Brief Answer:
First make sure that your ED is due to diabetes and not some other issue

Detailed Answer:
Good afternoon.

In response to your question my first suggestion is that there be a thorough analysis to be sure that your ED is due to diabetic neuropathy and not something else that is more easily correctable or treatable such as low hormonal levels. I refer to your age of 65 where hormonal issues can be prevalent.

The other detail I'd like to point out is that the role of diabetes in ED is more felt to be one of how diabetes affects the NEUROVASCULAR control of blood flow to the penis AS WELL AS the nerves that innervate the penis which are responsible to transmitting sensation back to the brain and spinal cord which is essential to trigger the excitatory pathways which eventually lead to the release of chemical substances that cause vasodilation and persistent engorgement of the penis long enough so that copulation can successfully take place.

In other words, it's not just an issue of "blocked" blood flow in "closed" arteries but a conjunction of blood flow in blood vessels which may cause microvascular blockages to flow as well as the neural control mechanisms that alter caliber of the arterial system as well as the neural control mechanisms that feed the autonomic nervous system that is part of the brain and spinal cord which feed the final common pathway in order to release the nitric oxide that results in VASODILATION.

The very best and most direct method of treating ALL AFFECTED FACTORS and PATHWAYS which are necessary to normal erectile processes to take place is TIGHT GLYCEMIC CONTROL. Doing that 1 thing well and consistently will make the most overall difference to this problems.

However, on the medication side of the equation you can consider the following agents which are the most popular oral agents:

1. Vardenafil
2. Sildenafil
3. Tadalafil
4. Avanafil

These are still by far considered the best first line choices to treat erectile dysfunction due to their robust and specific mechanisms of action.

If the above drugs are not effective enough or if they lose their effectiveness then, intraurethral injection of ALPROSTODIL can be attempted. Papverine and phentolamine can also be injected as treatments though these are a bit older drugs which are considered somewhat less robust.

In addition to the oral medications I mentioned above there are 2 devices you may or may not have heard about:

1. Vacuum pump units that can allow an erection to occur by basically DRAWING BLOOD into the penis due to the presence of a vacuum

2. Penile implants which is a surgical procedure and not really indicated for all people.

Other suggestions which have quite an impact on ED in general and need to be also followed would be SMOKING CESSATION, WEIGHT LOSS, ROUTINE EXERCISE/CONDITIONING/PHYSICAL ACTIVITY. LIMITED ALCOHOL INTAKE (not just BEFORE sex but at all times....limited).

I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 31 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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