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Medications and erectile dysfunction in men

By Alison Crow, Pharmacist and CDE

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

As health professionals it is important to have an awareness of common medication groups that can induce erectile dysfunction in men. Medications can impact on both the desire to have sex, and on ejaculation.

Diabetes and erectile dysfunction

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, reducing the desire to engage in 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.

Young men with type 1 diabetes may also experience ED. One overseas study focusing on 151 young men aged up to 35 years with type 1 diabetes quoted the overall prevalence of ED in this group was 37% with over 58% of this group reporting mild ED.3

Whilst erectile dysfunction is considered primarily a condition experienced by older males, men of younger age that live with diabetes can also experience ED.

Medications associated with Erectile Dysfunction

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
Tricyclic antidepressants
Antipsychotics For example, Olanzapine, risperidone
Allergy For example, cimetidine
Antiepileptics For example, Gabapentin, topiramate

 

Recreational drugs common in society may also cause erectile dysfunction. These include nicotine, alcohol and illegal drugs such as cocaine, amphetamines, and marijuana.

Other causes

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

Healthy lifestyle modifications that may help reduce erectile dysfunction in men with diabetes include;

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

Medication treatment options

Medications called phosphodiesterase 5 inhibitors (PDE5i)s are the most commonly available treatment for erectile dysfunction and include:

  • sildenafil
  • tadalafil

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 and requires that both the health professional and the patient 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.

Patients on long term medication may be unaware that 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 medication non-compliance. A variety of strategies exist to reverse medication induced erectile dysfunction including drug switching, dose reduction and drug holidays.

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. Having an open discussion with your patients about erectile dysfunction and its causes can help patients and their partners to have a greater understanding of diabetes complications, and treatment options and empower them to have a healthier sex life.

 

To learn more about diabetes and how you can support the people you see, view our CPD accredited range of online learning programs here

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