Diabetes is one of the most common chronic illnesses. 29 million Americans suffer from diabetes; 8 million of those are undiagnosed. 26% of Americans over 50 have diabetes.
First, what is diabetes?
Diabetes is a disease of high blood sugar. There are two types of diabetes:
Type 1) 5 % of those with diabetes have this type. It is usually diagnosed in children and young adults. The immune system of the body malfunctions and destroys the insulin-producing cells in the pancreas. Type 1 requires insulin from the onset.
- Type 2) This is the most common type of diabetes and primarily occurs as a result of obesity and not enough exercise, although some are more genetically at risk. It is first managed by weight control and daily exercise. Medication is added if diet and exercise are not enough. Insulin might eventually be needed for control.
How does diabetes affect sexual function?
Although manifested in different ways in women and men, it all comes down to nerves, muscles, and vascular structures. Blood flow is reduced to the genitals. Sphincter muscles and pelvic floor muscles may not work properly. Diabetic neuropathy, a type of nerve damage, can cause numbness, pain, or lack of feeling in the genitals. It also can inhibit orgasm or make it difficult to feel sexual stimulation.
Low libido, or sexual desire, is another real problem, more common in women and men with diabetes than without.
How does diabetes affect sexual function for women?
- The most common sexual issue for women is vaginal dryness. Besides being caused by the menopause, nerve damage and reduced blood flow are additional factors in those women with diabetes.
- Women with diabetes also have an increase in vaginal yeast infections as well as urinary tract infections. Some cases of diabetes are first diagnosed in women experiencing recurrent yeast infections.
- Orgasm is more difficult to reach. The neurovascular system is necessary for arousal and orgasm. If the genital nerves are not working properly, sensation is diminished affecting both arousal and orgasm. Normal blood flow to the clitoris is needed for engorgement and orgasm; a compromised blood flow affects both.
How does diabetes affect sexual function for men?
The most widely reported problem men face is erectile dysfunction (ED)—the inability to have an erection. Sometimes diabetes is first diagnosed when a man seeks treatment for ED.
The disease can affect blood flow to the penis because of blocked or partially blocked vessels, making it more difficult to get an erection. Diabetes can also interfere with the proper nerve communication between the brain and the genitals, so the signals to send blood to the penis may not be properly generated or received. The brain also sends signals to hold blood in the penis after an erection has occurred; these also may not be generated or received in those with nerve damage secondary to diabetes.
Orgasm can be hard to reach in men suffering from neurovascular damage of diabetes and the lack of blood flow and the sensation it creates.
Tips for satisfying sex with diabetes
- Maintain proper blood sugar levels.
- Review with your doctor the medications you are taking to determine if they might cause side effects like decreasing your sex drive.
- What is good for your heart is good for your genitals—exercise regularly.
- Discuss sexuality and any concerns with your partner. Make time for each other. Explore ways to express intimacy that don’t include intercourse, such as massages, baths, and cuddling.
- Use over-the-counter lubricants liberally to overcome vaginal dryness—water based lubricants are the best. Hormone replacement therapy (HRT) can help a lot, especially vaginal estrogen creams. HRT systemically in the form of pills, patches, transdermal creams, and injectables are good for low libido, estrogen in low doses can be used safely in patients with diabetes
- There are many treatment options for ED, including drugs like Viagra and Cialis, injectable medications or suppositories, penis rings, vacuum pumps, support sleeves, and penile implants.
What is the take home message?
- Most middle age and older adults with partners are still sexually active despite their diabetes. Physical intimacy continues to be extremely important. A satisfying sex life is one way of feeling normal.
Talk with your doctor. Sexual dysfunction can be an indicator of disease progression or poor control
Pay close attention to your relationship. Talk.
This is the third article in our series of chronic illness and sexuality, with more to come. We’d like to hear from you about what topics you’d like us to cover. Let us know in Ask the Experts page.
