A healthy sexual relationship is one of life’s expectations and pleasures. When things go wrong, whether or not we have diabetes, many of us find it hard to accept that there might be a problem. It’s important to know there is a great deal of support available.
While most people with diabetes, both male and female, are able to lead completely normal sex lives, diabetes may contribute to sexual problems for some people.
The most common problem is erectile dysfunction in men (also known as impotence) which results in the inability to get or keep an erection long enough for intercourse. Ejaculation may or may not be affected. Fertility remains normal.
It’s easy to pin a lagging libido on stress, depression, age, or lack of sleep. But if your sexual feelings have changed or if intercourse has become uncomfortable or nearly impossible, either as a result of chronically high blood glucose levels (an occasional high level will not cause long-term problems) or nerve problems, diabetes could be the cause.
Experts estimate that 75 percent of men and 35 percent of women with diabetes experience some sexual problems due to diabetic neuropathy (nerve damage) to the nerves that stimulate normal sexual response.
The good news: Research has shown that people can lower their risk for diabetes-related sexual problems by taking steps to control their diabetes, including:
- controlling blood glucose.
- lowering blood pressure.
- lowering cholesterol.
- lowering triglyceride levels.
The Diabetes Control and Complications Trial (DCCT), a 10-year National Institutes of Health study of individuals with type 1 diabetes, found that improved diabetes control decreased the risk of developing neuropathy by 60 percent. This means the steps you can take to manage your diabetes are the same keys that open the doors to a healthy sexual relationship.
What Men Should Know About Sex and Diabetes
Like women, men can experience a drop in libido due to weight gain or depression, but the most common sexual complication for men with diabetes is erectile dysfunction (ED), the inability to achieve or maintain a satisfactory erection for sexual intercourse. Many men with diabetes develop ED because of a testosterone deficiency, which can be detected by a simple blood test.
There are many different causes of ED besides diabetes, including stress, high blood pressure, excess alcohol intake, and depression. So it’s a good idea to consult your doctor to rule out or treat other causes.
ED treatments vary, and there are many products available, including:
- prescription medications (such as Viagra, Cialis, or Levitra)
- testosterone treatments.
- penile constriction rings.
- penile sleeves, vacuum pumps, injections, suppositories, and surgical implants.
Before you invest in a solution, find out if it’s proven to work, then see if your health insurance will cover it. Ask your doctor or pharmacist for recommendations.
Most men have an occasional problem with erectile dysfunction at some time in their life. This can be caused by many factors like being tired, stressed, and depressed or drinking too much alcohol. Some medications may also cause erectile dysfunction, such medications for high blood pressure, depression or stomach ulcers.
It’s important to always tell your doctor about any medications you may be taking for other conditions. Both men and women with diabetes may also lose their sexual desire when their blood glucose levels are high.
Reduced blood flow and nerve damage to the penis are generally the underlying reasons for erectile dysfunction for men with diabetes. Often men with diabetes who have the condition also have other complications related to nerve damage or blood circulation problems, such as high blood pressure, high cholesterol or heart disease.
Erectile dysfunction can be treated in a number of ways including:
- Tablets (e.g. Viagra, Cialis and Levitra)
- Prostaglandin injection into the side of the penis (e.g. Caverject)
- Devices such as the vacuum pump
- Surgery such as penile implants.
While tablets are easy to take, they may not work for everyone. So discuss all the options with your doctor to decide what’s best for you.
What Women Should Know About Sex and Diabetes
Women with diabetes may find it difficult to stimulate lubrication, experience orgasm, or even feel sexual desire due to nerve damage. These steps can reduce sexual complications and increase pleasure.
Get rid of dryness: For persistent vaginal dryness, purchase a water-base vaginal lubricant over the counter from any pharmacy. You might also work on relaxing the muscles around the vagina with Kegel exercises: contracting your pelvic muscles to control the flow of urine.
Lose weight: Being overweight can contribute to low self-esteem and loss of libido. A recent Duke University study found that shedding weight (17.5 percent of body weight) helped obese men and women feel better about sex than they had previously. To lose weight, get help from a registered dietitian or participate in a healthful weight-loss program.
Reduce stress: Stress can also inhibit sexual desire. Remove as many stressors from your life as possible. To better handle unavoidable stress, consider taking up a yoga or meditation class to reduce anxiety and provide calm.
Treat depression: Talk to your health-care provider about being screened for depression if you’ve been feeling low and have had little interest or pleasure in sex or other activities for more than a couple of weeks. Depression can also lead to difficulty with sex and/or loss of pleasure.
Sexual & Reproductive Health in Women
In general, much less is known about sexual problems in women and this includes women with diabetes. The main sexual problems that women deal with are vaginal dryness, a decrease in sexual desire, pain during sex and trouble having an orgasm.
Whether diabetes affects these problems is unclear although women who find it hard to come to terms with having diabetes are more likely to report sexual problems.
Women with poorly controlled diabetes are more likely to have frequent bouts of thrush (yeast infection). In most cases, keeping blood glucose levels under control will help.
During periods or menopause, blood glucose levels may change. Women affected by this will need to adjust their treatment. Your doctor or Credentialled Diabetes Educator will help during these times.
How to Talk with Your Doctor About Sex
While it’s difficult to discuss sexual issues, it’s important to share them with your doctor because they may indicate other health problems, such as depression or high blood pressure. Plus you may discover a good solution and get your sex life back on track.
At your next visit, make it a point to list problems with your sex life right off the bat, before your nerves get the best of you and while there’s plenty of time to tackle treatment options. Not sure how to bring it up? Try rehearsing one of these openers:
“Doctor, I have something personal to discuss.”
“I was wondering: Can my diabetes affect my performance in the bedroom?”
“I’m having some problems enjoying romance/intimacy.”
Dealing with Sexual Problems
Sexual problems are the same as any other medical problem. You need to talk to your doctor about the strategies that will best suit you and your lifestyle.
Accept that there is a problem. Thinking it might go away will only delay treatment. The sooner you seek help the sooner the problem can be treated. If you have a partner, talk through the problems you are both experiencing.
Sexual problems have the potential to cause a strain in the relationship. If you feel this is happening, you may like to contact Relationships Australia.
Learn about the condition. Finding out as much as you can and the treatments available will bring positive results and improve your sense of well being.