Diabetes mellitus, or diabetes, is a chronic disease that impacts the whole body. It affects the pancreas, an organ responsible for producing the hormone insulin.
Insulin helps to regulate blood glucose (blood sugar) levels. When the pancreas doesn’t produce enough insulin or when the body doesn’t respond to insulin the way it should, blood sugar levels rise.
Such is the case with diabetes; blood sugar levels can rise to an unhealthy level without intervention.
Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes.
Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a significant risk factor for eventually developing type 2 diabetes.
The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
Chronic high blood sugar related to diabetes can damage the arteries and vessels carrying blood throughout the body. This also can cause damage to organs and nerves. Because of its damaging effects on the body, diabetes can affect sexual function in men and women.
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How does diabetes affect your sex life?
Sexual pleasure stems from nerve stimulation for both men and women. Chronic, poorly-controlled diabetes can cause nerve damage, called diabetic neuropathy. When neuropathy affects the sexual organs, it can cause problems such as the inability to become aroused, leading to low libido.
The World Health Organization refers to sexual dysfunction as “the inability of an individual to participate in a sexual relationship.” The prevalence of sexual dysfunction is higher in people with diabetes and increases with age.
Sexual dysfunction can result from a type of neuropathy affecting the autonomic nervous system, or ANS. This type of neuropathy is called autonomic neuropathy. The autonomic nervous system affects many-body systems, including the gastrointestinal, cardiovascular, and genitourinary systems.
Diabetic neuropathy can result in sexual dysfunction, referred to as “one of the least recognized and understood diabetes complications.” The likelihood of diabetic neuropathy increases with low blood glucose control, longer duration of diabetes, kidney disease, and those who are obese use alcohol and smoke. On the other hand, good blood sugar management can help prevent neuropathies and other diabetes-related complications.
Another consideration is the link between mental health and sexual health. People with diabetes are more likely to suffer from conditions such as depression. Depression has been known to affect libido negatively. Interestingly, prediabetes and undiagnosed diabetes have also been associated with a moderately increased prevalence of depression.
Erectile dysfunction is the inability to get and keep an erection firm enough for sex. Diabetes can cause erectile dysfunction because it damages the blood supply to the penis and the nerves that control an erection.
Men with diabetes are likely to experience erectile dysfunction symptoms 10-15 years earlier in life than men without diabetes. While some men may experience erectile dysfunction symptoms from time-to-time, persistent issues become problematic for a man’s sexual health and should be addressed.
Over 50% of men with diabetes are estimated to have difficulty initiating or maintaining an erection. Advancing age is also a risk factor for erectile dysfunction. The incidence of erectile dysfunction is as high as 95% in men 70 and older. Part of the reason is because of vascular changes that can occur with age, impacting the blood flow that supplies the penis.
There is an association between diabetes and low testosterone. Testosterone is a sex hormone in men. Testosterone is responsible for many things, such as:
- The development of the penis and testes
- The deepening of the voice during puberty
- Appearance of facial and pubic hair starting at puberty; later in life, it may play a role in balding
- Muscle size and strength
- Bone growth and strength
- Sex drive (libido)
- Sperm production
A testosterone deficiency can fuel libido issues, but it isn’t always the cause of low libido in men. Some men function well at lower testosterone levels than others. It’s an individualized response, but if testosterone levels drop drastically enough, it’s more likely to impact sex drive.
Rarely, diabetes can cause retrograde ejaculation, which is when part or all semen goes into the bladder instead of out of your penis during ejaculation. This condition isn’t dangerous since the semen is urinated out safely. However, it can cause fertility issues due to inadequate amounts of sperm being released with ejaculation.
Diabetes can increase the risk of high blood pressure by damaging the blood vessels carrying blood throughout the body, as well as hardening the arteries. High blood pressure can cause erectile problems in men. It’s estimated that two-thirds of people with diabetes have high blood pressure or are on medications for high blood pressure.
One of the biggest complaints of women with diabetes is vaginal dryness. Vaginal dryness can occur from damage to the nerves that lubricate the vagina. High blood glucose levels are also dehydrating, reducing the amount of lubricative fluid normally produced in response to sexual arousal. This can lead to painful intercourse and sexual dysfunction.
Some studies have found that women with diabetes are more likely to experience sex drive issues, especially those suffering from depression. In a study of 150 women with type 2 diabetes, over 65% had depression, and over 95% had anxiety, as well as almost 60% suffering from diabetic neuropathy. All of these complications can negatively impact sexual desire.
The body tries to rid itself of extra glucose by excreting it through the urine. Because of this, high blood glucose levels also increase the likelihood of developing urinary tract infections. Women are already at increased risk of developing urinary tract infections compared to men.
Women with diabetes are at even higher risk of developing a urinary tract infection. Urinary tract infections are painful and can sometimes be worsened with sex due to bacterial transfer. As a result, women with chronic urinary tract infections may be less likely to engage in sex.
Glucose feeds bacteria and yeast, which contribute to urinary tract infections as well as yeast infections. Yeast infections are also more common in diabetic women and occur due to increased sugar feeding yeast and weakened immune system response due to high blood sugar.
If women engage in sexual activity with an active yeast infection, it can spread to their partner. Because of this, women with yeast infections are encouraged not to have sex, which can negatively impact their sex life.
The most important aspect of managing sexual dysfunction in men and women is proper blood sugar management. When blood sugar levels are normalized, complications such as sexual dysfunction can be avoided.
Diabetes can be medically managed in numerous ways. Some of the more popular medications used to treat diabetes include:
- Metformin: Helps to reduce the amount of sugar released by the liver and improves insulin sensitivity
- Sulfonylureas: Stimulate the pancreas to secrete more insulin
- GLP1 receptor agonists: Promote insulin production, decrease glucose release from the liver, and slows stomach emptying to increase satiety
- DPP-4 inhibitors: Promote insulin production, decrease glucagon (a hormone that increases blood sugar) production, and delays gastric emptying.
- Insulin is available in different types: long-acting, short-acting, rapid-acting, intermediate-acting, and mixed. They differ in how quickly they take to work, how long they are working the most to lower blood sugar, and how long they last to provide blood sugar control. People with type 1 diabetes are insulin-dependent and usually take at least two types of insulins on a daily basis.
Specific conditions impacting sexual health can also be managed on their own in addition to improving blood sugar control.
- Erectile dysfunction is often managed with medications that enhance nitric oxide, which is a natural chemical produced by the body that relaxes the muscles in the penis. Increasing nitric oxide production increases blood flow, which helps establish an erection in response to sexual stimulation. Common medications used to treat erectile dysfunction include:
Another potential treatment for erectile dysfunction is a vacuum constriction device. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, helping maintain the erection for up to 30 minutes.
- Vaginal dryness in women can be treated with vaginal lubricants, making sexual intercourse less painful. For post-menopausal women, hormonal therapy can be considered for treating vaginal dryness due to hormonal changes.
- Low libido in pre-menopausal women can be treated with a new medication called Flibanserin (Addyi). But the decision to take a medication like Addyi should be discussed with a healthcare provider.
- Low testosterone can be treated with hormonal replacement therapy. However, there are certain risks and side effects associated with hormonal treatment for low testosterone, including:
- Worsening sleep apnea (a potentially serious sleep disorder in which breathing repeatedly stops and starts)
- Causing acne or other skin reactions
- Stimulating noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer
- Enlarging breasts
- Limiting sperm production or causing testicles to shrink
- Stimulating too much red blood cell production, which contributes to the increased risk of forming a blood clot and forming a pulmonary embolism (blockage in the lung)
- Worsening sleep apnea (a potentially serious sleep disorder in which breathing repeatedly stops and starts)
Making lifestyle changes to promote healthy blood sugar levels is the best defense against diabetes-related sexual dysfunction. Outside of medical management, some lifestyle changes to consider include:
- Cut back on sugar. A higher intake of sugar has been associated with increased blood sugar levels and diabetes. Added sugars tend to be especially detrimental to health since they don’t provide any nutritional value and cause large blood sugar fluctuations.
- Exercise. Being physically active is a very important way to help control diabetes. 150 minutes per week of moderate physical activity, such as brisk walking, is recommended. Exercise can also help alleviate symptoms of depression and anxiety, which can impact sexual health.
- Eat a high-fiber diet. Plant-based foods rich in fiber tend to raise blood sugar levels more slowly than low-fiber plant-based foods. Fiber is in foods such as fruits, vegetables, grains, nuts, seeds, and legumes. A high-fiber diet has been associated with improved blood sugar control. Fiber is also beneficial for promoting heart health and can help reduce the risk of cardiovascular disease. A good amount of fiber to aim for is around 30 grams per day.
When to see a doctor
Any time blood sugar levels are consistently higher than individual target levels; a healthcare provider should make a consultation. Not only can high blood sugars impact a person’s sex life, but they can cause other complications if left untreated.
If someone’s sex life is being negatively impacted due to their health, it also warrants a visit with a healthcare provider to discuss options. Sexual health is an important aspect of overall health and wellness, so it shouldn’t be overlooked.
Diabetes can cause changes in blood flow and cause nerve damage, negatively impacting a person’s sex life. As a result, a potential complication from uncontrolled diabetes is sexual dysfunction.
Sexual dysfunction is defined as an individual’s inability to participate in a sexual relationship and can result from conditions such as erectile dysfunction, low libido, and vaginal dryness. Sexual dysfunction can impact both men and women.
The most important aspect of avoiding diabetes-related sexual dysfunction is to manage diabetes and promote healthy blood sugar levels effectively. Beyond that, several additional treatment options are to be considered after a consultation with a trusted healthcare provider.