Sexual Health Challenges

Sexual health and diabetes: an introduction

Diabetes is associated with vascular disease and damage to nerves, two areas that can have a significant impact on how we function sexually. It is no wonder that both men and women with diabetes experience sexual problems more frequently than people without diabetes.

Men with diabetes have a three-fold greater risk for erectile dysfunction (ED) (achieving and maintaining an erection) than men without diabetes. ED is the most common sexual problem in men with diabetes, but other problems, including decreased sensation, difficulty with ejaculation and/or orgasm, and loss of libido, may also occur.1

Sexual dysfunction in females with diabetes is less well understood than in men. However, a range of sexual problems, including difficulty achieving orgasm, vaginal dryness, and loss of libido, occur more frequently in women with diabetes than in women in the general population.2

Types of sexual problems by gender

Women
  • Decreased sensation or painfully heightened sensation in vaginal/clitoral area
  • Difficulty achieving orgasm
  • Dryness in vagina
  • Loss of libido
Men
  • Erectile dysfunction (difficulty achieving or maintaining erection)
  • Decreased sensation in penis
  • Difficulty achieving orgasm and/or ejaculation
  • Loss of libido

What causes sexual dysfunction in diabetes?

There are several mechanisms or factors that may contribute to sexual dysfunction in men and women with diabetes. These include1,2 :

High blood sugar. Having high blood sugar levels over time can decrease hydration of the mucous membrane of the vagina, resulting in problems such as dryness of the vagina and pain and difficulty during sexual intercourse.

Vaginal infections. Women with uncontrolled diabetes are at increased risk of a variety of infections, including vaginal infections, which can result in pain and difficulty during sexual intercourse.

Vascular damage. High blood sugar can damage blood vessels throughout the body, including those that supply blood to sexual organs. Vascular disease can reduce genital blood flow, in both men and women, resulting in problems such as ED, decreased sensation, and difficulty achieving orgasm and/or ejaculation.

Neuropathy. Neuropathy (nerve damage), which also results from high blood sugar, can lead impaired arousal and problems such as ED, decreased sensation, and difficulty achieving orgasm and/or ejaculation.

Psychosocial factors. Psychosocial factors include a range of emotional, behavioral, and interpersonal factors that may have an impact on sexual performance or the desire to engage in sex. These may include a mental illness such as depression or anxiety, stress from the burden of having a chronic disease like diabetes, or interpersonal difficulty with a sexual partner.

Several other factors may also contribute to sexual problems in a person, regardless of whether they have diabetes or not. These include medication and substance (tobacco, alcohol, or other drugs) use. Hormonal contraceptives have been implicated in decreased libido in women (both with and without diabetes). Nicotine has also been shown to decrease sexual arousal in women. Alcohol abuse can impair sexual function in both men and women, as well as contribute to other health problems that impact sexual function3

How is sexual dysfunction treated?

There are a number of treatment approaches for dealing with sexual dysfunction, depending on the type of problem. For people with diabetes who experience sexual problems, an important first step is to make sure that blood sugar is well controlled. Poorly controlled blood sugar can contribute directly to problems with sexual function in men and women, including ED in men and vaginal dryness in women.

Erectile dysfunction. A number of drug options are available for ED to increase blood flow to the penis. These include oral medications called PDE-5 inhibitors, such as Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) and injectable PDE-5 inhibitor medications such as papaverine and phentolamine.4

Other options for ED include the MUSE system, short for medicated urethral system for erections, which involves inserting a small pellet version of the PDE-5 inhibitor alprostadil inside the opening at the end of the penis using a thin applicator tube. Other approaches include inflatable devices and implants.4

Vaginal dryness. For women who experience vaginal dryness, over-the-counter lubricant products, such as Astroglide, Replens, or K-Y Jelly, can be helpful. These lubricant products are water-based and safe for use. Non-water soluble products like petroleum jelly (Vaseline) should not be used due to their risk for causing infection.5

Impaired sensation. Women and men with diabetes who experience a decrease in sensation in sexual organs may benefit from instruction or counseling in alternate techniques for sexual stimulation, including use a vibrator or other sexual aids. Your doctor should be able to refer you to a sexual therapist who has experience providing instruction to patients with chronic diseases that affect sexual performance.5

Emotional issues. Emotional problems, including depression, anxiety, loss of self-esteem, anger, and stress, can have a profound effect on the ability to perform sexually and the desire for sexual intercourse. If you think that your sexual dysfunction may have to do with emotional issues, ask your doctor for a referral to a mental health professional. Additionally, a trained sexual therapist may also be able to help you with psychological and physiologic issues that impact sexual performance.5

Written by: Jonathan Simmons | Last reviewed: May 2014.
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