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Erectile dysfunction is a common occurrence in men with diabetes. The incidence of erectile dysfunction increases progressively with age, from 5% in men age 20 to 75% in men over age 65.

The cause of erectile dysfunction in men with diabetes is usually related to a decrease in the blood supply to the penis as well as to injury to the nerves that are responsible for the erection mechanism. A decrease in testosterone production has also been identified as the cause in some men with diabetes. Since 1998, when sildenafil (brand name Viagra) first came on the market, oral therapy has been successfully used to treat erectile dysfunction in many men with diabetes.

(Sildenafil was followed in 2003 by the drugs tadalafil [Cialis], vardenafil [Levitra] and avanafil [Stendra], which work in much the same way.) Some 50% of men with

Type

treat

Possible side effects of these drugs include headache, facial flushing, nasal congestion, and transient abnormal vision. (In October 2007, the FDA added a warning about sudden hearing loss to the package labels of oral erectile dysfunction drugs.

While it’s not absolutely clear that the drugs can cause sudden hearing loss, a number of cases have been reported in men within hours or days of taking one of the drugs.) — Learn More About Complications & Prevention >> Another common reason for failures of oral therapy is the absence of sexual or genital stimulation prior to attempting sexual intercourse. These medicines facilitate an erection by increasing blood flow to the penis, but they do not act as an aphrodisiac or as an initiator of the erection.

A man who is not “in the mood” or does not have adequate physical stimulation will not respond with an erection.

Yet another reason for the drugs not to work as intended is the consumption of a high-fat meal before or along with taking the drug.

The fat in such a meal can decrease absorption of the medicine from the gastrointestinal tract. It’s also possible for anxiety about intercourse after a prolonged period of abstinence, fear of side effects, or unaddressed psychological issues such as guilt or religious concerns about engaging in sexual intimacy to interfere with the ability to get and maintain an erection.

In many of these cases, a discussion between the physician, the man with erectile dysfunction, and possibly his partner can help to resolve the issues leading to treatment failure.

For men who experience severe side effects, can’t take the drugs for other reasons (such as

taking

It is unlikely that a man with diabetes who has other medical problems such as high blood pressure, buy

generic

Some doctors prefer to start a man on the lowest dose of an oral medicine and increase the dose until an effective one is found. Others prefer to start with the highest dose and go to a lower dose only if a man complains of side effects.

In either case, it’s important for a man to communicate with his doctor to let him know how the dose he’s using is working. For some men, daily administration of a low dose of one of the oral medicines may result in improved blood supply to the penis, resulting in better erections. Switching from one of the oral medicines to another may be tried before proceeding to a more invasive or costlier treatment. However, there are few studies that show any one of the drugs being significantly more effective than another. Low testosterone Before a man concludes that oral drugs don’t work for him, he should have his testosterone levels checked to rule out hormone deficiency as the cause of (or as buy generic sildenafil citrate a contributor to) his sexual dysfunction. Other symptoms of low testosterone include a low sex drive and infertility.

Checking testosterone levels requires a blood test.

If a man’s levels of testosterone are decreased or at the lower end of normal, his doctor may prescribe supplemental testosterone therapy, either as testosterone injections or testosterone gel, which is applied daily to the skin.

In some cases, testosterone therapy alone can resolve sexual dysfunction, or it can be combined with the use of oral erectile dysfunction drugs. Combining treatments Combination therapy has proven effective for some men who don’t respond adequately to oral medicines.

The idea is to use two drugs with different mechanisms of action for better results. Commonly, sildenafil is used in combination with pellets of alprostadil (synthetic prostaglandin E1) that are inserted into the urethra (the tube in the penis that carries urine from the bladder to the outside of the body).

Alprostadil also increases the blood supply to the penis, but by different means. Alprostadil can also be injected directly into the penis.

A very small needle about the size of those used to inject insulin is used for this purpose, so any pain or discomfort should be minimal.

Penile buy generic sildenafil citrate injections can be used alone or in combination with an oral drug.

Yet another common erectile dysfunction treatment that can be used in combination with oral drugs is a vacuum pump. This device consists of a plastic cylinder, a pump, a set of constriction bands, and a water-soluble lubricant. The lubricant is applied to the base of the penis to help form an airtight seal. The cylinder is placed over the flaccid penis and held tight against the pelvis.

The pump is used to create a vacuum within the cylinder, drawing blood into the penis. Once the penis is engorged with blood, a constriction band is rolled off the cylinder to near the base of the penis. The constriction band is helpful for men with venous leakage, in which blood flows out of the penis as fast as it flows in.

However, it should be left on for no more than 30 minutes at a time. Surgery Surgery for erectile dysfunction is usually considered only after all other options have failed. The two surgical options include the insertion of a semi-rigid rod or the implantation of a three-piece inflatable prosthesis.

Penile prosthesis implantation has low infection, complication, and malfunction rates. However, since placement of an implant requires permanent injury to the erectile tissue of the penis, implant treatment is considered irreversible.

For more information about the various options for treating erectile dysfunction, check out “Drugs and Devices for Erectile Dysfunction.” The emotional side No matter what the cause of erectile dysfunction, it is likely to cause feelings of stress buy viagra without a doctor prescription and other emotional reactions.

It’s also not uncommon for erection problems to cause tension in a relationship, particularly if one or both partners withdraws emotionally and the problem is not talked about.

And it’s possible for a man’s renewed ability to have intercourse after a period of no sexual activity to stir up relationship issues.