It may be surprising to learn that a common challenge of men with diabetes is erectile dysfunction (ED). That’s not being able to get an erection or keep one long enough to have sex. In some cases, ED is even the first sign of diabetes in men. A summary of several studies shows that: Men with diabetes are 2 to 3 times more likely than men without diabetes to have ED. Men with diabetes can start to have ED 10 to 15 years earlier than men without diabetes. ED is less likely in men whose diabetes is well controlled. What Causes ED With Diabetes? To understand the connection between ED and diabetes, you need to know a few things about each individual condition. An erection is a complex event involving hormone and nerve pathways, muscles, and blood vessels. Any disease or injury that affects the blood vessels, muscles, or nerves can make it difficult to achieve and maintain an erection. Diabetes occurs when the body isn’t able to effectively convert sugar into energy. This causes high blood sugar levels, which, over time—and especially when diabetes is not well controlled—damages the nerves and blood vessels. Since erections depend on a healthy nervous system and increased blood flow to the penis, diabetes greatly increases the likelihood of ED. But, diabetes isn’t always the direct cause. Here are other health challenges common in people with diabetes and also linked to ED: Medical conditions that commonly occur in men with diabetes. Heart disease, obesity, high blood pressure, and depression can all lead to ED. In many cases, getting these medical conditions under control can increase sexual function. Medications. These include medications used to treat diabetes or its complications, such as depression and high blood pressure. Your doctor may be able to change your medication or combination of medications to see if ED resolves. Habits that commonly occur in men with diabetes. Poor diet, smoking, and lack of physical activity can make ED worse. Changing these behaviors can help restore sexual function. Hormone imbalances. Men with diabetes can in some cases have abnormally high or low levels of certain hormones, such as testosterone. Doctors can often treat hormone imbalances with oral medication. Mental or emotional health conditions including depression, anxiety and stress. These account for a small percentage of ED cases, according to the American Diabetes Association. Treatments for Erectile Dysfunction If you have diabetes and problems getting an erection, keeping your blood sugar levels under control will help you avoid long-term problems with ED, and you have a good chance of regaining sexual function. If treating and managing underlying conditions has not improved your ED, ask your doctor about these more direct ED treatments: Oral medications, such as sildenafil citrate (Viagra) or tadalafil (Cialis) Suppository medications inserted into the tip of the penis Vacuum erection devices (penis pumps) that help draw blood into the penis Self-injected medication into the base of the penis Penile implants, which is surgery to place bendable or inflatable rods into the penis The right treatment for you can depend on how well controlled your diabetes is, other medical conditions you have, and your personal and sexual partner’s preferences.