Sex and Diabetes
By Alan Uphold
It’s not always easy to talk about sex, regardless of whether you have diabetes or not. If you are a person living with diabetes, here are some important things to bear in mind when you're in the bedroom.
When I was in college in the mid-1980s, there was a popular dance hit that we frequently played at our fraternity called, “Let’s Talk About Sex,” by the hip-hop duo, Salt-N-Pepa.
The song was a lot of fun to dance to, but unfortunately, none of us ever actually talked about sex.
How come?
Any credible mental health specialist will tell you that healthy sexual relations between consenting adults is an important aspect of physical and emotional well-being.
And while everyone experiences some form of sexual anxiety at some point in their lives, people with diabetes have an added level of stress.
Having said that, Dr. Helen Baron, diabetes and metabolism specialist, admits that her first priority for her patients with diabetes is not sexual health.
Her first and most important priority is to minimize the complications that can cause the most harm. Risks such as heart attack, stroke, and cardiovascular disease are her first priority, followed by complications like blindness and renal failure. Basically, her first priority is keeping her patients alive.
Baron acknowledges that for her (and presumably for many of her colleagues), “Sexual dysfunction may be considered to be more a quality of life issue than a length of life issue.”
Bottom line, extending your life is (understandably) likely to be higher on your endocrinologist’s priority list than addressing any sexual dysfunction issues you may have.
That is all the more reason why people with diabetes should be proactive about mentioning sexual dysfunction issues to their health care providers.
So to quote those brilliant lyricists, Salt-N-Pepa, “Let’s talk about sex, baby.”
Urologist and sexual health specialist, Dr. Joshua Gonzalez, explains that diabetes affects the microvascular system, which is responsible for delivering hormones to the body’s reproductive organs.
The microvascular system is part of the circulatory system, which is one of the most commonly affected systems among people with diabetes.
It’s not surprising that those living with diabetes may experience changes to the microvascular system, which could result in some form of sexual dysfunction at some point.
In a study published in 2021 in Diabetic Medicine, 36% of men and 31% of women with diabetes reported some type of sexual dysfunction
Both men and women with diabetes reported a higher rate of impaired physical well-being, lower emotional well-being, and moderate to severe anxiety compared to people without diabetes.
Before specifically addressing the mental health issues that people with diabetes experience as a result of sexual dysfunction, let’s review those sexual dysfunction issues.
Issues that men might experience:
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Erectile dysfunction (ED). According to a 2017 article in Diabetic Medicine, men with diabetes are three times more likely to experience ED than men without diabetes. Diabetes can decrease blood flow to the penis, which can inhibit a man’s ability to achieve and maintain an erection.
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Decreased libido. Men with diabetes may have decreased testosterone levels, which may lead to decreased libido and sexual desire.
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Pain when having sex. Men with diabetes are more likely to develop a condition known as Peyronie’s Disease, which is a curvature or bend in the penis. While the condition is rare, it can result in painful sex.
Fewer studies have been done about the sexual health of women with diabetes compared to the number of studies for men.
Women with diabetes have their own specific sexual dysfunction issues that can affect their mental health, and women’s issues are no less distressing than those experienced by men.
A previous article focused on sexual issues faced by women with diabetes.
Some of the issues addressed include:
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Vaginal dryness. Many post-menopausal women experience vaginal dryness, but women with diabetes across all age groups report this problem more often than women without diabetes.
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Urinary Tract Infections (UTIs) and Yeast Infections. Women with diabetes are at a higher risk of developing (often chronic) UTIs and yeast infections, which can result in painful sex.
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Decreased libido. While decreased libido can be an issue for both men and women, it tends to be more problematic for women. As noted in Garza’s article, 50% of women with diabetes reported decreased libido. This can lead to feelings of depression and low self-esteem.
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Difficulty achieving orgasm. A study published in Obstetrics & Gynecology in August 2011 found that women with diabetes between the ages of 40-80 were 80% more likely to experience trouble reaching orgasm than women of the same age without diabetes.
Experts agree that the most important thing that people with diabetes can do to reduce sexual anxiety and improve mental health is to take control of their diabetes.
Watching your diet, exercising regularly, taking your medications, and maintaining a healthy lifestyle (e.g., quit smoking, monitor your alcohol intake, get regular check-ups for your feet, eyes, teeth, etc.) are good for your general health as well as your sexual health.
Experts stress the importance of keeping your diabetes in check and maintaining a healthy A1C.
This can, in turn, contribute to achieving a healthy sex life and improving your mental health.
According to Edward Ruiz, diabetes care and education specialist and dietitian at Eisenhower Medical Center in Rancho Mirage, “When someone’s blood sugar goes high or low it can cause emotional distress. Glycemic management with diabetes has a large impact on preventing complications, as well as improving the person’s mental health”
In addition to your general health and well-being, other treatments can improve your sexual performance and improve your mental health.
Drugs like Viagra (for men), Cialis (for both men and women), hormone therapies (for both men and women), and even over-the-counter lubricants (for women) can help improve self-esteem and make you feel more confident in the bedroom.
If you prefer to take a non-medication approach to treating your sexual performance issues, there are natural supplements for both men and women.
Dr. Myles Spar, an integrative medicine specialist, former chair of the American Board of Integrative Medicine, and author of the book, Optimal Men’s Health, points out that there are natural supplements that have been found to help with libido.
“Many cultures have libido enhancing herbs in their folk medicine traditions,” says Spar, including maca root, used in Native American and Latin American medicine (for both men and women), and tribulus, an Ayurvedic herb (for women).
Spar stresses that before starting any new drug or supplement therapy, you should always first check with your healthcare provider.
Even when treating the root causes of our sexual health anxieties, some may still feel sexually insecure or inadequate.
Urologist Gonzalez encourages you to seek help from a mental health professional.
He works closely with psychotherapists and sex therapists to help his patients overcome the mental health issues related to sexual health.
He reminds us all that you should not hesitate to turn to mental health experts for help and guidance.
The American Diabetes Association also has some good tips about sexual health.
So to review....work with your health team to bring your diabetes under control, then ask them about drugs, hormones, or supplement therapies that can improve your sexual health, and finally consider reaching out to a mental health expert.
As endocrinologist Baron suggests, “If your medical provider is not asking the right questions about your health concerns—general, sexual, mental, or otherwise—then speak up!”
