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Diabetes and ED

Patients with diabetes know that diabetes is a very insidious disease, causing potential problems with almost all organ systems. The penis is no exception. Men with diabetes are much more likely than other men to have ED, and many men (around 10%) who come to a doctor with ED are found to have diabetes that they didn’t even know about! Diabetes is particularly tough on the penis because it affects both nerves and blood vessels. In many men with diabetes, there is also a lowered testosterone level.

Unfortunately, pills do not work as well in men with diabetes compared with other men with ED. They are still often worth trying. Similarly, the other medications available for ED are often not as effective in men with diabetes. It is critical for men with diabetes to make sure their health is good, watch their blood sugars and blood pressure, not use tobacco, exercise, etc.

Prostate Cancer and ED

The nerves that are necessary for normal erection are located just next to the prostate. Therefore, any treatment for prostate cancer can cause ED. This includes surgery or any of the radiation or other approaches (external beam, IMRT, brachytherapy, cryotherapy, proton beam, etc). Many men are now getting their prostate removed with the robotically-assisted approach (“Da Vinci”), but this approach certainly does not guarantee preserving erection function and most studies show that the rate of ED is the same if a man has the robotically-assisted approach or the traditional open approach.

Although the rate of ED is not as high as it was before the new techniques, very few men feel that they are as potent after treatment as they were before. Some factors that determine the patient’s potency after treatment include their age, whether or not nerves could be spared, and their sexual function before the surgery.

Treatment for prostate cancer can also affect urinary control. Please visit the male incontinence section for more information.

There are many options for treatment of ED after treatment for prostate cancer. Pills do not work as well in men after treatment for prostate cancer compared with other men with ED. They are worth trying, but many men go on to try injections, suppositories, and/or vacuum devices. In men for whom these treatments do not work or are not satisfactory, a penile implant is often the best choice.

Neurologic Disease and ED

Men with a variety of neurological diseases and injuries may suffer from ED. However, it is treatable, particularly in men with spinal cord injuries. Because the blood vessels are often normal, many men with ED and neurologic issues do very well with medications, suppositories, or injections. In men for whom these treatments do not work or are not satisfactory, a penile implant is often the best choice.

Bicycling and ED

Bicycling is a very popular recreational activity and means of fitness all over the world; it is low impact, low cost, and efficient. Some people have proposed that bicycling is harmful for erections and there are many reports of ED resulting from bicycle injuries. Overall, however, the cardiovascular benefits of bicycling outweigh the smaller risk of ED. If a patient suspects that they may have ED from bicycling, they should make an appointment to see a Urologist. ED resulting from bicycle saddles or injuries is treatable. One of the most important elements is a good fit on the bicycle. Although of course this is important for serious amateur and professional cyclists, studies suggest that it may be even more important for novice and intermediate cyclists. There are several very experienced and “penis-savvy” professional bicycle fitters in the Salt Lake City area. Men from outside of the Salt Lake City area should consider discussing this with their local bike shop to see who is recommended locally.

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