Diabetes and Sexual Dysfunction: How to Find a Balance

On top of all the other health concerns related to diabetes, there is also an increased risk of sexual dysfunction in people of any sex or gender living with this all-too-common disease.

Although the cause of sexual dysfunction is not entirely clear, research suggests that it may be due to a combination of factors, including complications of the disease itself paired with health or lifestyle factors that contribute to both diabetes and sexual problems like erectile dysfunction or loss of libido.

This article explores the causes and risks of sexual dysfunction in people with diabetes and the treatments that may help improve your sex life. It also offers tips on discussing these concerns with a healthcare provider so that you can take the steps needed to enhance your sexual health.

Diabetes: A Risk Factor for Sexual Dysfunction

By definition, sexual dysfunction is a problem that interferes with any part of normal sexual activity, including sexual desire, arousal, physical pleasure, and orgasm. It is a largely subjective issue that can vary by a person's age and personal preference. "Sexual dysfunction" usually is defined as a "person's inability to participate in a sexual relationship as they would wish."

The rate of sexual dysfunction in people with diabetes is statistically higher than in the general population. In males, this mainly involves erectile dysfunction and ejaculation problems, while in females, sexual desire, arousal, and the ability to orgasm are often affected.

Erectile Dysfunction

Erectile dysfunction (ED) is the inability to achieve or sustain an erection suitable for sex. An erection is a complex function involving emotions, hormones, nerves, muscles, and blood vessels that work together to engorge a penis with blood to make it stiff enough for sex. A failure in any of these processes can lead to ED.

In males with diabetes, the risk of ED is 3 times greater than in those without it. Moreover, the symptoms tend to be more severe and occur 10 to 15 years earlier than in the general population, no matter if you have type 1 diabetes (the type you get through genetics early in life) or type 2 diabetes (the type you mainly get through lifestyle habits later in life).

The reasons for this are far from clear. Some studies have shown a relationship between ED and poor blood glucose (sugar) control, while others have not. Those that show a relationship suggest that uncontrolled diabetes may damage the nerves and blood vessels needed to achieve an erection.

Other risk factors statistically linked to ED in people with diabetes include:

• Older age: The risk of ED also increases as a person ages.
  
• Low testosterone levels: The condition, known as hypogonadism, affects 1 in 4 males with diabetes.
• Medication side effects: These include side effects of beta-blockers, thiazide diuretics, and antidepressants used to treat complications of diabetes.
• Having diabetes for a longer time: This may explain why males with type 1 diabetes, who typically develop the disease in early childhood, have higher rates of ED.
  

Other risk factors specifically linked to type 2 diabetes are also linked to increased risk of ED, including:

• Obesity
• Smoking
• Metabolic syndrome (a group of conditions that can lead to heart disease, stroke, and type 2 diabetes)
• Hypertension (high blood pressure)
• Hyperlipidemia (high cholesterol)

Ejaculation Dysfunction

Ejaculation is the sudden discharge of semen from the body during an orgasm. In the same way that diabetes can increase the risk of erectile dysfunction, it can also increase the risk of male ejaculation problems, such as:

• Premature ejaculation: This is when ejaculation occurs earlier than wanted.
• Delayed ejaculation: This is when ejaculation takes excessive time or stimulation.
• Anejaculation: This is when no semen is released during ejaculation.
• Retrograde ejaculation: This is when semen flows back toward the bladder rather than out of the body.

As with ED, the cause of ejaculation problems in people with diabetes is poorly understood.

Some scientists believe that hyperglycemia (high blood sugar) can damage the nerves and muscles involved in ejaculation, either by altering the body's response to physical stimulation (making it oversensitive or under sensitive) or affecting contractions (spasms) of ejaculatory muscles.

Female Sexual Dysfunction

The causes of sexual dysfunction in females with diabetes are even less understood than in males. The problems can affect females of any age but are most common after menopause.

Whether you have diabetes or not, female sexual dysfunction is influenced by many things, including psychological and health-related factors. But, when diabetes is involved, the risk can increase exponentially, irrespective of whether you have type 1 or type 2 diabetes.

According to a 2013 study in Practical Diabetes, the types and frequency of sexual problems experienced by females with diabetes include:

• Loss of sexual interest: Also known as hypoactive sexual desire disorder (HSDD)
• Lack of response to stimulation: Also known as female genital arousal disorder (FGAD)
• Loss of vaginal lubrication: Also referred to as vaginal atrophy
• Difficulty reaching orgasm: Also known as anorgasmia
• Pain during sex: Also known as dyspareunia

Unlike males with diabetes, the causes of sexual dysfunction in females appear to be mainly psychological, although there are also physical concerns.

Diabetes, especially type 2 diabetes, is associated with a high body mass index (BMI). In females especially, high BMIs translate to higher rates of depression and anxiety and, in turn, higher rates of sexual dysfunction. Moreover, the medications used to treat depression and anxiety (including antidepressants, mood stabilizers, and anxiolytics) can make things worse.

On top of this, uncontrolled hyperglycemia can reduce moisture levels in vaginal tissues, leading to vaginal dryness, pain, and an increased risk of infection.

Improving Sexual Health With Diabetes 

Regardless of sex or gender, maintaining control of your blood sugar can help improve—and even normalize—many facets of your health, including your sexual health. This involves monitoring your blood sugar, adhering to your medications, and embracing healthy lifestyle choices like regular exercise, weight loss, and a diabetes-friendly diet.

There are also several treatments a healthcare provider may recommend for the specific types of sexual dysfunction you are experiencing.

Erectile Dysfunction

The treatment of erectile dysfunction in people with diabetes is largely the same as in those without and may include:

• Lifestyle changes: In addition to diet, weight loss, and exercise, efforts should be made to quit smoking.
• Erectile dysfunction drugs: The drugs, also known as phosphodiesterase 5 (PDE5) inhibitors, are used in the first-line treatment of ED. These include Viagra (sildenafil) and Cialis (tadalafil).
• Alprostadil: The drug works by dilating (widening) blood vessels in the penis. Alprostadil (sold under the brand name Caverject and others, can be combined with other medications in a mixture) is injected into the shaft of the penis. The suppository form called Muse is inserted into the opening of the penis (known as the urethra).
• Testosterone replacement therapy: This helps boost testosterone levels in people with hypogonadism. Testosterone replacement therapy may be delivered by injection, patches, creams, or a new nasal gel called Natesto.

Vacuum pumps, penile implants, and other therapies may be explored if ED is severely impacting your sexual health and well-being. Counseling can help address the psychological causes of ED.

Ejaculation Dysfunction

Ejaculation dysfunction typically requires diagnosis and treatment by a specialist known as a urologist who is trained in disorders of the urinary tract and male reproductive system.

The treatment of ejaculation dysfunction varies by the cause:

• Premature ejaculation: The treatment may involve counseling, numbing creams to reduce penis sensitivity, and sexual techniques such as the "stop-start method" to delay orgasm.
• Delayed ejaculation: Testosterone replacement, counseling, and an adjustment of medications may all be explored. Sex therapy may also help, including the use of penile vibrators.
• Anejaculation: In addition to counseling, sex therapy, and a change of medications, anxiolytic drugs may help ease anxiety and stress that contributes to ejaculation problems.
• Retrograde ejaculation: Medications like Tofranil (imipramine) may be prescribed to help keep the bladder neck closed during ejaculation. Assisted fertility procedures may also be needed as retrograde fertility is linked to an increased risk of male infertility.

Female Sexual Dysfunction

The treatment of sexual dysfunction in females with diabetes is more or less the same as in those without.

Depending on the symptoms and causes, the treatment may involve:

• Cognitive behavior therapy (CBT): A form of psychotherapy, or talk therapy, CBT typically involves one-on-one counseling to address the underlying causes of HSDD, FASD, and other arousal or orgasm disorders.
• Clitoral stimulation: This may involve devices like clitoral vibrators, clitoral suctioning devices, and air-pulsating devices to help stimulate the clitoris.
• Sex therapy: This may involve erotic touch, masturbation, and outercourse (non-penetrative sex) to avoid painful intercourse and reduce stress caused by sexual dysfunction.
• Depression and anxiety treatment: In addition to antidepressants or anxiolytics, group or one-on-one therapy may be advised, along with routine exercise and mind-body therapies.
• Hormone replacement therapy: Estrogen replacement therapy (with pills or vaginal creams, rings, or suppositories) can help reduce vaginal pain and dryness after menopause.
  

Tips for Feeling Comfortable at Your Next Provider Visit 

It can be awkward and even embarrassing to discuss sexual problems with a healthcare provider. If you're feeling this way, the first thing to remind yourself is that you are not alone.

If you're uncomfortable discussing sexual problems with your primary healthcare provider, ask for a referral to a specialist called an endocrinologist, who treats hormonal disorders, including diabetes. Endocrinologists have an in-depth understanding of the complications of diabetes and are experienced in dealing with sexual problems associated with the disease.

The first rule to overcoming awkwardness is to come prepared for your appointment. It often helps to make a list of your concerns so that you don't forget anything, namely:

• What symptoms you are experiencing
• When they started
• How often they occur (with dates and times, if possible)
• What you have tried to do to treat them (such as ordering Viagra online or using a vibrator)
• How the symptoms make you feel emotionally
• If you are dealing with any other physical or emotional issues

By focusing on the medical concerns and answering questions as honestly as possible, you can provide the specialist with the information they need to start the investigation.

Summary

People living with diabetes are at far greater risk of sexual dysfunction than people without. In males, erectile dysfunction and ejaculation problems are common concerns. In females, a loss of sexual interest, arousal problems, vaginal dryness or pain, and an inability to orgasm are linked to psychological and physical concerns.

While treatments can help overcome these symptoms (including medications, counseling, and sex therapy), an emphasis would also be placed on better managing your blood sugar and embracing lifestyle choices that improve your general health and your emotional and sexual health as well.

A Word From Verywell

Sexual health is directly linked to general health and well-being, so don't minimize any sexual problems you have or dismiss them as "one of those things" you have to live with.

Leaving these concerns unspoken can damage relationships or isolate you if you are outside of a relationship. This can increase the risk of depression, which, in turn, affects sleep, concentration, and appetite while causing physical symptoms like headaches, muscle aches, and digestion problems.

Sexual health is a facet of your general health. Therefore, it is in your best interest to regard it with the same importance as any other medical concern you face.