As people grow older, they may experience troublesome changes in sexual function. This includes difficulty with erections, which is known as impotence, or erectile dysfunction.

Impotence includes:

* The total inability to have an erection
* The inability to sustain an erection
* The occasional inability to have or sustain an erection.

There are several possible causes of impotence, including:

* Diabetes
* High blood pressure
* Kidney disease
* Alcoholism
* Blood vessel disease
* Side effects of medications
* Psychological factors
* Smoking
* Hormonal deficiencies.

Having diabetes can mean early onset and increased severity of impotence. By keeping the condition under control, however, you can lower your risk of diabetic impotence.

Understanding Nerves

When you want to take a step or lift your arm, your brain sends nerve signals to the appropriate muscles.
Internal organs like the heart and bladder are also controlled by nerve signals, but you do not have the same kind of conscious control over them as you do over your arms and legs.

The nerves that control your internal organs are called autonomic nerves, and they signal your body to digest food and circulate blood without you thinking about it. Your body’s response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax.

Damage to these autonomic nerves is what can hinder normal sexual function.

Diagnosing Diabetic Impotence

If you experience diabetic impotence, talking to your doctor about it is the first step in getting help. Your doctor may ask you about:

* Your medical history
* Your medications
* Your smoking and drinking habits
* The type and frequency of your sexual problems
* Other health conditions.

Your doctor may conduct a physical exam and laboratory tests to help pinpoint causes. Your blood glucose control and hormone levels also will be checked. The doctor may ask you whether you are depressed or have recently experienced upsetting changes in your life. In addition, you may be asked to do a test at home that checks for erections that occur while you sleep.

Treatment Options

Treatments for diabetic impotence caused by nerve damage (also called neuropathy) include:

* Oral pills
* A vacuum pump
* Pellets placed in the urethra
* Shots administered directly into the penis
* Surgery.

All of these methods have benefits and drawbacks. Psychotherapy to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries may also be considered.

Who Gets Diabetic Impotence?

Risk factors are conditions that increase your chances of getting a particular disease. The more risk factors you have, the greater your chances of developing that disease or condition. Diabetic neuropathy, including related diabetic impotence, appears to be more common in people who:

* Have poor blood glucose control
* Have high blood pressure
* Have high levels of blood cholesterol
* Are over the age of 40
* Are overweight
* Smoke.

Can It Be Prevented?

You can lower your risk of diabetic impotence by keeping your blood glucose, blood pressure, and cholesterol close to the target numbers your doctor recommends. Being physically active and maintaining a healthy weight can also help prevent long-term complications of diabetes.

Smoking is a particular problem — quitting will improve your health in many ways. If you quit smoking, you can lower your risk not only for nerve damage, but also for heart attack, stroke, and kidney disease.

Statistics on Diabetic Impotence

Diabetic impotence is estimated to affect 20 percent to 85 percent of men with diabetes. A recent study of a clinic population revealed that 5 percent of the men with impotence also had undiagnosed diabetes.

Men who have diabetes are three times more likely to experience impotence as men who do not have diabetes. Among men with impotence, those with diabetes are likely to have experienced the problem as much as 10 to 15 years earlier than men without diabetes.