The Hidden Link between Erectile Dysfunction and Insulin Resistance

By: Dr. Denise Renye

As an online sex therapist, I continue to invest in courses that expand my understanding of mental and sexual health so I can better serve the folx I work with. Recently I learned more about the hidden link between erectile dysfunction (ED) and insulin resistance.

First, some definitions. ED means the following:

·      Getting an erection sometimes, but not every time, the person wants to have intercourse.

·      The erection not lasting long enough for fulfilling or "satisfactory" intercourse. (Note: Even though medically defined concerns and disorders use words like “satisfactory,” it is very subjective as to what that actually means. Only those in the relationship itself can truly come to an agreement as to what “satisfactory” is.)

·      Not getting an erection at all.

Insulin resistance is when your muscle, fat, and liver cells don't respond as they should to insulin, a hormone that regulates blood sugar or glucose. Glucose can't enter the cells as easily, so it builds up in the blood and can eventually lead to type 2 diabetes. According to Dr. Benjamin Bikman, who focuses on metabolic disorders, insulin resistance contributes to ED through the following mechanisms:

1.     Endothelial dysfunction and impaired blood flow. Insulin resistance leads to endothelial dysfunction, which is when the lining of the blood vessels (endothelium) does not function properly. This reduces nitric oxide (NO) production, essential for vasodilation and penile erection. Without sufficient NO, blood vessels fail to relax properly, impairing erectile function.

2.     Chronic inflammation and oxidative stress. High blood sugar and insulin resistance increase inflammation throughout the body as well as oxidative stress. This damages the blood vessels and nerves involved in sexual function.

3.     Hormonal imbalances. Insulin resistance is often associated with low testosterone levels, which further contributes to ED by reducing libido and impairing erectile function.

4.     Neuropathy and nerve damage. If left untreated, over time insulin resistance can lead to diabetic neuropathy. This damages the nerves throughout the body, including the ones responsible for erectile function. The neuropathy can also reduce penile sensitivity.

5.     Cardiovascular disease. Again, because insulin resistance is connected with blood flow, left untreated it can create cardiovascular disease. Typically, cardiovascular disease means some issue with blood flow overall, including blood flow to the penis.

I’m not a medical doctor so I can’t speak to medical options for ED treatment but as an online sex therapist, my role is part of the holistic approach to treating ED. It’s important to integrate both physiological and psychological interventions because otherwise the person is putting a Band-Aid over the problem and treating the root cause.

Medications such as PDE5 inhibitors (e.g., Viagra and Cialis) can help with penis functionality but do not address either the underlying metabolic dysfunction or the emotional and relational aspects of sexual health associated with ED. Many individuals with ED experience performance anxiety or shame. That’s because in a patriarchal society, “hardness” is valued – both in and out of the bedroom. Patriarchy encourages people to be cutthroat in the workplace and also to be the “boss” at home. In terms of erectile dysfunction, there can be deep shame not only about the erection itself, but also the experience of being “too soft” generally.

If “hardness” is associated with “manliness,” then the inability to be hard translates into being less of a man, the thinking goes. This is not true but due to the social conditioning we’re all receiving living under patriarchy, it permeates our culture and puts a great deal of pressure on those with penises.

Furthermore, people with ED can be disconnected from their bodies. That’s been true with the people I’ve worked with. They are often complex and intricate thinkers. They are highly intellectual, which is fabulous and has gotten them far in life. They are usually very successful in the traditional way society measures success (material wealth, high status, etc.). However, in addition to buying into the patriarchal messages society sends about how they "should" behave and feel, they have also divorced themselves from their bodies.

They could be dissociated from their bodies after years of intensely focused academic study, climbing the corporate ladder, or using their minds to develop the latest advanced technology to change the world. They have learned not to listen to their bodies and are unable to decipher the messages their bodies are sending. That disconnection can impact them in and out of the bedroom.

How do folx reconnect with their bodies? I have a meditation for that, but also generally mindfulness, breathwork, and guided touch exercises can help individuals regain confidence in their sexual response by fostering a deeper awareness of bodily sensations. Also, cognitive-behavioral strategies can assist in reframing negative thoughts about performance and sexual adequacy, which reduces the cycle of anxiety that often exacerbates ED.

And for people who are partnered, sex therapy can play a crucial role in improving communication between partners. Many couples struggle with unspoken fears and frustrations related to ED, which can lead to emotional distance and avoidance of intimacy. As an online sex therapist, I can facilitate conversations that help partners navigate these challenges with openness and compassion. We shift the focus from performance to pleasure and connection.

For patients with ED, I also encourage sensate focus exercises, which involve non-demand, consensual, exploratory touch. These are sensual exercises, not overtly sexual ones, and can help rebuild intimacy without the pressure of achieving an erection.

Bottom line, by integrating sex therapy with medical and lifestyle interventions, people can not only improve their erectile function but also cultivate a more fulfilling and resilient sexual relationship. If that’s something you’d like support with, schedule an appointment. As an online sex therapist, I’m here to help with ED or any other sexual challenge you may be experiencing.