For many otherwise healthy men, ]]>impotence]]> can be an infrequent source of embarrassment and mild concern. But for some men with diabetes, impotence is a painful fact of daily life. The cause: ]]>diabetic neuropathy]]>, a nerve disorder that can disrupt the neural pathways responsible for creating and sustaining an erection.

You've Got Nerves

Neuropathy derails the brain signals that would normally speed along the nerves from the spinal cord to the erectile tissue of the penis. These nerve messages normally release nitric oxide, a chemical that relaxes arteries in the penis, which allows increased blood flow and makes erection possible. Neuropathy also disrupts the "erection messages" that are sent from the penis to the brain—for example, during physical stimulation of the penis.

In other words: a communication breakdown. And that means no sex.

According to the National Diabetes Information Clearinghouse, diabetic neuropathy can occur at any time, although the chances of it developing rise the longer a person has diabetes. It usually develops over a period of years and initially shows no symptoms. The risk of neuropathy appears to be more common in smokers, people over age 40, and those who have had problems controlling their blood glucose levels. Researchers believe that diabetic neuropathy is likely caused by a combination of factors including: metabolic problems (eg, high blood glucose), damage to blood vessels, genetics, and lifestyle factors (eg, smoking, alcohol use).

Get a Diagnosis

Neuropathy isn't the only cause of impotence in men with diabetes. Many people who have had diabetes for a long time also have vascular disease, which may diminish the flow of blood to the penis. In addition, hormonal imbalances, side effects of medications, and other physical problems unrelated to diabetes can all lead to impotence. And the causes of erectile dysfunction go beyond physical well-being. Psychological stress, too, can be a factor. Simply living with diabetes can be stressful enough in itself to affect sexual performance.

An accurate diagnosis is the first step toward finding a solution. According to Kenneth Snow, MD, director of the Sexual Function Clinic at Harvard University's Joslin Diabetes Center, doctors can gather nearly all the initial diagnostic information through a routine physical exam and a thorough patient history. Doctors will likely check blood sugar and cholesterol levels and, sometimes, testosterone levels, in addition to taking pulses throughout the patient's body to check for signs of vascular problems.

Consider Seeing a Specialist

In many cases, general practitioners are capable of diagnosing and treating erectile dysfunction in their patients with diabetes. In some cases, however, it may be necessary to consult a specialist. "I believe patients either need to seek out a specialist or make sure their physician is aware of the range of treatments," Dr. Snow says. When choosing a specialist, give preference to one who focuses on sexual dysfunction, not just urology.

Speak Up

Patients also need to remember that a doctor is not a mind reader. Unless a physician has a complete picture of a man's situation—no matter how embarrassing that picture may be to the patient—he will be ill-equipped to recommend a solution.

What might be perceived as impotence may actually be the result of natural physical changes that occur as we age. While advanced age does not automatically lead to sexual dysfunction, many older men find it takes more time or effort to initiate and complete the act of sex. For example, failing to get an erection at the sight of a sexual partner may not be impotence at all. It may simply indicate that he needs more tactile, rather than visual, stimulation to achieve an erection. Doctors should be willing and knowledgeable enough to probe for such important details, and patients need to share them.

Treatment Options

Treatment begins by addressing the physical factors that may be contributing to the problem. These may include:

  • Blood-glucose levels
  • Smoking
  • Alcohol intake
  • Medications and their dosages
  • Low testosterone levels

Beyond diabetes-specific concerns, the methods used to treat impotence in the general population are also effective for men with diabetes.

A Washington State University College of Pharmacy report on "Current and Future Therapies of Diabetic Neuropathy" summarizes some available approaches for impotence treatment:

  • Oral drug therapy, such as ]]>vardenafil]]> (Levitra) or ]]>sildenafil]]> (Viagra)
  • Self-injections of erection-producing agents, such as prostaglandin E1
  • Intrapenile doses of prostaglandins (that is, inserting suppository-like capsules into the urethra)
  • Vacuum pumps, which use air pressure to draw blood into the penis
  • Permanent surgical implants

Thanks to the variety of treatments available, most men who experience impotence due to diabetic neuropathy can find a solution that works. That's something to get excited about.