When a person has diabetes, their body cannot use insulin properly, and this can lead to high blood sugar levels. Over time, these can lead to complications such as nerve damage and cardiovascular problems. Both have implications for sexual health.
Diabetes can also have an impact on a person's mental health and self-esteem, and this, too, can affect sexual health.
Impact on women
Diabetes may impact a woman's sexual health by damaging the nerves that can sense sexual stimulation.
High blood sugar levels can cause nerve damage throughout the body.
In women, this can affect:
- the ability to experience sexual stimulation and arousal
- the release of vaginal lubricant
These changes may result in painful sex and a reduced ability to experience an orgasm.
During menopause, a woman with diabetes may experience sudden drops in her blood sugar levels.
This may affect her sexual health because she might experience symptoms of low blood sugar during sex. This may make sex seem more of an inconvenience than a pleasure.
She may also have to check her blood sugar before having sex.
In addition, women with diabetes are more likely to experience infections, such as thrush, cystitis, and urinary tract infections. These can all impact the ability to have or enjoy sexual intercourse.
Click here to learn more about the impact of diabetes on women.
Impact on men
However, the main sexual health problem affecting men with diabetes is an inability to achieve or maintain an erection, known as erectile dysfunction (ED).
For a man to achieve an erection, there must be significant blood flow to the penis. However, diabetes damages the blood vessels, which can affect blood flow to the penis.
Diabetes can also lead to nerve damage and make it more difficult for him to maintain an erection.
According to the American Diabetes Association, 10–20 percent of cases of ED are due to stress, depression, low self-esteem, fear of sexual failure, and other mental health concerns. These can all affect a person with a long-term condition, such as diabetes.
Click here to learn more about the specific ways in which diabetes affects men.
Impact on both sexes
People with diabetes often feel tired. They may also have a range of health concerns, due to complications, and they may invest a significant amount of time in managing their health. These factors may decrease a person's overall sex drive.
Using an insulin pump
Some people with diabetes wear a small pump that supplies insulin to the body. This helps them maintain their sugar levels and may enable them to enjoy sex more spontaneously.
A person may feel self-conscious about wearing the pump during sex or afraid that it may detach.
It is safe to disconnect the pump for up to 1 hour during intimacy, according to one source, and it is not dangerous for a pump to become detached.
However, the user must remember to reattach it within 45 minutes to one hour.
Explaining to a new partner about diabetes early in the relationship will lead to a better understanding and communication and reduce embarrassment on both sides.
A number of psychological effects can also make sex more difficult.
- changes to self-image
- concerns over weight gain
- loss of self-esteem
A doctor can help a person get help to resolve these problems.
Drugs are available to treat people who are struggling with mental health issues as a result of diabetes. Known as selective serotonin reuptake inhibitors (SSRIs), examples include Prozac and Zoloft.
These medications can help reduce the incidence of depression, but they may also result in reduced libido.
Maintaining healthy blood sugar levels is vital in preventing the nerve damage that can cause problems, including for a person's sexual health.
Ways of managing blood sugar levels include using insulin, taking medications, and checking blood glucose levels regularly.
Treatment options for men
For some men, medication can enhance blood flow and improve the ability to maintain an erection.
There are several medications a doctor can prescribe to enhance blood flow and improve a man's ability to achieve an erection.
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
- avanafil (Stendra)
However, these medications may not be suitable for every man, particularly those with high blood pressure or heart conditions.
Find out more here about these drugs.
Some men may find that mechanical methods to improve blood flow, such as vacuum pumps and injections into the penis, are effective.
Some men undergo surgery, such as a penile implant, which can also increase the ability to get an erection.
Treatment options for women
Women may wish to use a vaginal lubricant before engaging in sex to reduce pain during intercourse. The lubricant should be water-based.
Lubricants are available at most drugstores or for purchase online.
Hormone replacement therapies
Hormone replacement therapies can improve sexual desire for both men and women.
However, these therapies can have side effects, so it is important that people discuss these fully with a doctor before starting to take any medications.
A study published in 2016 notes that it is not yet clear how hormone therapy will affect an individual's insulin sensitivity, especially during menopause.
Living a healthful lifestyle is an important way for men and women with diabetes to boost their overall sense of wellbeing, as well as their sexual health.
- eating a healthful diet
- exercising regularly
- maintaining a healthy weight
These practices are excellent for overall good health and can promote self-esteem.
Pelvic floor exercises
In 2017, researchers suggested that sex education and exercises for the pelvic floor muscles — known as Kegel exercises — may improve a woman's sexual response after menopause.
Follow these simple instructions to identify and exercise the muscles:
- Identify the pelvic floor muscles by sitting on the toilet and trying to stop a stream of urine. Or insert a finger into the vagina and squeeze the vaginal muscles around the finger. These are the target muscles.
- Tighten and hold the muscles. Start by holding the muscles for about 3 seconds and then releasing for 3 seconds. Repeat the exercise 10 times in a row, if possible.
- Repeat the exercises at least twice per day, increasing the length of time the muscles are contracted from 3 seconds to 5 seconds.
Men can also do Kegel exercises and may find the exercises improve their control over ejaculation and reduce incidences of incontinence.
People with diabetes may find that engaging in stress-reducing practices can help. Examples of these practices include:
- reading a book
- listening to music
Taking even a small amount of time during the day to do something enjoyable can help reduce stress for people with diabetes.
When to see a doctor
According to a study published in the September 2010 issue of the journal Diabetes Care, only 19 percent of women and 47 percent of men with diabetes had discussed their sexual health with their doctors.
However, sexual health problems are not inevitable with diabetes. The study also found that a significant number of men and women with diabetes, aged 57–85 years, engaged in sexual activity 2–3 times a week.
If people with diabetes have any questions about sexual health then they should consult a healthcare professional.
People with diabetes who have concerns or questions about their sexual health should contact their endocrinologist or doctor.
Examples of questions to ask include:
- What do I need to know to better manage my diabetes?
- What other health problems do I have that may be affecting my sexual health?
- What medications am I taking that could be affecting my sex life?
A doctor may also recommend seeing a counselor or therapist to help improve self-esteem and overall self-perception. Counseling for couples can also be beneficial.
Whatever the treatment decisions, a person should never feel ashamed or embarrassed if diabetes affects their sexual function.
Reaching out to a trusted healthcare professional and having an open, honest discussion with a partner can be the first steps to living a healthier life overall, with a better sex life.