Sexuality & Diabetes
For those living with Diabetes, multiple aspects of the disease can impact one’s sexual wellness. Sexual wellness is much more than sexual intercourse and includes our feelings, attitudes, self image and behaviors. It influences how we experience the world. One’s concerns about sexual wellness can be a hard topic to discuss, so we are hoping that this information will provide both information and hope for you and your partner. After the introduction, this article is divided into sections for men and women. There is also a list of resources at the end of the article. We encourage you to read on and then take your unanswered concerns and questions to your primary care provider.
Nerve damage caused by diabetes not only affects the feet, heart and stomach (GI tract), but also the sexual organs. Narrow blood vessels and clogged arteries can decrease the blood flow to the penis and for women blood flow to the vagina and clitoris. Some medications for depression and high blood pressure can contribute to a lack of interest in sex. Smoking, untreated depression, recreational drug and alcohol abuse may also contribute to decreased sexual function. American culture can place tremendous importance on being thin and the obesity associated with diabetes may cause an individual to feel unattractive.
Sexual difficulties may also be a response to past or present challenges in one’s life. Stress, loss, strained relationships and abuses from the past can influence one’s desire and ability for healthy sexual relationships. Discussion of these concerns with your primary care provider or a mental health provider can help you clarify issues and begin treatments for recovery.
The most important step for both men and women with diabetes in improving their sexual wellness is to maintain a healthy lifestyle. Keeping one’s blood sugar, blood pressure and cholesterol as close to target is very important. Working on a healthy diet and active lifestyle is essential and helps one feel both physically and emotionally well. The next step is to be informed.
Sexuality Issues with Men with Diabetes
Erectile Dysfunction (ED) is the inability to have or sustain an erection sufficient for intercourse. As previously mentioned, nerve damage, narrowing blood vessels, clogged arteries and some medications contribute to ED. Fifty percent of all males with diabetes experience some sexual difficulties. Fortunately there are numerous treatments for ED. Many are listed below:
- Medications
These are prescription medications that help a man develop and maintain an erection. These are called PDE5 (phosphodiestorase-S) inhibitors. Examples include; Viagra, Cialis and Levitra. These medications don’t increase sexual desire but make it physically possible to obtain an erection when aroused.
- Suppository in the Penis
These are medications for erectile dysfunction that are not a pill taken by mouth, but a pellet that is inserted into the tip of the penis with an applicator. This medication widens blood vessels and relaxes muscle tissue in the penis, allowing blood to fill the tissue that makes the penis erect.
- Injections into the Penis
These are medication injections that a man can give himself that go directly into the penis. The medication is injected about 30 minutes prior to intercourse and in most men lasts about one hour.
- Vacuum Constriction Devices
This is a combination of using a tube that fits over the penis and a pump that draws out the air in the tube. Blood rushes into the penis to replace the air and once the penis is erect, a rubber band is placed at the base of the penis to keep the blood inside. These devices are available without a prescription, but it’s important to buy them from a reputable manufacturer.
- Surgery
Most men prefer to avoid surgery, but for some men penis implants are the preferred choice for regaining sexual function. A prosthesis (artificial substitute) is implanted in the penis and can create a permanent erection or a pump can be used to stiffen the penis.
- Lifestyle Changes
As alcohol, smoking and recreational drug use can impact sexual function decreased usage or abstinence can be beneficial.
- Herbal Supplements
There are herbs and supplements that people believe are helpful with sexual function, but there are no studies to prove that they help with erectile dysfunction.
- Testosterone
Men with diabetes are more than twice as likely to have low testosterone compared to other men. Testosterone is the most abundant sex hormone in a man’s body. Some men’s bodies do not produce enough testosterone, resulting in below normal levels of this hormone. Symptoms of low testosterone include low sex drive and erectile dysfunction. A simple blood test can determine if your testosterone levels are below normal. Testosterone gels, patches, injections and tablets can help your level return to normal.
As there are multiple treatments and everyone has their own unique concerns, it is essential to discuss treatment choices with your primary care provider. Also, a list of resources is included at the bottom of this page that describe these treatments in more detail.
Sexuality Issues for Women with Diabetes
Multiple factors may influence the sexual wellness of women with diabetes. Because women do not have a penis the complications of diabetes on sexual wellness may not seem as obvious, however they are equally as important. High blood sugars, nerve damage, and narrowing blood vessels contribute to decreased blood flow to the vagina and clitoris, causing a range of complications. Research also tells us that women’s sexual desire is more “responsive” than “spontaneous.” This means that a women’s sexual desire doesn’t automatically occur, but is a response to interplay of factors such as self esteem and feelings about one’s partner. Therefore, a women who has decreased desire, doesn’t necessarily have a sexual problem. Open communication with one’s partner is essential to “creating the mood.”
Listed below are common complications for women with diabetes. Some of the problems experienced with diabetes are also seen in menopause, so discussion with your physician is essential.
Complications
- Decreased interest in sex and inability to have an orgasm
- Vaginal thinning and dryness which may contribute to painful intercourse
- Irregular menstrual cycles
- Yeast infections of the vagina
- Depression
Treatments
- Lubrications
There are many over the counter water-based and oil-based lubricants that a woman can use to decrease dryness and make it easier for the penis to enter the vagina.
- Estrogen
Hormones play an important role in regulating sexual function. This can be especially significant for women who are menopausal or have experienced a hysterectomy. There are multiple ways to provide hormone replacement. These include pills taken by mouth, vaginal suppositories and cream.
- Prescription Medications
The use of prescription medications that help men sustain and maintain an erection are still undergoing evaluation for women. Preliminary findings demonstrate positive effects for some women. Also, Tibolone, a prescription medication currently available in Europe and Australia may soon gain FDA approval in the United States. It is taken by mouth as a hormone replacement and may help sexual function.
- Herbal Supplements
There are herbs and supplements that some people believe are helpful with sexual wellness, but there are no studies that prove they are helpful in restoring sexual function.
- Increased Stimulation
As women with diabetes may have decreased blood flow to the vagina and clitoris, increasing manual and /or oral stimulation can be helpful to achieve or maintain sexual desire.
- Lifestyle Changes
As alcohol, smoking and recreational drug use can impact sexual function decreased usage or abstinence can be beneficial.
- Yeast Infections
A vaginal yeast infection is usually treated with an antifungal cream or suppository that is put into the vagina, or a single dose tablet taken by mouth. There are both prescription and over the counter medications available.
As there are multiple treatments and everyone has their own unique concerns, it is essential to discuss treatment choices with your primary care provider. Also, a list of resources is included here that describe these treatments in more detail.
Resources
Web sites
See your doctor for more information
If you want to know more about sexual activity during and after pregnancy, speak with your doctor and pregnancy care team.
