To understand how diabetes leads to erectile dysfunction (ED), you first have to understand how erections work. Getting an erection is really a complicated process.
Anatomy of an Erection
In the shaft of the penis there are two side-by-side chambers of spongy tissue called the corpora cavernosa. They're mainly responsible for erections. Just below them is another chamber called the corpus spongiosum. The urethra, which carries semen and urine, runs through the center of it.
The corpora cavernosa are made of small arteries and veins, smooth muscle fiber, and empty spaces. The chambers are wrapped in a sheath of thin tissue.
When you get an erection, nerve signals from your brain or from the nerve endings in your penis cause the smooth muscle of the chambers to relax and arteries to dilate, or open wider. This allows a rush of blood to fill the empty spaces.
The pressure of blood flow causes the sheath of tissue around the chambers to press on veins that normally drain blood out of the penis. That traps blood in the penis. As more blood flows in, the penis expands and stiffens, and you have an erection.
When the excitement ends, the smooth muscle contracts again, taking pressure off the veins and allowing blood to flow back out of the penis. Then the penis returns to a flaccid state.
Diabetes: A Perfect Storm for Erectile Dysfunction
Many common problems related to diabetes all come together to cause erectile dysfunction. That's why various studies show that 35% to 75% of men with diabetes will develop some degree of erectile dysfunction. If you are having difficulty getting erections, there may be a number of things going on in your body.
Nitric oxide is a chemical released into the bloodstream by the lining of blood vessels. It acts as a kind of chemical messenger that tells the smooth muscles and arteries in the penis to relax and let in blood.
High blood sugar, which must be managed carefully if you have diabetes, causes blood vessel and nerve damage that affects many processes in the body. Sexual response is one of them. Damage to the blood vessels blocks the release of nitric oxide. A lack of nitric oxide results in constricted blood vessels and reduces blood flow to the penis.
What's more, according to the American Diabetes Association, 73% of adults with diabetes have high blood pressure or take blood pressure medication. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow.
High cholesterol is also common in people with diabetes. LDL cholesterol, or what's called "bad" cholesterol, can interfere with the ability of blood vessels to dilate. High cholesterol levels result in fatty deposits in artery walls. This buildup of fatty deposit can reduce blood flow.
Some of the choices that men with diabetes make also feed into this "perfect storm." Smoking, especially. Smoking by itself reduces blood flow all through the body.
Last but not least, feeling badly about your health can lead to erectile dysfunction. For most men, erectile dysfunction is mainly a physical problem, but the mind always plays some part in sexual arousal.
Although having diabetes means that you may encounter problems with your sexual functioning, you really can turn it around. By living a healthy lifestyle and working with your doctor, you can get your diabetes under control and treat erectile dysfunction if it becomes a problem for you.
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