. Nevertheless, it can interfere with a man’s selfimage as well as his and his partner’s sexual life.

Although this condition is more often seen in men above the age of 65, it may happen in younger men. As men age, it is normal for changes in erection to occur. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections. In younger individuals, the onset of symptoms may be more acute and circumstances may depend on the situation.

The causes of ED may be classified as Organic or Psychogenic. Organic causes are physical problems that include structural, vascular or nerve-related defects in the anatomy of the erection pathway. Organic causes also include endocrine problems such as deficiencies in testosterone, the male hormone responsible for growth and development of the male reproductive tract and involved in libido and sexual desire. Another major endocrine problem that may cause ED is diabetes mellitus. Although diabetes mellitus is the most common endocrine disorder, it causes ED through its vascular, neurologic and psychogenic complications rather than through the hormone deficiency itself.

Psychogenic causes of ED may be generalized or situational. Generalized causes include a primary lack of or decline in sexual arousability. This may be age-related or due to a chronic disease. Situational causes of ED include partner-related causes such as lack of arousability in a specific relationship or conflict with a partner. Another example of a situational cause is performance related cause. Premature ejaculation or repeated fear of failure to perform (performance anxiety) may further cause a problem by perpetuating ED. Lastly, an example of a situational cause of ED is related to psychological stress or adjustment-related. Depression or major stress at work or at home may result in problems with erection.

Drug-induced ED has been documented. Erectile dysfunction frequently occurs in older men and thus, may coexist with other medical problems that are themselves risk factors for ED such as depression, diabetes, hypertension and other cardiovascular diseases. Drugs for hypertension such as certain betablockers, and diuretics have been shown to cause ED. Certain psychotropic medications and antidepressants have also been shown to have an effect on erection. Some medications for benign prostatic hyperplasia (BPH) such as 5reductase inhibitors have documented effects on erection and may often cause problems in erection.

Substance abuse, such as tobacco, marijuana and alcohol, has also been proven to increase the incidence of erectile problems.

Diabetes mellitus (DM) is a common chronic disease affecting a lot of men worldwide.The prevalence of ED is three times higher in diabetic men than in men without DM, occurs at an earlier age, and increases with disease duration. At 30 years of age, the prevalence of ED in patients with DM is 15 percent. It rises to 55 percent at age 60. ED is more frequent in men with coexisting diabetic neuropathy. The prevalence of coronary artery disease and peripheral vascular disease among    men with DM is far higher than that of the normal population.Thus, DM may cause ED through one or through a combination of pathways.

In 12 percent of men with diabetes, deterioration of sexual function can be the first symptom.These men may not even suspect themselves as having DM. The causes of ED in men with diabetes are complex and involve impairments in nerve, blood vessel and muscle function. To get an erection, men need healthy blood vessels, nerves, male hormones, and a desire to be sexually stimulated. Diabetes can damage the blood vessels and nerves that control erection. Therefore, even if you have normal amounts of male hormones and you have the desire to have sex, you still may not be able to achieve a firm erection.

Diabetes can cause neuropathy or damage to nerves throughout your body, including the penis. Damaged nerves can’t communicate properly. So even though you might be emotionally stimulated to have intercourse, nerve damage means that information isn’t relayed to the penis, and it doesn’t respond.

In addition, poor blood sugar control can inhibit nitric oxide production. Lack of nitric oxide can prevent the pressure of blood within the penis from raising enough to close off penile veins, allowing blood to flow out of the penis instead of remaining trapped for an erection. The penis then becomes flaccid.

Blood vessels can also become narrowed or hardened (atherosclerosis) by conditions that often accompany diabetes, such as cardiovascular disease. When atherosclerosis occurs in arteries that supply the penis or pelvic area, sexual function may be disrupted. The treatment of ED depends on the nature of the problem. For patients with ED secondary to psychogenic causes, elimination of the psychogenic cause often solves the problem. Of course this is easier said than done.

It is not easy for one to determine whether one’s problem is due to a psychogenic or an organic cause. Oftentimes, urologists can help you find out. As for people with organic causes such as ED, prevention of complications is the most important way to reduce the risk for ED. This may be done by closely following up with your physician.

In a lot of individuals with ED, oral medications would suffice. However, this treatment is not for everyone. Each individual must seek medical consult prior to trying these oral medications. There may be disastrous side effects if taken in certain medical conditions or with other medications. Withdrawal of drugs with potential side effects on erection may solve the problem in some. Other forms of treatment are prostaglandins that may be in the form of injection or suppository. Vacuums and certain prosthetic devices may also be used in patients who do not improve with oral medications or prostaglandins.

How Can I avoid or manage ED in Diabetes?
Talk to your doctor. Initially, you might be embarrassed to talk to your doctor about sexual health. But because ED is a common diabetes related problem, your doctor won’t be surprised when you mention the topic. Your doctor may even ask you about it first. Talking to your doctor before a problem occurs can help you prevent or delay ED. Your doctor can also help determine if ED is the result of diabetes or another condition. Control your blood sugar. Good blood sugar control can prevent the nerve and blood vessel complications that lead to ED. If you’re having trouble controlling your blood sugar, talk to your doctor about treatment plan.

Avoid tobacco. Smoking and other tobacco use cause blood vessels to narrow, further contributing to blockages that can lead to ED. Smoking can also decrease nitric oxide levels.

Avoid excessive alcohol. Drinking excessive amounts of alcohol can cause ED by damaging blood vessels. For men, no more than two alcoholic drinks a day, and for women, no more than one.

See a urologist. Urologists have special expertise in sexual health. Some specialize specifically in ED. They can help assess your condition, determine its cause, and identify safe and effective treatments. For the past 10 years, oral medications have been available to help solve the problem of ED. Your urologist may prescribe some for you after getting clearance from your cardiologist.

Get mental health treatment. Stress, anxiety and depression can cause ED. Even the fear of having erectile problems can make the worse. Talk to your doctor to see these issues are playing a role in your ED. Treatment with a mental heal professional might help.

Reduce your cardiovascular disease risk. Men with diabetes who also have cardiovascular disease, such as heart disease or high blood pressure face an even greater likelihood developing ED because of the added damage to blood vessels. Reducing yo risk of developing cardiovascular disease or taking the right steps to control existing conditions, such as exercise and a healthy diet, can help prevent ED.

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