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In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex. Without blood vessels and nerves that control erection, ED can still occur despite a desire to have sex and normal male hormones.

Many other factors bear on erectile dysfunction amongst diabetic men.

Being overweight Smoking Taking too little exercise and other lifestyle factors. Surgery can damage nerves and arteries linked to the penis, as can some injuries. Many common medications (including antidepressants and blood pressure drugs) can produce ED.

Psychological factors also have an enormous influence.

Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of ED cases. Erectile dysfunction is diagnosed using several different methods. Patient history often informs the degree and nature of the ED.

Medical and sexual past often has an influence, as does prescription or illegal drug use.

ED patients may be physically examined, and bodily features can give clues to the cause. Laboratory tests can also be key for diagnosing ED. Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to cancel some causes out. Furthermore, psychological examination can reveal psychological factors.

Are there treatments for men with diabetes and erectile dysfunction?

Men who have diabetes and are having trouble achieving or maintaining an erection can take oral medicine The NHS can provide the following medications on prescription for men with diabetes: Brand names include: Viagra Cialis Levitra.

However, these medicines can all affect the heart rate, and detailed consultation with your doctor is necessary to determine the best course of action. Additional treatments include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy and sex therapy.

Psychotherapy can have an enormous influence on erectile dysfunction.

Further treatment such as surgery and vacuum devices may also have a role to play in some specific cases. Additional treatments include vacuum constriction devices, intraurethral alprostadil suppository or intracavernous injection therapy and sex therapy. Vacuum pumps consist of a plastic tube, in which you

place

A vacuum pump is not for use if you have a bleeding disorder or take anticoagulants.

Alprostadil is a form of hormone medication that stimulates blood flow to penis, and may be given by two different methods: Intracavernosal injection – whereby alprostadil is given by injection into the penis Intraurethral application – whereby a pellet (1.6mm diameter and 6mm length) of alprostadil is inserted into the urethra via a urethral stick. Alprostadil may be prescribed if you do not respond to other treatments, or you are unwilling to

try

Your health team may provide training on how to inject or insert alprostadil. The most suitable treatment will depend on the health of the patient and their own ability to tolerate the treatment.

Specialists such as urologists can work with individual cases and determine the best treatment. What is the future of diabetes and erectile dysfunction? Better medications, implants, vacuum devices

and

and

Cleveland Clinic is a non-profit academic medical center.

We do not endorse non-Cleveland Clinic products or services. While these are the most common methods, they may not work for everyone. For example, real cialis for sale male heart patients who take coronary vasodilators (to help open up coronary arteries) should not take medication for ED in the first place because both types of medications lower the blood pressure, and in combination, they lower the blood pressure too much, according to urologist Drogo “Karl” Montague, MD.

Fortunately for these men, there are a few other options, each with its own pros and cons. The choice generally comes down to personal preference, he says.

“We do see an increased percent of ED as men

age

“ED may also be the result of a relationship disturbance or death in the family.

When you have sudden onset of ED with somebody who has something [emotionally upsetting] going on in his life, it may well be related.” He recommends three other options for ED when medication or lifestyle changes do not solve the problem: 1. Some men use a vacuum device into which they insert their penis: They grease the tube, lower a rubber ring and squeeze a pump that creates a vacuum inside the chamber. With the rubber ring in place for 30 minutes, men often are then able to have sex, Dr. Some find it too mechanical, and it has a “hassle factor,” he says, and the device also can be uncomfortable and/or impede ejaculation.

Other men opt for a penile injection, using a diabetic’s syringe and needle. The injected medication dilates the arteries and increases blood flow every time they want to have sex.

The needle is small, so the injection is not terribly painful,

but

the

Those who would prefer not to use either of these first two options can turn to a surgical procedure. The surgeon inserts two cigar-shaped cylinders filled with saline attached to a small pump between the testicles and places a saline-filled reservoir inside the abdominal muscles.

None of this is visible from the outside, although you can feel the pump from the outside of the scrotum.

Squeezing that pump causes the saline to fill the cylinders, which simulates blood flow into the penis and causes “something close to a normal erection,” says Dr.

“The head of the penis doesn’t fill up, but otherwise it’s the same,” he says.

“Each time the man pumps it up, it gets fully firm.

But it gets firm, stays firm, and he doesn’t have to worry about

losing

It doesn’t go down until he withdraws and presses a relief valve.” The downside of implants is a 2 percent chance of infection, which requires removal of the device, and a 6 percent chance of the device failing within five years (and 19 percent within 10 years), Dr. “The attractive thing about an implant is that it’s part of your body,” he says. “If you go on vacation, you don’t have to remember to take syringes or medications.

It’s MRI safe, and it doesn’t set off any detectors at the airport. You can have sex whenever you want, at no cost per use, with the same response every time.” Surgical implants are typically not a man’s first choice, he adds, but men rate them most highly of all options in satisfaction surveys.

A man’s wife or significant other typically is supportive of a patient with erectile dysfunction, in the sense that partners typically say, “Honey, it’s OK. But he encourages partners to mention that it’s a common problem and that there are straightforward solutions that a man can discuss with his urologist.

“She should encourage him to mention this to the doctor as part of his annual checkup,” he says.

If a man has a problem in this area, he will invariably get referred to a urologist. If they fail, then they go to a urologist who specializes in erectile dysfunction.” Cleveland Clinic is a non-profit academic medical center. We do not endorse non-Cleveland Clinic products or services. Can Viagra, testosterone, or other drugs really restore your love life?

But the reverse is true, too: Good sex may help keep you healthy. "A satisfying sex life can foster good emotional health, which in turn can promote good physical health," says Julia Heiman, Ph.D., director of

The

Indeed, people who have strong, intimate relationships tend to have fewer chronic diseases and to live longer, some research suggests.

So there can be good reasons beyond just pleasure to address any significant loss of sexual appetite or activity, regardless of your age. The introduction of sildenafil ( Viagra ) a decade ago has graphically demonstrated that some sexual problems can be eased. But it has also fed the misconception that every sexual difficulty can—and should—be cured by popping a pill. More and more doctors, with little supporting evidence, are now prescribing sildenafil and related drugs not only to men but women too, as well as the hormone testosterone, in an effort to boost libido. And many consumers are buying DHEA (see caution) a potent hormone sold as a dietary supplement that the body converts to both testosterone and estrogen, with hopes of improving their sex drive and performance.

However, psychological issues, not physical ones, are usually the major culprits in the two most common sexual problems—lack of

desire

This report will help you talk intelligently with your doctor about when sex-enhancing drugs may be appropriate and when other steps-including leaving well enough alone-are enough. Despite the increasing use of testosterone to stoke waning sexual desire, our consultants say that it's rarely worthwhile, for several reasons.

There is little or no correlation between libido, sexual performance, and the normal age-related decline in testosterone.

There's little evidence of the therapy's long-term efficacy and safety. And many other factors—from stress and lack of sleep to changed feelings about a partner—can contribute to decreased sex drive.

When low testosterone levels are well below normal, sexuality and performance may be affected.

But those declines often stem from correctable health problems, notably pituitary or testicular disorders.

Even when those causes have been ruled out, taking testosterone is still a gamble.

In men, while it can boost libido in those who have clearly low levels, side effects include breast enlargement and decreased sperm production. And it may speed the growth of prostate cancer and increase the risk of blood clots. In women, some research suggests that restoring testosterone to a high normal level can increase sexual desire, at least temporarily. But it can also cause hair growth and acne, and may raise the risk of breast cancer.

And other possible risks are largely unknown because of lack of long-term studies. Moreover, the only testosterone product (EstraTest) approved for women in this country uses a combination that can reduce HDL (good) cholesterol. And while some doctors and pharmacists now compound special testosterone formulations for women, or use creams or gels intended for men, the safety and efficacy of such products or such use is even less well understood.

The reservations about

testosterone

That's because there's even less evidence of its safety and benefits and because it may increase both estrogen and testosterone levels. Further, dietary supplements are largely unregulated, so you don't know if what's on the label is in the bottle.

And your use of this potentially potent hormone is unlikely to be monitored by a physician.

What to do : Our consultants advise avoiding DHEA entirely, and taking testosterone only after evaluation by an endocrinologist, a specialist in hormone therapy.

(See "Testosterone Treatment in Men and Women," below).

Other measures—treating underlying disorders, adjusting drug dosages, reducing stress, or addressing problems in your relationship with your partner, with a therapist's help if necessary—should generally be tried first.

The therapist could be a traditional one, a marriage counselor, or a sex therapist who focuses on negative sexual attitudes or beliefs.

And remember that a lack of sexual desire is only a problem if you think it is.

A recent study published in the November 2008 issue of Obstetrics & Gynecology found, for example, that while 43 percent of women report sexual problems, most commonly reduced libido, only about 12 percent were actually bothered by it.

Testosterone treatment in men and women Despite its increasing use, testosterone should be prescribed only in very limited circumstances, described below.

Men Women Comments Consider testosterone replacement therapy if… You have signs of testosterone deficiency, notably bothersome decline in libido and potency, enlarged breasts, loss of body or facial hair, or osteoporosis, particularly before age 65.

AND Other causes of low testosterone or the associated problems have been ruled out or addressed.

AND You understand that long-term risks, especially for men with moderately low levels, are largely unknown.

You have bothersome decline in libido starting after ovary removal or possibly after

menopause

cancer

· Men should avoid it if they've had breast or prostate cancer or have high prostate or breast-cancer risk, major prostate enlargement, or elevated red-blood-cell count. Treatment options include… Injections (Delatestryl, Depo-Testosterone, Testro-La), patches (Androderm, Striant, Testoderm), or gels (AndroGel, Testim). · For women, some doctors use low doses of men's creams or gels or create special formulas, though their safety is unknown.

While anxiety sometimes causes erectile dysfunction, that disorder usually stems from physical problems, often the same ones that cause heart disease. Sildenafil ( Viagra ), tadalafil ( Cialis ), and vardenafil ( Levitra ) can help improve men's potency by dilating blood vessels in the penis, to allow for the increased blood flow necessary for an erection. However, such drugs should be used cautiously, since they can cause potentially serious side effects.

Those risks may include an increased chance of heart attack or stroke among men already at risk of such events-including those with coronary disease-as well as fertility problems and worsened sleep apnea.

In some men, the drugs may also cause temporary vision or hearing problems. And they can interact with many medications, most notably nitrates (used to relieve angina) and certain herbs, including St. What to do: Addressing coronary risk factors—reducing blood pressure, cholesterol levels, and weight, stopping smoking, exercising more, and rigorously treating diabetes—may help correct erectile dysfunction. Pelvic-muscle exercises called Kegels—where you tightly tense the muscles that interrupt the flow of urine or passage of gas—may be worth trying as well.

If reducing risk factors and performing Kegels don't help, men could consider erection-boosting medication. Tadalafil, which lasts for about 36 hours compared with 4 hours for the other two drugs, may be a good choice for men who value spontaneity, though side effects may also be prolonged. Men considering any impotence drug should first have a doctor assess their risk of heart disease and review all of their medications for possible interactions.

Reduced vaginal lubrication and clitoral sensitivity may sometimes stem from the same cardiovascular problems that can cause erectile

dysfunction

But more often those problems stem from declining estrogen levels after menopause. Sildenafil ( Viagra ) and related drugs may improve sexual function in some women, including those who experience side effects from antidepressant drugs such as fluoxetine ( Prozac and generic), paroxetine ( Paxil and generic), and sertraline ( Zoloft and generic), according to preliminary research. Supplemental estrogen can also help relieve that problem as well as vaginal dryness.

But both treatments pose risks, so should be used cautiously. What to do: In theory, reducing coronary risk factors may improve sexual function in women as it does in men.

Extended foreplay and nonpetroleum lubricants like K-Y Jelly and Replens can usually provide sufficient moisture. Staying sexually active may also help keep the vagina moist and responsive. Those steps, combined if necessary with treatment of a partner's sexual problems or of issues that impair libido, may improve a woman's ability to achieve orgasm as well. Women who want to try estrogen for dryness or possibly insensitivity can use creams (Estrace, Premarin) or vaginal inserts (Estring), which allow you to use smaller doses that are less likely to increase the risk of breast cancer and heart disease.

If those don't help, consider short-term use of low-dose estrogen pills or patches, provided you're not at high risk of those diseases. Women with antidepressant-related sexual problems should try other measures before talking with their doctor about possibly trying sildenafil. For example, they could try a lower dose or switch to generic bupropion, since some research suggests it's less

likely

There are currently no drugs approved for treating premature ejaculation, the most common form of sexual dysfunction in men. But some doctors do prescribe antidepressants such as fluoxetine ( Prozac and generic), paroxetine ( Paxil and generic), and sertraline ( Zoloft and generic) for premature ejaculation, since one of their common side effects is to inhibit orgasm. Unfortunately, they probably have to be taken daily, not just before sex, and can cause a number of side effects.

Some other doctors prescribe topical anesthetics, such as lidocaine, but the evidence for such use is sparse.

What to do: You may be able to ease the anxiety and overexcitement that often underlie premature ejaculation by having sex more often, prolonging foreplay, and trying not to worry during or after sex, regardless of the outcome. Or talk with a sex therapist about other approaches that may train men to gain physical control over ejaculation.

Before resorting to medication or hormones to treat sexual problems, you and your doctor should first consider whether the problem stems from an underlying disorder or a medication you take.

In some cases your doctor could ease or eliminate the problem by changing the prescription or treating the disorder.

Note that some side effects listed here may be only theoretical, particularly in women, or based on limited evidence, and that the list may not be complete. If you experience a sexual side effect soon after starting any new medication, ask your doctor if the drug could be contributing to the problem.

Note that many of the brand-name drugs listed below are also available as generics.

It’s the truth: You reach a certain age where

having

Many factors can contribute to erectile dysfunction (ED) — anything from smoking to cardiovascular disease to general stress — and you shouldn’t be shy about discussing any erectile

problems

If there’s an underlying health condition causing your troubles, treating the cause may get you back to top form in no time.

Of course, these days we also have a variety of medication available to help men achieve and maintain an erection.

But before you pop a pill, try these natural tips for sexual health. Smoking causes arteries to become stiff, which can have the opposite effect on your erection. Decreased blood flow to your sexual organs can make it difficult to achieve an erection. It can’t be stressed enough — a healthy diet and lifestyle has numerous benefits, including in the bedroom. ED is linked to cardiovascular disease and diabetes, so eating a Mediterranean-style diet rich in fresh fruits and vegetables, healthy fats, and whole grains can reduce your chance of developing heart problems and, in turn, can alleviate your ED. Studies have shown that engaging in aerobic exercise at mid-life may treat erectile dysfunction.