Lots of men with diabetes have a satisfying sex life but some may have problems with sex at some point, known as sexual dysfunction.
Erectile dysfunction — where you can't get or keep an erection during sex — is the main sexual problem in men, particularly those over 40. It happens to all men from time to time. There can be lots of causes including diabetes. So if it starts to happen more often and you don't know why, speak to your GP or healthcare team.
There is support and treatment available.
On this page we cover:
- How does diabetes affect a man sexually?
- Diabetes and erectile dysfunction
- Screening process for men’s sexual problems
- Treatment for men’s sexual problems
- Helping to prevent sexual problems
- Further information and support
How does diabetes affect a man sexually?
How diabetes affects sexual function is an under-researched area, but there has been more research on the effects in men than in women.
Most research has concentrated on erectile dysfunction, the most common sexual problem in men, sometimes called impotence.
We know that men with diabetes are more likely to have problems with erections than men without diabetes.
We also know that heart disease and kidney disease can be a factor in erectile dysfunction.
Diabetes and erectile dysfunction
Men with diabetes are three times more likely to have trouble getting or keeping an erection than men without diabetes.
Although erectile dysfunction is more likely in older men with type 2 diabetes and those living with obesity, it can affect men of any age with any type of diabetes.
Having high blood sugar levels over a prolonged period of time can damage your blood vessels and nerves, including the ones that supply your penis.
This damage can restrict the amount of blood flowing to your sexual organs and may cause some loss of sensation or feeling.
This could mean you have difficulty getting aroused, both physically and in how you feel, which can cause erectile dysfunction.
"More than half the time I can do without the tablets, but it’s good to know they are there as a back up." Read Paul's experience of treatment for erectile dysfunction caused by neuropathy.
Emotions
Problems with erections can be very upsetting and result in a lot of stress and worry, whatever the cause. For some men, this can also play a part in making it difficult to get and keep erections as well as lowering sex drive.
And diabetes distress caused by the relentlessness of managing a long-term health condition, is more likely to cause sexual problems in women but can still affect some men sexually.
How you’re feeling can have a big impact on how you have sex too, along with how comfortable you feel with someone. Feeling worried or embarrassed may make it difficult to have sex.
See our tips on using diabetes tech
Other causes of erectile dysfunction
Lots of things can cause erectile dysfunction apart from diabetes. So your GP or healthcare team may want to rule those out.
High blood pressure, high cholesterol levels and side effects from some medication can all be factors.
Problems with erections can become common as you get older. That may be due to physical health problems or emotional difficulties due to life’s challenges, or a combination.
Smoking, being relatively inactive and stress and depression can all be factors in erectile dysfunction.
Depending on the cause of erectile dysfunction, you may still be able to get an erection sometimes, for example, when you are asleep or in the early morning.
Hormones
A deficiency in the male hormone testosterone has been linked to erectile dysfunction in men with type 2 diabetes, says the BSSM – British Society for Sexual Medicine
The BSSM is calling for all men with erectile dysfunction to have their testosterone levels checked, which isn’t currently routine.
More than 70 per cent of men with type 2 diabetes of any age might experience erectile dysfunction due to testosterone deficiency, suggests the BSSM.
Rather than a big drop in testosterone levels, the NHS says that erectile dysfunction in older men (late 40s and early 50s) is more likely to be linked to other physical changes such as fat redistribution and factors affecting their emotional wellbeing.
Urinary tract and other infections
Having high blood sugar levels can also make developing a urinary tract infection (UTI) after sex more common.
And high blood sugar levels can also make you more likely to develop thrush and penile foreskin infections. Symptoms of thrush or penile foreskin infections can include itchiness or soreness on the tip of the penis or under the foreskin. You might notice discharge or find it hard to pull your foreskin back.
The symptoms of both thrush and a UTI can be uncomfortable and can affect your sex life until they’ve cleared up. If you or your partner has a UTI or thrush, it’s best to avoid sex until it’s better.
What is the screening process for men’s sexual problems?
Men with diabetes are much more likely to be asked about any sexual problems during their annual review than women with diabetes.
Men should be asked about erectile dysfunction and any concerns about sexual health.
If erectile dysfunction is present, National Institute for Health Care Excellence (NICE) guidance recommends that men are assessed, provided education and supported as necessary.
Assessment may include a blood test to check testosterone levels. If the results show that your testosterone levels are low you may be referred to a specialist for further assessment and treatment.
Treatment for men's sexual health problems
Your GP should work through a recommended list of assessments, including carrying out a medical check-up to rule out other health conditions.
This may include checks and tests such as your blood pressure, cholesterol and HbA1c. And they should ask you questions about how you live your life, your relationships and any stress.
They will provide advice and refer you for any further support and treatment you might need, including a referral to a sexual health clinic.
The treatment will depend on the cause. It could include:
- Anti-depressant medication
- Cognitive Behavioural Therapy (CBT) or counselling for stress, depression and anxiety.
- Treatment for erectile dysfunction – see below.
There are different treatment options for erectile dysfunction. Speak to your healthcare team about what treatments are available and right for you.
The main treatments are medicines that increase the blood flow to your penis such as Viagra, Cialis and Levitra. If medicine is not suitable or does not work, there are also vacuum pumps that encourage blood flow to the penis, causing an erection.
Erectile dysfunction linked to testosterone deficiency is usually treated with testosterone therapy. This may be an injection or gel alongside a daily tablet tadalafil (brand name Cialis).
Find out more information about treatments for erectile dysfunction on the NHS website.
Helping to prevent sexual problems
To help you reduce your risk of sexual problems from your diabetes, it’s important to:
-
Go to your diabetes health checks (annual review)
Your blood sugar levels (HbA1c), blood pressure and cholesterol will all be measured and you can see if you need support from your healthcare team to keep your levels for each within target range. -
Keep your blood sugars near or within your target range
This will help reduce blood vessel and nerve damage which can affect blood flow to your sexual organs. And it will help you avoid thrush or UTIs. Other things you can do to help prevent thrush or UTIs is to drink plenty of sugar free fluid, and don't use perfumed shower gel or wear tight underwear. -
Continue to take any medication to lower your blood sugar levels
-
Get support to be physically active
-
Eat a healthy balanced diet
Having all the vitamins and minerals you need will help protect against and repair early nerve damage. -
Limit your alcohol intake if you drink.
Aim for fewer than 14 units a week spread over at least three days. -
Get support if you're finding it hard to manage your diabetes
Speak to your diabetes team. They should support you to help prevent diabetes distress or burnout which can lead to sexual problems. -
Stopping smoking
If you cycle a lot discuss with your healthcare team whether reducing the amount you cycle could help.
Further information and support
A leaflet called Sexual health and diabetes for men has been produced by the Diabetes Research and Wellness Foundation.
Download the leaflet from the Diabetes Research and Wellness Foundation website – or listen to an audio version.
As well as your healthcare team, our helpline is here to answer your questions or just listen.
You can also reach out on our forum to ask others about their experience of sexual problems or get advice on your own situation.
