Sexual problems as a result of having diabetes can affect both men and women. Although these sexual health problems can be fairly common among people with diabetes, they are often not widely discussed. The good news is that often there are treatments for diabetes-related sex problems.
There are a few reasons why men with diabetes may suffer from sexual problems. Some of these problems are no different to those that the general male population might have.
Erectile dysfunction and diabetes
The most common sexual problem in men with diabetes is erectile dysfunction (sometimes called impotence) — an inability to have an erection firm enough for sexual intercourse. This includes difficulty getting and sustaining an erection.
Erectile dysfunction in men with diabetes can be caused by:
damage to nerves or blood vessels supplying the penis;
poor blood sugar control; and
stress or fear of not being able to achieve an erection.
Nerve and blood vessel damage
Nerve damage, or neuropathy, can come about because ongoing high blood sugar levels damage the blood vessels that bring oxygen and nutrients to the nerves. When the nerves are damaged they are not able to transmit signals properly.
If the nerves that supply the penis are damaged, even though you might have the mental stimulation to have sex, the message from the brain doesn’t reach the penis and it doesn’t respond.
As well as blood vessels damaging nerves, nerve damage can damage blood vessels and narrow them. If the blood vessels supplying the penis become narrowed, blood can’t flow in fast enough to make an erection and keep it.
Another problem that can occur with the blood vessels is atherosclerosis. This is the name doctors give to hardening and narrowing of the arteries. People with diabetes are susceptible to atherosclerosis as they are at increased risk of high blood pressure and/or high cholesterol. If atherosclerosis occurs in the arteries that supply blood to the penis, the blood supply may not be sufficient to achieve an erection.
Poor blood sugar control
As well as causing neuropathy, another mechanism by which poor blood sugar control can affect erections is by holding back production of nitric oxide. Nitric oxide is a body chemical necessary for erections, which is released in the penis.
High blood sugar can also cause a reduction in libido, or sex drive. Bringing blood glucose back under control again may sometimes restore a man’s sex drive.
Stress and fear of failure
A couple of episodes of not being able to perform sexually may be enough to make a man anxious about having sex and this can be a cause of erectile dysfunction.
Similarly, stress in a man’s life and other psychological factors, such as depression, can also cause erectile dysfunction. So, it’s often a combination of physical and psychological causes. Erectile dysfunction that starts off having a physical cause can often acquire a psychological component to it as a man becomes worried about his performance.
Treatments for erectile dysfunction
Fortunately, there are now many options to help men with erectile dysfunction: treatments to help with the physical causes; and psychological training and counselling to help with the psychological aspects.
Medicines taken by mouth, such as Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil), have been shown to be effective in treating erectile dysfunction in men with diabetes. Vacuum pump devices are a physical method of producing an erection. Injection into the penis with the medicine Caverject (alprostadil) is also another treatment for erectile dysfunction. Penile implants are a type of surgical treatment that may be suitable for some men when other treatments have not been successful.
So, there are several successful treatments available to help men with diabetes who are having problems with their erections. Your doctor is the best person to advise which treatment would be most suitable in your case. Remember that erectile dysfunction occurs more often and on average 10-15 years earlier in men with diabetes than in men without diabetes.
Lifestyle changes are also important, particularly stopping smoking, if you do smoke.
Other sexual problems in men with diabetes
Retrograde ejaculation
Retrograde ejaculation is a condition where semen passes backwards into the bladder instead of through the tip of the penis.
In men with diabetes, retrograde ejaculation can result from damage to the sphincter muscle at the neck of the bladder. Raised blood glucose levels can damage the sphincter muscle and the nerves that control it, meaning that the sphincter doesn’t close properly and allows semen into the bladder.
Retrograde ejaculation is not harmful, and only needs treatment if you are trying to father a child. Controlling blood sugar levels can help, but couples trying to conceive may need to use assisted fertilisation procedures.
Testosterone deficiency
Testosterone deficiency — inadequate production of the male sex hormone, testosterone — can cause decreased libido in adult men. Men with type 2 diabetes are at risk of testosterone deficiency, particularly if they are also overweight.
Losing weight, controlling blood glucose levels and getting regular exercise can help prevent and treat testosterone deficiency in men with diabetes. Testosterone replacement therapy is appropriate in some cases.
Sexual problems in women with diabetes
The sex problems experienced by some women with diabetes are the same problems that may be experienced by women without diabetes, namely:
lack of vaginal lubrication;
uncomfortable or painful intercourse; and
loss of desire — reduced libido.
Just like other women, some women with diabetes may suffer problems with orgasm. If you are having sexual problems that may or may not be related to your diabetes, see your doctor — there may be some simple things you can do to improve the situation.
Lack of lubrication
Dryness of the vagina, due to a lack of lubrication or slow lubrication, can lead to painful intercourse for women. It is thought that nerve and blood vessel damage in diabetes contributes to this effect. The problem is easily remedied by using a water soluble personal lubricant which should provide relief from discomfort during sex.
Oestrogen creams or pessaries are sometimes prescribed to women going through the menopause or who have had the menopause, because the body slows down its production of oestrogen during and after menopause, leading to vaginal dryness. Your doctor will be able to advise the most suitable options for you.
Painful sex
Pain during sex can be due to yeast infections (thrush) as well as vaginal dryness. Women who suffer from poor blood glucose control are more susceptible to vaginal yeast infections, because the yeasts flourish in high sugar environments.
Thrush can be treated with antifungal creams or vaginal pessaries.
Loss of desire
Losing interest in sex is not the sole domain of women with diabetes. Decreased sexual desire can be due to many factors, but one which does relates to women with diabetes is widely fluctuating blood glucose levels. Poor control of blood glucose can lead to tiredness and a lack of interest in sex. Bringing blood glucose control back under control may help restore desire.
Sex and blood sugar — for both men and women
Whether you’re a man or a woman, when you do have sex, always remember that sex is like any form of exercise — your muscles need glucose for energy. Afterwards, your blood sugar may drop.
