In one study, nearly 40% of men with diabetes had erectile dysfunction.

In one study, nearly 40% of men with diabetes had erectile dysfunction.(ISTOCKPHOTO)Erectile dysfunction is a common problem in diabetes. Diabetic nerve damage and blood vessel disease are usually the culprits, although blood-pressure-lowering medication, stress, and depression can also play a role.

A study of nearly 28,000 men in Europe, North America and South America found that 16% of the men reported erectile dysfunction, but nearly 40% of those with diabetes had problems with erections.

Many men with diabetes can benefit from prescription medications, such as Viagra, Cialis, and Levitra, says Thomas Blevins, MD, an Austin, Texas–based endocrinologist.

But in the study, called "Men's Attitudes to Life Events and Sexuality," or "MALES," men with diabetes were more likely than other men to consider their erection problems "severe" and "permanent." Men with diabetes were also more likely to stop taking such drugs because they didn't solve their erection problems.

It important not to assume that erectile dysfunction is caused by diabetes itself, or to give up if Viagra or a similar drug doesn't work—there are other options.

If Viagra doesn't help, there are alternatives
Dick Robbins, 72, of Hot Springs Village, Ark., was diagnosed with type 2 diabetes in 2001. He experienced erectile dysfunction and saw a urologist for help. He tried Viagra with little success as well as another drug, alprostadil. Alprostadil is delivered via injection into the shaft of the penis or by suppositories inserted into the tip of the penis.

One of the important messages is, if you are having a problem, be sure and tell your doctor.

—William Bornstein, MD, EndocrinologistAlthough injecting a drug into the penis "sounds horrible," many men tolerate the injections well and find they are helpful, says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta.

A few years after his first wife died, Robbins remarried. He discussed his erectile dysfunction before they tied the knot.

"I haven't tried anything since then and she accepts that and we're living with it," he says. "We're in love with each other so that's secondary. When I was 20 years old, it was the most important thing in my life. Now that I'm 70, it's OK."

Talking to your doctor is key
"One of the important messages is, if you are having a problem, be sure and tell your doctor," Dr. Bornstein says. "Maybe he needs to change your medication or maybe we need to investigate whether there's some reason for it. There are lots of things we can do for that."

When pills don't work or can't be taken due to other medical conditions, one option is a vacuum pump. A man can use this device to temporarily expand his penis.

For a man who can get an erection but can't maintain it, rubber rings, called constriction rings, may be placed at the base of the penis. This will help retain the erection through intercourse.

There are also "surgical interventions that are also very effective, enabling men to get erections," says Dr. Bornstein.