Diabetes and erectile dysfunction: why the silence?

Malawi is among countries in sub-Saharan Africa with an increasing prevalence rate of diabetes among adults aged 20-79 years olds, with an estimated figure of 468,00 people living with diabetes.

The major risk factors, according to medical researchers, include physical inactivity, obesity, psychosocial stress, smoking, unhealthy diet and excessive alcohol drinking.

More men compared to women have diabetes mellitus which collaborates global estimates that 17.7 million more men than women are diagnosed with type 2 diabetes.

Additionally, diabetes can cause various health complications which hit men below the belt causing erectile dysfunction, in which a man can’t get or keep an erection firm enough for sex.

According to the Centre for Disease Control (CDC), erectile dysfunction is common in middle-aged and older men as high blood sugar damages nerves and blood vessels needed to have an erection.

The CDC research shows that men with diabetes are 3 times more likely to have erectile dysfunction, but 95% of cases are treatable.

However, here in Malawi, there is little or no effort at all to help men in addressing such mental and psychosocial issues originating from effects of diabetes in their sexual and reproductive health.

The Diabetes Association of Malawi-DAM acknowledges that erectile dysfunction is a major cause of concern among diabetic men in the country, which sometimes lead to fertility issues.

But DAM President Clement Mandala who leads a charity organisation of more than 9000 clients, says this matter is not publicly discussed including in their weekly diabetes clinics, amid fears that those affected would be deemed not being man enough.

“Almost every day, I receive calls or messages from our members asking how they can deal with erectile dysfunction as the situation affects their sexual life especially those in marriages. It seems they open up to me because it would be a taboo to discuss such issues in public,” reveals Mandala, who blames the situation to societal stigma.

Asked how, he then, responds to such messages, Mandala says “I just advise them to change their lifestyle by investing much of their time in doing physical exercises such as walking and jogging. I sometimes tell them to visit registered pharmacies for proper medication to improve their sexual performance.”

He therefore admits gaps in awareness, saying it is high time issues of erectile dysfunction become a routine conversation during diabetes clinics or in marriage set-ups so that spouses understand the condition.

“In counselling those who approach me, first of all, I advise them to sit down with their spouses and tell them that the situation originates from the diabetes condition and not traditional beliefs that someone has been bewitched. If you make your wife understand the condition, it becomes a huge relief for the husband,” he adds.

Generally, the lack of community awareness on diabetes is also collaborated in a published study titled Primary health care preparedness to integrate diabetes care in Blantyre, Malawi.

“In facilities where diabetes services were available, utilization was low. Participants perceived that utilization was low due to lack of community awareness on the existence of the services and lack of trust in the services,” reads the study published on May 21 2024.

“Key informants from urban facilities were of the view that many of the clients with diabetes were not utilizing the primary care facilities despite increase in diabetes cases within the catchment areas.”

The research was done by medical and scientific researchers namely Chimwemwe K Banda, Ndaziona PK Banda, Belinda Gombachika, Moffat J Nyirenda, Mina C Hosseinipour and Adamson S Muula.

As Mandala stated, privacy and lack of openness on issues relating to erectile dysfunction is doing more harm to diabetic patients in regard to issues of mental health.

He therefore challenges the authorities, health workers, health rights groups to open up the conversations and address the low esteem among the affected people.