Diabetes and Sexual Function

If you have diabetes, there are an awful lot of things you have to learn to accept — but sexual dysfunction doesn’t have to be one of them.

«The two greatest misconceptions about diabetes and sexual health is that it’s not a big problem for other people and that it’s an inevitable part of diabetes that you have to learn to live with» said Dr. Kenneth Snow, M.D., director of the Sexual Function Clinic at the Joslin Diabetes Center in Boston.

The actuality is that millions of people with diabetes will experience some type of sexual problem and most of them can be helped, according to Dr. Alan L. Rubin, M.D., an endocrinologist in San Francisco and author of Diabetes for Dummies.

From decreased sexual interest and painful intercourse to erectile dysfunction and vaginal dryness, a visit to the doctor can help alleviate the problems.

«You can successfully treat these patients 90 to 95 percent of the time. The problem is that patients discuss their sexual problems or their doctors bring up the topic of sexual health only about five percent of the time» Dr. Rubin said.

For men, the most common complaint is impotence, meaning the inability to achieve or maintain a firm erection. It’s a problem that more than half of the men with diabetes will experience in their life, Rubin said. The age at which it impacts these men depends on a number of factors, including how long they’ve had the disease and whether they’ve controlled their blood sugar levels. As with other complications of diabetes, patients who don’t control their glucose levels are more likely to develop erectile dysfunction and at an earlier age.

Rubin, who said the problem could strike as early as age 25, said it’s more common in middle-aged men or those who have had poor sugar control for 10 or more years.

A less common occurrence is retrograde ejaculation, meaning the sperm goes backward into the bladder instead of being discharged. It’s not a health concern, but can obviously present problems for a couple trying to get pregnant, according to Snow.

Women most frequently complain of vaginal dryness that makes sex uncomfortable and of not being able to achieve orgasm, sometimes due to a loss of sensation in the genital area.

One of the most common complaints of both men and women is a lack of sexual interest. Both sexes may also experience urinary infections more often, are at risk for hypoglycemia after sex, may have a heightened sense of pain due to nerve damage and are at greater risk for the spread of sexually transmitted disease, due to the dry, cracked skin in many patients.

Often, getting blood sugar under control can solve sexual problems, Snow said. Vaginal dryness, the frequency of yeast infections and diminished libido can all be improved when glucose levels are where they should be. Even when neuropathy has set in, controlled blood sugar can help reverse some of the nerve damage, giving men a better chance of achieving an erection, and women of becoming more easily aroused and having an orgasm, he said.

Other times, simply changing a medication or correcting hormone levels can do the trick, Rubin added. Anti-hypertension and anti-depressant drugs, for example, can be the culprits of some problems, such as arousal in men and women.

Although doctors are aware of the side effects such drugs may cause men, they may not realize those drugs can also impact the sexual health of women, Snow said. It was only in recent years that more attention has been paid to the fact that diabetes can cause sexual problems in women as well as in men. «Many medications were never really studied concerning the sexual health of women. That’s only being looked at now» he said.

In addition to prescribed medications, recreational drugs and alcohol are «two of the highest offenders in erectile dysfunction» according to Snow.

What doesn’t cause erectile dysfunction, he pointed out, is oral or injected insulin. «Sometimes patients are put on a tough regimen of insulin and then have sexual problems and blame it on that. In fact, it’s a common opinion among many patients with diabetes that insulin kills an erection. Really, the exact opposite is true — if they’d been on it and maintained good blood sugar control, they probably wouldn’t be facing the problem» he said.

When male patients still have problems attaining an erection, their doctors may suggest Viagra, which Dr. Rubin said is effective in 70 percent of patients. Still, men with diabetes have to be particularly cautious of interactions with medications they’re taking, especially heart medicines in the nitrate category. Men can also use devices such as a pump that puts liquid into the penis to maintain an erection.

In some cases, vascular surgery may be needed to improve blood flow and the sexual health of men and women. In other cases, the problem may not be so much physical as it is psychological. But once that’s determined, patients can receive the medication or counseling they need, Rubin said. And sometimes, the problem may not even related to diabetes, but to another treatable health problem, such as a hormone imbalance.

In other words, Dr. Rubin said, «All of these problems are manageable and treatable. But unless the patients inquire about it, they’ll never know.»

(For more information, visit the Sexual Function Clinic’s Web site at www.joslin.harvard.edu/jboston/sexual.html, Dr. Rubin’s Web site at www.drrubin.com or the American Diabetes Association at www.diabetes.org)

If you’re experiencing a sexual problem, you should discuss it with your doctor. The doctor’s exam, according to the Joslin Diabetes Center, should include the following:

Medical history, including questions about morning erections (which are a sign that the impotence is probably not due to a physical problem), how long the problem has occurred, and whether you are experiencing anxiety or stress.

  • A physical exam and review of diabetes complications.
  • Lab tests to check hormone levels.
  • Review of medicines taken.
  • Occasionally, additional testing, including measurements of erections, an ultrasound, and/or neurological and other tests at the doctor’s office or by you at home.