By Lauren Cox Reviewed by Rosalyn Carson-DeWitt, MD
Tips to help keep diabetes from interfering with your sex life.
While nightly TV drug commercials seem to imply that sexual dysfunction is a problem only for slim, silver-haired men on vacation, it can plague a larger, and often younger, group of people because of diabetes.
Men and women with diabetes can face a variety of challenges in the bedroom, from erectile dysfunction to loss of sensation or lack of desire. Studies have estimated that anywhere from 20 to 75 percent of men with diabetes suffer from impaired sexual function, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and between 18 and 42 percent of women are affected.
Why Diabetes Is Linked to Sexual Problems :
Most sexual problems related to diabetes can be traced back to restricted blood flow and nerve damage.
“If blood sugars are too high, blood vessels and nerves throughout the body are damaged,” says Joshua Safer, MD, an endocrinologist at Boston Medical Center and an associate professor of medicine at Boston University School of Medicine.
If a person has had high blood sugar for years, this damage can injure vital organs, including the eyes, kidneys, and heart. “But the places that are going to suffer first are the places farther out — our fingers and toes,” says Dr. Safer. In men, the penis is also susceptible. Women may experience nerve damage and blood flow problems in the genitals, too, he adds, although the phenomenon is less well studied in women.
People with type 2 diabetes may be at additional risk because of such related health issues as unhealthy cholesterol levels, excess abdominal fat, and high blood pressure, which can further damage blood vessels.
A diabetes diagnosis, however, doesn't mean that sexual dysfunction is inevitable. “Broadly speaking, the problem develops when diabetes is not well treated,” says Safer. And even if you do develop a long-term dysfunction, many options are available to help you have a better sex life despite diabetes.
Erectile Dysfunction :
Although the risk of erectile dysfunction increases for all men as they age, men with diabetes are more likely to develop it 10 to 15 years earlier than men without diabetes, according to the NIDDK. The best treatment will depend on the individual.
“If someone has erectile dysfunction, I will usually check their testosterone level first,” says Kristi Silver, MD, the vice division chief of endocrinology, diabetes, and nutrition and an associate professor of medicine at the University of Maryland. If a man has low testosterone, then Dr. Silver says that hormone therapy may be prescribed. If low testosterone is not the underlying cause of erectile dysfunction, then drugs that increase blood flow may help.
Some men may find devices and prosthetics to be more helpful than medications. Devices such as vacuum pumps can help men get an erection, and constriction devices can help them keep it. If other treatments fail, a urologist can implant a prosthetic.
Low Arousal, Low Response in Women :
Women with diabetes may experience a numbed response to sexual contact and reduced blood flow to their genitals. Diabetes can also decrease vaginal lubrication, leading to discomfort during sex, according to the NIDDK.
To combat numbness and increase sensation, you can try experimenting with different types of foreplay or sex toys. If lubrication is a problem, both prescription and over-the-counter lubricants can help.
High blood sugar slows the immune system's response throughout the body and increases the risk of infections, including those that can interfere with your sex life. Perhaps the most common among these are vaginal yeast infections, which cause itching and irritation, discharge, and a burning sensation during urination and sex.
Although many women experience yeast infections, those with type 2 diabetes tend to have them more often, probably because elevated blood sugar can encourage the growth of yeast, according to the American Diabetes Association.
Even a short-term blood sugar spike can increase your risk of infection. If this happens, talk to your doctor and try to get your blood sugar back to safe levels. If you experience a yeast infection, your doctor may recommend over-the-counter creams or suppositories. Medication can be prescribed for frequent yeast infections.
Low Libido :
Not in the mood? This common problem can affect both men and women with diabetes for several reasons, starting with problems related to high blood sugar and inflammation. Medications taken to treat high blood pressure and high cholesterol can also inhibit desire.
Emotional health may play a role as well. People with diabetes are nearly twice as likely to experience depression than people without diabetes, according to the National Institute of Mental Health. Unfortunately, libido can be lowered by depression itself, as well as by antidepressants used to treat it.
Talk with your doctor if your sexual desire seems inhibited, since it may be a symptom or side effect that can be addressed.
Better Diabetes Control Can Mean Better Sex :
Taking control of your diabetes may put a stop to the physical — and emotional — roots of sexual dysfunction. Endocrinologists and sex therapists agree that what's good for diabetes overall will also be good for sexual problems caused by diabetes.
“It's a whole lifestyle cluster,” says Richard Siegel, a certified sex therapist in Boca Raton, Florida, and a member of the American Association of Sexuality Educators and Therapists.
Siegel says the same sedentary lifestyles and poor diets that are associated with uncontrolled type 2 diabetes also contribute to the mood problems behind sexual dysfunction and low libido. “There's a ripple effect. You feel [lousy], then you don't feel in the mood,” he says. “I would recommend staying healthy, being vibrant, and getting lots of exercise.”