ED disorder

October 13, 2011

5, 2011

Several therapies are available to treat erectile dysfunction.

Dear and Aisha, I am a 39-year-old married man who has had type 1

<http://www.diabeteshealth.com/browse/community/type-1-issues/> diabetes

<http://www.diabeteshealth.com/> for 22 years. My A1C

<http://www.diabeteshealth.com/browse/monitoring/a1c-test/> levels run

around 7.5%. About six years ago, I started having trouble with erections.

Now they are very rare, even with ED pills. I know you say that there is

more to sex than intercourse, and my wife and I still enjoy ourselves

however we can. But we both miss the erections.

I have heard lately that erectile dysfunction can sometimes be improved. How

can that happen? I don't want any surgeries. What do you know about

recovering erections?

Happily Married but Frustrated

Dear Happily Married,

You picked a good time to write. Recent research has pointed to at least

three ways that erectile dysfunction (ED) can be not only treated, but often

resolved. Normalizing blood

<http://www.diabeteshealth.com/browse/monitoring/blood-sugar/> sugars can

help; so can losing weight. There are also programs of " penis

rehabilitation " that will improve erections.

Glucose Levels

First, what causes erectile dysfunction in diabetes? There are many causes,

but the main one is nerve and blood vessel damage caused by high blood

sugar. Elevated sugar levels contribute to inflammation, which can damage or

kill nerves and narrow or block blood vessels, causing them to leak. Either

factor can block erections.

Fortunately, we now know that lowering blood sugar allows nerves, and

sometimes blood vessels, to heal and regenerate. Just as neuropathic pain in

the feet often resolves as blood sugars improve, nerve function to the

genitals can too.

Studies in the US, Egypt, and Italy consistently show that A1C levels are

the strongest predictor of erection problems. The higher a person's A1C, the

more sexual problems he is likely to have. Your level of 7.5% is a bit high.

If you could get closer to 6.5%, your sex life might improve significantly.

Talk with your doctor or educator about the best ways to do that. It will

take time for the nerves to heal. Don't expect immediate results, but over a

year or so, you and your wife might be pleasantly surprised. You'll also be

protecting yourself against future complications.

Weight

You don't say how heavy you are, but in heavy men, weight loss

<http://www.diabeteshealth.com/browse/fitness/weight-loss/> has recently

been shown to improve erectile function scores rather dramatically.

According to an Australian study of men with type 2

<http://www.diabeteshealth.com/browse/community/type-2-issues/> , published

on August 5, 2011, in the Journal of Sexual Medicine, weight loss improved

sexual function, sexual desire, urinary function, and inflammation levels.

Sexual function continued to improve during a year of follow-up.

The subjects in this study ate a high-protein, low-grain, high fruit and

vegetable diet. Low-grain diets are often recommended for people with

diabetes anyway, so here is another reason to consider them. Exercise

<http://www.diabeteshealth.com/browse/fitness/exercise/> was not part of

the weight loss program in this study, but the researchers think that

exercise helps.

Hunter Vessels, chairman of urology at the University of Washington School

of Medicine, says, " Exercise has a set of potential effects that are not

strictly related to weight loss. " A recent Italian study in the Journal of

Sexual Medicine found that exercise plus a PDE-5 inhibitor drug like

sildenafil (Viagra) worked much better than the drug alone. Another Italian

report showed that exercise was a major contributor to sexual function and

blood vessel condition.

Inflammation

Reducing inflammation may have been a big part of the weight loss program's

success. Blood tests done throughout the year showed that the diet lowered

the levels of inflammation in the men's bodies. University of Adelaide

researcher Dr. Wittert said that inflammation could be part of what

causes urological problems in overweight men.

Consequently, taking other steps to reduce inflammation might also heal ED.

Ask your doctor about going on a low-cost anti-inflammatory medicine like

salsalate, which has been shown to help diabetes in some studies. Also, make

sure your dental

<http://www.diabeteshealth.com/browse/complications-and-care/oral-health/>

health is good. A large Chinese study found that gum disease was strongly

correlated with ED in men with diabetes. That doesn't prove that gum disease

causes ED, but it is a major cause of system-wide inflammation, which won't

do your blood vessels any good.

Penis Rehabilitation

In addition to lowering blood sugars, reducing weight, and controlling

inflammation, a number of treatments classed as " penis rehabilitation " have

been effective in men with ED. Penis rehab involves ways of restoring blood

flow to the penis. Many of these treatments were developed for men

recovering from prostate surgery. They have been used by soldiers returning

with injuries and PTSD. They also seem to be effective in some men with

diabetes.

One way to improve penis circulation is to take low doses of a PDE-5

inhibitor, like Cialis, Viagra, or Levitra, on a frequent or everyday basis.

A number of studies show that regular PDE-5 inhibitor use seems to heal

blood vessels and increase smooth muscle mass in the penis. The smooth

muscle helps hold blood in the penis.

A Russian study of men with ED taking vardenafil (Levitra) every other day

found that they had much better erections and their blood vessels expanded

more than men who took the drug only when needed for sex. Cialis has now

been approved for everyday use, so that is an option for you. You could ask

for referral to a urologist specializing in sexual function to obtain these

meds.

With the PDE-5 treatments, it also helps to masturbate or have some sexual

interaction with your wife to get the blood flowing more. Intercourse and

ejaculation are not necessary; the point is to practice having erections.

Urologists like New York's Dr. Werner say that using injectable

erection medicines every other day or twice a week helps restore erectile

function. These medicines can be given through an injection device, so you

don't have to stick a needle in yourself. Again, the idea is to have

erections to open the blood vessels.

These drugs can be expensive, but are sometimes covered by insurance. The

three most common medications used for injections are papaverine,

phentolamine, and prostaglandin E1. According to Dr. Werner, " Two-thirds of

men who used the injections on average twice a week recovered erectile

function to the point where they could have intercourse without any outside

help. "

Non-drug approaches to rehab include using a vacuum constriction device.

This is a plastic cone that you place over the penis, then pump out the air

inside to create a vacuum. The vacuum draws blood into the penis. For

intercourse, an elastic band is slid over the penis to keep the blood in.

But for rehab, you don't use the band; the idea is just to keep the erection

for 10 to 15 minutes, or as long as possible. According to San Diego Sexual

Medicine, doing this three times a week can help restore normal sexual

function. This can be combined with a PDE-5 inhibitor.

Dr. Werner says, " A recent study of men (after prostate surgery) who

committed to a program of penile rehabilitation showed that 52 percent of

them recovered unassisted functional erections, compared to a recovery of 19

percent in the group who did not participate in rehabilitation. " In this

same study, 64 percent of men who went through penis rehab recovered

adequate erections with Viagra, compared to 24 percent of other men.

It's a lot of work, but it's probably worth it. Your partner can help.

According to Dr. Werner, " Studies have shown conclusively that the

involvement of your partner (if you have one) is beneficial in making this

process as smooth and successful as possible. Partner's motivation and

interest are often driving factors in the rehabilitation. "

A couple of final tips: First, don't forget to check your testosterone

level. Testosterone is frequently low in men with diabetes and can cause

loss of sexual interest and function. Don't stop doing the non-intercourse

sex practices you and your wife have discovered. Finally, if erections are

important to you, we encourage you not to wait. The longer the blood vessels

stay blocked or leaking, the longer it will take to recover function.

_____

Categories:Diabetes

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<http://www.diabeteshealth.com/browse/complications-and-care/erectile-dysfun

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<http://www.diabeteshealth.com/browse/complications-and-care/sexual-issues/>

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