Q:   I have had diabetes for 12 years and recently have had difficulty maintaining an erection. What can I do?
A:  

Erectile dysfunction in patients with diabetes can have complicated origins. If a careful review of hypertensive or other medication does not reveal a culprit and the patient still has the sexual desire, then the dysfunction may be due to diabetic neuropathy.

This is a common term for dysfunction of the sensory, motor and autonomic nerves that occurs with long-term diabetes. Scientists have not figured out how diabetic neuropathy occurs, but they do know it tends to strike diabetic patients who have had diabetes for a long time or diabetics who do not control their blood sugars well. Even though glucose itself does not seem to cause nerve damage, it may trigger another mechanism that does.

The specific neuropathy that affects the genitals is a combination of autonomic neuropathy and motor neuropathy. Currently there are no cures for diabetic neuropathy, but there are advancements in treating the symptoms.

Previously, injection of the penis with medications or applications with medications were the few medical options available, but prolonged, painful erections were a side effect. Mechanically, vacuum pumps can also be used with some success. Recently, sildenafil (Viagra) has been shown to improve sexual function in 50 percent of diabetic patients; however, since most diabetic patients have heart disease, a careful cardiac exam with review of cardiac medications is needed prior to starting sildenafil because of the medication's cardiac side effects.

Prevention of further neuropathy seems to occur with tight control of blood sugar and the stopping of drinking and smoking.

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