Sexual health and diabetes

A healthy sexual relationship can be one of life’s greatest expectations and pleasures. Our sexuality and feelings as sexual beings are very much part of our psyche irrespective of age. Sometimes however, as we get older, our ability to enjoy and even participate in sexual activity may be diminished. When things go wrong it is hard to accept that there might be a problem that may need to be discussed or even treated.

Clear communication with spouses/partners at such times is crucial but conversations about sexual health problems can be difficult to broach and our communication skills often let us down. Knowing that sexual problems are common, and understanding what is happening, can help us overcome fears about asking for external help.

Sexual problems are common in people living with diabetes and may affect both men and women. It is also important to remember that some of these problems are no different to those that the general population might have.

Some sexual problems that may affect men with diabetes are:

  • Difficulties with erections due to poor blood glucose control
  • Difficulties with erections due to stress or fear of not being able to achieve an erection
  • Difficulties with erections due to damage to the nerves or blood vessels supplying the penis

Men living with diabetes may have high blood glucose levels which can cause a reduction in libido, or sex drive. Bringing blood glucose levels back under control again may sometimes restore a man’s sex drive.

Issues such as relationship problems, financial problems, certain medications, stress and depression can also cause sexual difficulties. Talking to a health professional about these problems can be helpful.

Persistently high blood glucose levels can damage the nerves over a period of time. If the nerves connected to the penis are damaged then messages from the brain don’t reach the penis. Such nerve damage can cause ejaculation difficulties. Those with long term diabetes may also have damaged blood vessels. Lack of blood supply to the penis may make it difficult to achieve an erection.

Erectile dysfunction is often used to describe erection problems that happen more than three quarters of the time.

Oral medications, such as Viagra, Cialis and Levitra have been shown to be effective in treating erectile dysfunction in men with diabetes.

Vacuum pump devices are a physical method and another way for inducing an erection. Injection into the penis with the medication Caverject is also another treatment for Erectile Dysfunction.

Currently only ten percent of Australian men with erectile dysfunction seek treatment. Your doctor is the best person to talk to when discussing erection problems and also the best person to advise which treatments would be most suitable. Erectile dysfunction occurs more often, and on average, 10-15 years earlier in men with diabetes than in men without diabetes.

Some of the sexual problems that affect women with diabetes are:

  • Dryness of the vagina
  • Pain during sex
  • Decreased sexual desire

Vaginal dryness is due to lack of lubrication and can lead to painful intercourse. It is thought that nerve and blood vessel damage in diabetes contributes to this effect. The problem may be remedied by using a water soluble personal lubricant (such as Sylk ®) to provide relief from discomfort during sex.

Vaginal dryness can also be caused by a slowing of oestrogen production during and after menopause. Oestrogen creams or pessaries are sometimes prescribed to help alleviate this problem.

Pain during sex can be due to yeast infections (thrush) as well as vaginal dryness. Women with diabetes who have from poor glucose control are more susceptible to vaginal yeast infections. Thrush can be treated with oral tablets, anti fungal creams or vaginal pessaries. If you get recurrent thrush infections, it may be that your partner is carrying the yeast infection and re infecting you during sex. If this is the case your partner will need to be treated as well.

For women, losing interest in sex can be due to many factors. Apart from dryness and pain an additional problem for women with diabetes is fluctuating blood glucose levels. Poor control of BGL’s can lead to tiredness and therefore a lack of interest in sex. Bringing BGL’s back under control may help restore desire.

As explained, diabetes can cause a range of sexual health difficulties and problems. Each problem needs to be assessed individually and the best treatment or management should be discussed with your health professional.

Keep in mind that often the focus of management or treatment of sexual difficulties tends to be medically focused.  While this is important, most of the success in ensuring good sexual relationships will come from you and your partner talking openly and sensitively about feelings and emotions.

Start really talking with your partner, discuss what you enjoy sexually, explore ways to give and receive pleasure and explore feelings of being attractive and desirable. Relax, talk openly and your communication will improve. Remember, that active listening and emotional sharing are the keys to good communication. Let your partner know that you care.

Take the self blame and shame out the relationship. These are often common issues in people with type 2 diabetes. “If I had taken better care of myself I wouldn’t be having these sexual problems”. Partners can also blame the person with diabetes further damaging self esteem. Conversely partners can also experience feelings of rejection, unattractiveness and guilt in relation to their partners’ sexual difficulties.

Communicating with your partner is essential. Talk openly with your health professionals about sexual health difficulties and problems is vital.

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