Diabetes is an incurable disease affecting millions of people. Two causes of the disease are known; lack of insulin secretion from the pancreas and insufficient intake of glucose by muscles. This lowered insulin level prevents glucose from properly supporting carbohydrate metabolism. Vascular and neurological components both contribute to the pathology of diabetes. Both affect sexual functioning.
Polyuria, polydipsia, fatigue, pruritus, and vision changes are all common symptoms of severe diabetes. Diabetes can present itself at any stage in life. The most common, juvenile-onset diabetes, presents itself early in life. Insulin is typically needed to control juvenile-onset diabetes. Adult-onset diabetes usually presents itself later in life in people between 60 and 70 years of age. Adult-onset diabetes does not typically need insulin to control the disease.
Effects of Diabetes on Sexual Health
Diabetes can affect your sex life on a physical and mental level. The changes in sexual desire cause emotional stress which leads to a lower sex drive.
- Diabetes and your Mind
- Your reactions to a diagnoses of diabetes will directly affect your outlook on sex. Sexual desire is greatly powered by the way you feel about your body. When changes are made in your life as a result of changes in your body you can become depressed or stressed making it harder to feel sexual.
- Diabetes and your Body
- Two physical characteristics of diabetes are linked to your sex drive: nerve damage and blood vessel damage. They both contribute to a decrease in sex drive.
- Nerve Damage:
- The brain sends messages to the body through your nerves. When there is nerve damage the message of desire can sometimes not be sent to the body. The brain feels desire but the body does not get the message and does not react. Nerve damage can also contribute to tingling, burning, and numbness of your genitals.
- Blood Vessel Damage:
- Lack of blood flow to the genitals affects men and women with diabetes. Men may have erectile difficulties such as the inability become or maintain an erection. The restricted blood flow to womens genitalia can contribute to poor vaginal lubrication.
Most Common Sexual Complications for Men
Sexual problems in men with diabetes are common with over half of men being impacted. Age and the progression of the disease both increase the risk of erectile dysfunction and low testosterone, the two most common sexual health issues.
- Erectile Dysfunction (ED)
- Erectile Dysfunction is a condition that affects a man’s ability to become and remain erect during sexual activity. ED may be diagnosed if the problem occurs multiple times for more than three months.
- Cause of ED
- Both physical and emotional issues in diabetes contribute to erectile dysfunction. Nerve damage and restricted blow flow to the penis are the physical attributes. Depression, anxiety, and stress are the emotional attributes.
- The cause of ED will determine the treatment. Men may need to be treated in multiple ways before finding the treatment that works. These treatments can include:
- Oral medications
- Penile Suppositories
- Vacuum Pumps
- Surgical Implants
- Penile Injections
- Low Testosterone (Low T)
- A man’s testosterone contributes to their hair growth, muscle mass, and sperm count. Low testosterone may cause:
- Decrease in sex drive
- Erectile dysfunction
- Depression or symptoms of depression
- Weight gain
- Lower energy levels
- Cause of Low Testosterone (Low T)
- The symptoms of diabetes can themselves lower testosterone levels. High blood pressure and excessive weight gain (obesity) are the most common of these symptoms affecting a man’s sexual desire. These in coordination with the natural decrease in testosterone at midlife can cause severe drops in testosterone.
- Blood tests are used to determine an inefficiency in testosterone. Once diagnosed testosterone levels can be raised using:
- Medicated gels
- Oral medications
Other sexual problems men experience include:
- Pain and numbness of genitals (caused by nerve damage)
- Less sexual desires (caused by emotional stresses)
- Retrograde, premature, and delayed ejaculation
- Infertility. Infertility can not be treated but artificial insemination is an option.
The earlier problems with sex drive and desire are spotted the easier they are to treat. If you feel or know you are having problems in your sex life it is important to speak with your health care provider promptly.
Most Common Sexual Complications for Women
Sexual problems in women are also common although not always reported. It is estimated that one third of women may have problems with sexual desire, vaginal dryness, and the ability to reach orgasm.
- Vaginal Dryness
- The natural lubrication of the vagina can be limited with diabetes. This may cause discomfort and pain including during sexual activity.
- Cause of Vaginal Dryness
- Vaginal dryness is most commonly linked to high blood sugar causing nerve damage. This in combination with a natural decrease in hormones as a women nears menopause can cause severe sexual issues.
The best treatment for vaginal dryness will vary depending upon the severity of the condition. Some common treatments are:
- Personal water-based lubrication (including KY gels, AstroGlide, or Sylk)
- Vaginal Moisturizers
- Hormone replacement therapy
- Manual stimulation and foreplay prior to intercourse
- Inability to Achieve Orgasm
- Orgasm can be difficult or impossible to reach when suffering from the inability to achieve orgasm. This is only a problem when it is impossible or difficult with manual stimulation which is necessary for almost all women to reach orgasm.
- Causes of Inability to Achieve Orgasm
- Physical and emotional issues with diabetes contribute to a woman’s ability to reach orgasm during sexual activity. Physical conditions include restricted blood flow and nerve damage. Emotional conditions include depression, anxiety, and stress.
Women may use more than one treatment to treat problems with sexual activity including:
- Manual stimulation
- Electrical stimulation
- Kegel exercises
Other sexual problems women experience include:
- Pain or numbness of genitals (caused by nerve damage)
- Low sexual desire (caused by emotional stresses)
- Vaginal infections such as yeast infections. These can be avoided by keeping the vagina dry, eating a balanced diet, and managing stress.
Talking to your doctor is important when having problems with sexual desire and activity. Once the cause has been determined treatment can begin. The sooner treatment begins the more successful it can be.
Taking Care of Sexual Health
As with all other symptoms of diabetes you can make lifestyle choices to manage the effect the disease will have on your sex life. With proper management of the condition you reduce your risk of having sexual health issues.
- Eat healthy.
- Eating healthy will help manage your blood sugar. Following a plan provided by your doctor or a source he recommends can give you the knowledge on eating a balanced diet, eating appropriate portions, and eating regularly.
- Monitor and control your blood sugar.
- Nerve damage and inefficient blood flow is directly related to a problem with blood sugar control. Check and record your blood sugar often. Discuss your numbers with the doctor to develop proper medication levels to control your blood sugar.
- Keep up with medications.
- Talk to your doctor about medications. You should know their benefits and side effects. Take them as prescribed to ensure your diabetes symptoms are being managed properly.
- Monitor your blood pressure and cholesterol.
- Proper blood flow and a healthy cholesterol is crucial to your sexual wellbeing. These two inefficiencies are the number one contributers to sexual health problems.
- Exercise is not limited to working out. Daily activity can keep you active which will help manage your diabetes. Just taking care of household chores, stepping outside for a quick walk, and staying active in day to day life will lower your risk of sexual health problems. Be sure to include your doctor in your exercise regimen.
- Don’t Smoke.
- Smoking limits proper blood flow by shrinking blood vessels throughout your body. Talk to your doctor to develop a plan to quit if you are a smoker.
- Limit alcohol use.
- Alcohol can make it more difficult for you to become aroused.
- Take care of your emotional needs.
- Talking to your doctor about the way you are feeling emotionally is just as important as talking about your physical health. Your emotional health can negatively affect sexual health if not managed just as well as all other diabetes symptoms.
Bouncing Back from Sexual Dysfunction
Problems in your sex life can be difficult to manage. Knowing that it is never too late to improve your sexual health is important when working to fix it. The best thing you can do to manage your sex life is understand how to best resolve or lower influence your problems are having on you and your sexual activity.
- Understand your body.
- Much more than sexual activity and the direct act of having sex go into understanding yourself on a sexual level. Explore your entire body to pinpoint exactly what you enjoy. If you have a partner you should share with them how you feel about sex and what you like or dislike.
- Get your body in the mood.
- Often times the mind is ready well before the body is. Don’t hesitate to take your time with foreplay or just touching for a while.
- Try something new.
- Routines can restrict freedom to express yourself sexually. Try exploring new ways to enjoy sexual desires. This will bring in new energy and improve your sex life. Keep in mind that the key to success with trying new sexual activities is that both you and your partner are into the activity. You should both be comfortable. Some great ways to change things up include:
- Give or receive romantic massages.
- Imagine or act out sexual fantasies with your partner.
- Just be close to and enjoy your partner. This can include hugging, kissing, caressing, or massaging.
- Have sex in a new place or at a random time.
Communicating How you Feel with your Partner
Your sex life is a large part of your overall relationship with your partner. Problems with sex can have a negative effect on you, your partner, and how you each feel about the relationship. It is important that you know how to talk to your partner in a way that they will understand you and your sexual problems.
- Plan what you want to say.
- You can’t plan the conversation because it’s two sided but you can plan what you need to share. Planning it out may help you better understand exactly how you really feel. Problems in your sex life can get very confusing. Just writing them down may guide you to the real problems versus the symptoms of the problems.
- Make time to communicate regularly.
- Talking to your partner on a regular basis about where you stand is important. Make the talks scheduled by intentionally setting aside the time to talk. This lets them gather their thoughts to share with you at that time as well.
- Listen to your partner.
- You and your partner are both equally invested in your sexual health. Your problems affect them as their problems affect you. Be sure to hear what they feel, understand them, and give them the same love and support you ask for. You’re in this together.
- Don’t talk when your angry.
- Talking when you or your partner is angry will lead to no resolution. If the conversation begins to get heated set it aside for a while. Come together when things are calm enough to discuss each other’s feelings.
If you or your partner feel like your not being heard look into couples counseling. A counselor will help sort through the problems to get past anger and hurt. They can share ideas and techniques to get your sex life back on track.
Talking to your Doctor About Sex
Inviting someone else into your sex life can be a challenge. Putting aside the embarrassment of the topic is key to communicating with your doctor to get help. Here are some things to know before getting ready to have the talk with your doctor.
- Be prepared.
- Being prepared for the talk will help with anxiety regarding the uncomfortable topic. Try these steps to get better prepared:
- Think about all the questions you have. Write them down. Go over them a few times aloud to make sure you are comfortable with the wording. Keep telling yourself this is absolutely a normal subject for the doctor. He hears it all the time.
- Ask your partner to go to the visit with you. Use your partner in the visit. “WE have some concerns …”, “WE have a question …”. This will make it less personal for you.
- Open the conversation near the beginning of your visit. This will help with the stress of it on your mind. It will also give the doctor time to address all of your concerns.
- Know what to expect.
- You should understand what will happen and why it will happen. Sexual dysfunction is usually caused by a condition, the doctor will want to find out what. Here are some things that the doctor may recommend:
- Getting information about your medical history. This can include medications, past illnesses, other conditions, and sexual health problems.
- A physical exam.
- A full lab workup. This can include your cholesterol, AIC, hormone levels, and tests to detect nerve damage.
Telling yourself on a regular basis that your doctor is there to help you manage your health not be a friend can get you through tough or embarrassing conversations. He has heard it all before and knows how to talk to you in a non-personal doctor-to-patient way.
Diabetes is a complicated disease which consumes your entire life. Becoming close with your doctor to manage it is very important to maintaining a healthy lifestyle including your sexual health. Your doctor is a great resource for all the questions and concerns that you and those you share your life with can use. Follow his advice to manage your health and maintain the quality of your life.