The Secrets of Living and Loving with Diabetes (Continued)
Viagra and Beyond
Viagra (Sidenafil), first on the block to treat ED, has been joined by two additional choices, Levitra (Vardenafil) and Cialis (Tadafil). All improve ED in men with diabetes, are well-tolerated, and have few side effects. Because they increase and maintain blood flow to the penis, they cannot be taken with medicines such as vasodilators and nitrates (used to treat angina or chest pain) that have a similar action. Speak with your physician to see if any are appropriate for you.
All three of these treatments have raised public awareness of this common and uncomfortable topic. These drugs work by increasing the body's nitric oxide levels, a substance that helps the penis fill with blood and develop a successful erection. A dose is taken prior to intercourse and requires sexual stimulation to produce results.
Levitra is another medication that works well in men with diabetes. Both Levitra and Viagra should be taken approximately one hour prior to intimate activity to allow adequate time to be spontaneous and romantic. Like Viagra, Levitra requires sexual stimulation for a successful erection.
Cialis can be taken up to 36 hours prior to intimate activity. This lets you and your partner enjoy time together at a natural and relaxed pace. It takes effect within 30 minutes and remains active in the system for up to 36 hours (plenty of time for sex and growing tomatoes!). The manufacturer encourages users to avoid excessive alcohol intake, defined as five glasses of wine or five shots of whiskey. In France, Cialis is called "Le Weekend" because of its long-lasting effect. One pill taken at a hearty lunch on a Friday is rumored to be all one needs to stay sexually active for an entire weekend.
Possible side effects from these medications include headache, nasal congestion, or upset stomach. Viagra and Levitra may induce a temporary blue tint in your vision that can last for several hours, but is not permanent or dangerous. These problems diminish with continued use.
This treatment sounds like a form of torture but actually works quite well. You inject a specially prepared medication, such as Alprostadil, directly into the penis with a convenient autoinjector. The medicine relaxes the penile tissues and helps an erection develop in a way that is similar to Viagra, Cialis and Levitra but has a higher success rate since it enters the penis directly. An erection occurs within 5 – 20 minutes and is usually enhanced by sexual stimulation. For most individuals, the effects last less than an hour. Injections should only be given once every 24 hours and not more often than three times a week. Sticking a needle directly into the penis may not sound appealing, but with few nerve endings at the injection site, any discomfort is minimal.
Instead of injecting Alprostadil, a suppository can be inserted into the penis. It works in the same way as a penile injection but does not have as high a success rate.
Patients with a testosterone deficiency can be easily treated with hormone replacement therapy, either by injection or skin patches. A simple non-fasting blood test checks for testosterone deficiency. Men on this type of therapy should be carefully screened for prostate cancer by taking regular blood tests for prostate-specific antigen (PSA) and by digital rectal examinations. Low testosterone is an uncommon cause of ED and only occurs in about 5 percent of all cases.
Vacuum Constrictor Devices
Mechanical devices are helpful and work best with a partner you know well, since they take some of the spontaneity out of sex and require understanding and support. A vacuum constrictor is a great option for men with diabetes. The device's plastic chamber is placed over the penis. A vacuum pump creates negative pressure within the chamber and enabled the penis to fill with blood. Once engorged, a thick rubber band-like ring is placed over the base of the penis to help hold the erection long enough for intercourse. No surgery or injection is required.
Constriction rings can also be used alone, without a vacuum device. They are ideal for men who are able to achieve, but can't maintain an erection. Known as venous flow constrictors, these rings are found in pharmacies or shops that specialize in sexual enhancement items.
Surgical implants range from semi-rigid to inflatable and use pumps to inflate and deflate the penis as desired. Surgical complications are low, especially when the patient's diabetes control is stable prior to surgery. The internal anatomy of the penis changes with the implantation of these devices, which makes other options ineffective if the implant ever needs to be removed. Surgery is normally considered after more conservative measures have been tried.
Lifestyle Approached to ED
1. Exercise Regular exercise improves circulation, energizes you, and can improve your mood — all important for sexual health. In addition to these benefits, exercise enhances insulin sensitivity, improves cardiovascular risk factors such as blood pressure and lipid levels, can reduce your need for diabetes medications, and helps you to meet your weight-loss goals. Choose a variety of activities to do daily or several times each week.
2. Stop Smoking Although smoking is a very difficult habit to stop, it's worthwhile to try because smoking can affect your sexual performance. Many treatment options, ranging from medications to support groups, can help you break the habit. If you are ready to quit, discuss the different smoking cessation options with your diabetes caregiver. Although smoking cessation is not the most powerful ED remedy, many men see dramatic improvement in their ED after quitting.
3. Limit Alcohol Intake Too much alcohol can make it difficult to get or maintain an erection, whether you have diabetes or not. Moderation is the key. Consume your alcoholic beverages with food to help prevent a low blood sugar reaction. Remember, alcoholic drinks have calories and can promote unwanted weight gain. If you do imbibe, regardless of the amount, test your blood sugar frequently so that you can treat both high and low levels.
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dLife's Sex & Intimacy Content is contributed & moderated by
Janis Roszler MSFT, RD, CDE, LDN
Janis Roszler, MSFT, RD, CDE, LD/N is the American Association of Diabetes Educators' 2008-2009 Diabetes Educator of the Year. She is a certified diabetes educator, marriage and family therapist, and registered dietitian. Her books include Sex and Diabetes (ADA) Diabetes on your OWN Terms (Marlowe & Co) and The Secrets of Living and Loving with Diabetes (Surrey books).
Donna Rice MSW, BSN, RN, CDE
Donna Rice MBA,RN,CDE,FAADE is the 2007 Past President of the American Association of Diabetes Educators. She is a registered nurse, diabetes educator and has developed numerous educational programs on sexual health and wellness. She is the co-author of Sex and Diabetes (ADA) and Diabetes and Erectile Dysfunction - A Quick ‘n' Easy Handbook For the Diabetes Educator (Bella Vita). Her newest publication is a children's book, The Magic is Me (Searchlight Press).