AskNadia: Type 2 & Difficulty in Getting an Erection

Dear Nadia:

I have had type 2 diabetes for 20 years and it is difficult to get or maintain an erection. I don’t want to talk to my doctor about it until I know what my options are. So, I have been reading up online about my different alternatives.  Do know which therapy works the best?


Dear John:

There are several recommended therapies for what is now commonly called “erectile dysfunction.” I’m fairly certain, based on what you’ve told me, that you are familiar with most or all of them. They are:

Pills, such as Viagra, Cialis, and Levitra that act to direct blood to the penis and allow it to become erect for several hours. Drawbacks to these pills is that they can interact with some prescription drugs to lower blood pressure to dangerous levels.

Penile injections, using a drug called Alprostadil, which causes an erection. This therapy is often recommended for men who cannot take pills for ED. An interesting potential side effect is priaprism, a condition where the penis stays erect for hours at a time throughout the day. (Priaprism used to be considered the result of a mental condition, but the development of drugs that can inadvertently cause it has broadened its definition.)

MUSE (Medicated Urethral System for Erection) is a pellet inserted into the urethra that produces and hour-long erection within minutes. Side effects can be unpalatable: redness, burning, minor bleeding, etc.

Surgical implants work in two ways: 1.) Inflatable cylinders are implanted into the penis that can be pumped up with liquid to produce an erection; and 2.) a flexible prosthesis that can be aligned into the position of an erection and allow for successful penetration.

Vacuum pumps are an old solution to ED. A user places a plastic cylinder over his penis and pumps the air out of it. The resulting drop in air pressure around the penis allows it to become engorged with blood: an erection. Pumps have a fairly high success rate—75 percent among users—but the erections they produce don’t last as long as erections produced by other treatments and users have to be careful about subjecting their penises to prolonged low to non-existent air pressure.

Sometimes ED is mental: Performance anxieties, stress, a relationship going south can make it difficult to achieve an erection. That’s where sex therapy can come in, either solo or with a partner.

What Works Best?


You asked which “works best.” I’m assuming what you’re asking is what works best in terms of reliability and repeatability?  Assuming that you are in reasonably good health, the shortest and most direct route to overcoming ED would seem to be the pills. They have become the first line of treatment among the public and healthcare providers.

There is another factor to consider because you have diabetes: Neuropathy, the gradual affliction and deadening of nerves from high blood sugars, can lead to ED.  The good news here is that the pills listed above have become a standard treatment for diabetes-related ED. They certainly can be the first treatment you ask your doctor about.

Bear in mind that your doctor has been asked and addressed this one questions you want to ask. Find out what treatment(s) seems to mesh best with your metabolism and mental state and go from there. You can always circle back to try a different approach if the first therapy doesn’t work for you.

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Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

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 About Nadia:

AskNadia (ranked #1 by Google), named “Best Diabetes Blog for 2019 by Healthline. With 24 nominations, Nadia Al-Samarrie’s efforts have made her stand out as a pioneer and leading patient advocate in the diabetes community.


Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.


Under her reign- Diabetes Health magazine was named one of the top 10 magazines to follow in the world for 2019 by Feedspot Blog Reader.


Nadia has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized, and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.


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