These drugs all act in the same way but vary in how quickly they begin to work and how long the effect lasts. They help the blood vessel supplying blood to the penis to open up, allowing blood in faster than it drains out, and so the penis becomes stiffer for longer.
Because they cause the blood vessels to dilate, they can cause headaches, flushing, and runny nose as side effects. If you have heart disease and are taking nitrates, they may not be safe. They can sometimes cause problems with your vision, and if they work too well, can cause the penis to stay so stiff and engorged for hours on end that it can cause pain and damage to the penis (this condition is
called priapism).

All of these drugs work well for most men with diabetes who have erectile dysfunction. If they do not work, or if you are not able to take them because of side effects, then there are other options. An injection of papaverine or phentolamine or alprostadil given into the base of the penis can cause an erection sufficient to allow  intercourse.This is obviously a bit more painful and awkward than simply taking a pill but can be quite effective. Sometimes two of the drugs can be used together. Alprostadil can also be given by pushing a thin tube up the penis and injecting the drug from inside.

More mechanical solutions include vacuum devices to pull more blood into the penis until it is enlarged and stiff enough to allow intercourse. This is followed by placing a rubber band around the base of the penis to keep the penis stiff during intercourse. If the erectile dysfunction is due to a poor blood supply to the penis, then surgery to improve the blood supply can be successful. Plastic implants can also be inserted inside the penis to keep it stiff enough for intercourse.

Since the introduction of the phosphodiesterase-5 inhibitors a few years ago, it is much less common to need to use the alternative treatment that I have described. Your doctor can go over these options in more detail or can refer you to a sexual dysfunction specialist.

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Here are some of the things that you should explain to your partner. Your erectile dysfunction is not your partner’s fault. You still find your partner attractive. It is not your fault either. You are no less of a man because you have erectile dysfunction. Usually erectile dysfunction is not caused by a low testosterone level in men with diabetes (but your doctor will check to make sure). It is usually caused because the delicate nerves that cause blood to flow into your penis to make it stiffer have become damaged from diabetes. There are several treatments that can help. If you feel tense and under pressure to perform, your erectile dysfunction will get worse, so if you and your partner stay relaxed and good humored about it, things will go better. If you find other ways to give each other sensual pleasure without being under pressure to have sexual intercourse every time, this will help. Counselors at sexual dysfunction clinics often have specific techniques for you to try that can really help.

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