Is It Erectile Dysfunction from Diabetes or Performance Anxiety?

Erectile dysfunction (ED) is the inability to have an erection firm enough for sexual intercourse, and it is common in diabetes. Erectile dysfunction in diabetes type 1 affects approximately 30 million men; further, more than one third of young men ages 18 to 35 with type 1 diabetes have ED (Fennell, 2016).  Erectile dysfunction is also prevalent in diabetes type 2. Half of the men who are diagnosed with type 2 diabetes will develop the disorder in just five to 10 years (Roland & Santos-Longhurst, 2016). Reporting research studies, Cowley (2017) asserts that between 35 and 75 percent of men with diabetes will eventually have difficulty with erections and intercourse. Erectile dysfunction from diabetes is pervasive, but is it an effect of diabetes, or is erectile dysfunction from performance anxiety? It seems that both are involved.

Erectile Dysfunction from Diabetes

It’s the nature of the disease. Every part of the body, including sex organs, can be damaged by chronically high blood sugar. In diabetes, glucose, a sugar produced during digestion, stays in the bloodstream rather than entering the cells of the body. High blood sugar, known as hyperglycemia, does extensive damage. Sexual health is an integral part of mental health, and by causing ED, diabetes interferes in life quality.

Regarding ED, hyperglycemia impairs nerves and blood vessels. Nerve damage—neuropathy—is highly associated with this sexual disorder. Damage to the pelvic nerves interferes in the communication between the brain and penis. When the nerves responsible for stimulation and response are damaged, full erection can’t be achieved.

Similarly, if blood vessels are sufficiently damaged, blood flow to the penis is decreased enough to make erection impossible. When a man is aroused, a chemical called nitrous oxide is released into the bloodstream. Its function is to relax the penile muscles for increased blood flow. However, the body produces less nitrous oxide when blood sugar is high and as a result, not enough flows to the penis and erection can’t happen.

Both types of diabetes cause the blood flow and blood vessel damage that leads to erectile dysfunction. This is frustrating and anxiety-provoking for many men. Can performance anxiety be at work here, too?

Erectile Dysfunction and Performance Anxiety

Diabetes and its effects like ED can cause mental health conditions such as stress and anxiety. Stress and anxiety can, in turn, cause, worsen, or prolong ED.

Performance anxiety causes erectile dysfunction in specific ways:

• Blood flow problems
• Stress Hormones
• Anxiety

In both diabetes and ED, blood flow to the penis becomes problematic. Whereas in diabetes blood flow is restricted by high blood sugar and the subsequent decrease in nitrous oxide production, in erectile dysfunction from performance anxiety, blood flow is decreased by stress hormones. In either case, reduced blood flow to the penis inhibits erection.

Stress hormones disrupt sexual functioning, too. Epinephrine, norepinephrine, and cortisol—three primary stress hormones—block the production of other hormones necessary for erections and sexual performance. Unfortunately, this can cause a terrible cycle. Stress causes the release of hormones that make erections difficult if not impossible. This causes anxiety, which leads to more hormone production. This creates a negative cycle of performance anxiety that involves:

• Worrying about ED
• Fear about performance
• Thoughts of inadequacy
• Increased body image issues, especially weight in type 2 diabetes

Performance anxiety can cause ED. If it were solely a matter of anxiety, ED would be easier to treat; unfortunately, with diabetes involved, mechanisms of the disease complicate matters. That doesn’t mean, though, that ED is inevitable or permanent.

Rising Above Erectile Dysfunction in Diabetes

The strategies in this list can help you reduce performance anxiety, improve diabetes, and stop ED:

• Manage blood sugar
• Exercise
• Eat healthy foods
• Lose weight
• Stop smoking if you smoke
• Seek counseling to manage anxiety and deal with ED
• Seek couples counseling to work through any sexual issues
• Have regular checkups with your primary doctor and all care providers, and talk openly and honestly about ED, as they can help

Whether erectile dysfunction is from diabetes, performance anxiety, or both, it can disrupt your life. The good news is that with treatment, ED can be temporary ("How to Reverse Erectile Dysfunction from Diabetes").

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