When it comes to sex and diabetes, it’s sometimes hard not to get discouraged. Estimates of the number of diabetic men who experience sexual dysfunction range from 20 percent to a stunning 80 percent. And men with diabetes are three times more likely to experience sexual problems than men without diabetes.

Neuropathy, or nerve damage, is the primary culprit, but other contributors are lack of nitric oxide, a chemical that helps dilate your blood vessels, and damage to the blood vessel walls, which also reduces blood flow to the penis. On top of this, there are the medications that are often prescribed to men with diabetes, which can have side effects that cause difficulties with sexual functioning.

Peter, Meet ED

Fortunately, discussion about sexual dysfunction’s come a long way. For something that was never mentioned in good company, it’s out of the closet in a big way. It’s even got its own nickname these days: ED, for Erectile Dysfunction. The new openness is due in large part to Viagra, which brought ED out into the open and made it much less embarrassing to talk about with your doctor. Viagra, one of a group of drugs that also includes Cialis and Levitra, works by increasing blood flow to the penis and blocking the enzyme that allows blood to drain from the penis. As a result, an erection occurs naturally and stays around for quite awhile.

What’s Up, Doc?

Your doctor might tell you that Viagra is not for you because you have physical conditions that won’t allow it, you’re taking medications that don’t mix well with it, or your particular condition won’t respond to it. Nevertheless, you’re well on your way to a solution just because you’ve managed to bring up the topic of ED with your doctor. Now you can begin to discuss the plethora of other options that are available to restore your sex life. There’s a real can-do attitude out there when it comes to ED, and there’s no reason why you won’t be able to find something that works for you.

You might want to try penile injection therapy, in which you inject a medication directly into the penis that causes blood vessels to widen, allowing blood to flow more freely and create an erection. The idea of an injection might be a bit threatening, but in fact it’s really simple and works well for many men.

To use another method, known as intra-urethral pellet therapy, you place a tiny medicated pellet inside the tip of the penis. As the pellet dissolves, it releases medication that increases blood flow and causes stiffness in about five to ten minutes.

Then there’s the vacuum pump. To use this, you place a plastic device over the penis, and a vacuum withdraws all the air from around it, causing blood to flow into the penis and making it rise like a balloon. Then you put a constriction ring around the base of the penis to hold the blood in place. It’s a bit bulky and awkward to use at first, but it’s cheap and easy, and it often does the trick If these simpler treatments are unsuccessful, there are about 15 different models of penile prostheses available for surgical implant, and they’re far more sophisticated than they used to be. One, for instance, involves placement of two silicon rods into the penis, which keep it in a state of semi-erection constantly. Your doctor or urologist can tell you about the others and whether one might be right for you.

Talk It Over

Of course, it’s important to talk to your partner about what you’re going through if you’re concerned about erectile dysfunction. Sometimes just worrying about ED can cause ED, so talking to your partner might be all it takes. If you think it might help you, sex therapy is an option that can teach you and your partner about paths to satisfying sex that you may not have considered.

The most important thing, however, is not to give up. Sex is extremely important to a healthy life. After having sex, hormones are released in men that contribute to a feeling of love and attachment. You don’t want to let those feelings die. Go ahead and talk to your doctor about ED. It’s a very common problem, and it’s very often fixable. And remember to tell your partner what’s going on, because even if medical solutions aren’t your cup of tea, there’s more than one way to have sex—even if ED’s in bed with you.