Erectile dysfunction, (ED), also known as impotence, is the inability to achieve and sustain an erection adequate for sexual intercourse. ED is the third most common complication of diabetes reported amongst men¹.

It’s important to have an awareness of common medication groups that can cause ED. Medications can affect both the desire to have sex and ejaculation.

Diabetes and Erectile Dysfunction

Firstly, for men with diabetes, reduced blood flow and nerve damage can be the underlying issue of erectile dysfunction. Mental health, body image and high blood glucose levels can affect libido. They reduce the desire to have sex.

Erectile dysfunction is often considered a condition of older males. Demographics of erectile dysfunction in men in Australia have been reported as:

• 61% of men over 45 years presented some form of erectile dysfunction²,
• 20% of men with diabetes experience significant ED in the late 40 years or older². The type of diabetes was not reported.

While erectile dysfunction is considered primarily a condition experienced by older males, younger men who live with diabetes can also experience ED.

Medications associated with Erectile Dysfunction

Secondly, men living with diabetes will often be treated for other conditions such as depression or cardiovascular conditions.  Common medications used by men living with diabetes that are associated with erectile dysfunction include⁴:

Condition	Medication Group
Cardiovascular	Beta-blockers
Depression	Selective serotonin reuptake inhibitors Serotonin noradrenaline reuptake inhibitors Serotonin noradrenaline reuptake inhibitors
Antipsychotics	For example, Olanzapine, risperidone
Allergy	For example, cimetidine
Antiepileptics	For example, Gabapentin, topiramate

Recreational drugs can also cause ED. These include nicotine, alcohol and illegal drugs such as cocaine, amphetamines, and marijuana.

Other causes of Erectile Dysfunction

Thirdly, other factors that may contribute to or cause erectile dysfunction in men include:

• Being tired, stressed and depressed
• Smoking and maintaining an unhealthy weight
• Spinal cord injury, pelvic surgery, multiple sclerosis

Lifestyle modification

Fourthly, healthy lifestyle modifications that may help reduce erectile dysfunction in men with diabetes include:

• stop smoking
• decrease alcohol intake
• healthy eating including 2 serves of fruit and 5 serves of vegetables each day
• exercise
• maintain blood glucose levels in target range
• medications and devices.

Medication treatment options

Importantly, medications called phosphodiesterase 5 inhibitors (PDE5i) are the most commonly available treatment for erectile dysfunction and include:

• sildenafil
• tadalafil
• vardenafil

These medications are taken about one hour before the desired effect. These medications are not suitable for people taking nitrate medications.

Other treatments for ED include vacuum pumps, injections (alprostadil) or inflatable prosthesis.

Patient discussion

Initiating a conversation about erectile dysfunction is sensitive. It requires both the health professional and the client to be willing to talk about the issue.

Medications can cause specific issues in relation to sexual dysfunction and include:

• decreased sexual desire
• decreased sexual arousal
• difficulties with ejaculation.

As a result, people on long term medication may be unaware their medication may have caused their sexual dysfunction problem.

Some health professionals may be reluctant to discuss adverse effects of prescribed medications as it may lead to clients deciding not to take their medication.

A variety of strategies exist to reverse medication induced erectile dysfunction including drug switching, dose reduction and drug holidays.

Difficult to identify the cause

As men living with diabetes are at increased risk of erectile dysfunction, it may be difficult to identify if it is a medication or diabetes that is contributing to the issue.

Ring the NDSS helpline on 1800 637 700 to have a confidential chat to our diabetes health professionals. They know about diabetes, so you won’t have to explain about your condition.

Finally, having an open discussion with your regular health professional about erectile dysfunction and its causes can help you and your partner.

You can develop a greater understanding of diabetes complications and treatment options.

It can also empower you to have a healthier sex life.

References

1. A comprehensive review of urologic complications in patients with diabetes, Springerplus, 2014 3:549.
2. Much more than prescribing a pill – Assessment and treatment of erectile dysfunction by the general practitioner Volume 46, No.9, September 2017 Pages 634-639 https://www.racgp.org.au/afp/2017/september/much-more-than-prescribing-a-pill/
3. Erectile dysfunction in young men with type 1 diabetes. Int J Impot Res 2017 Jan;29(1):17-22. https://pubmed.ncbi.nlm.nih.gov/27654032/
4. Drug-induced sexual dysfunction in men and women. Aust Prescr 2013;36:42-5. https://doi.org/10.18773/austprescr.2013.021

By Alison Crow

Pharmacist and Credentialled Diabetes Educator