Helpful Tips for People with Diabetes - Improve Sexual Function and Libido
By Christina Frank
Been in the mood for love lately? If the answer is not so much, know that it's not just you. Approximately 50 percent of men and 35 percent of women with type 2 diabetes experience sexual difficulties. That's no surprise, considering the host of physical and psychological challenges that often accompany diabetes.
Still, you can clear sexual hurdles and attain an active love life. More than 60 percent of partnered, middle-aged people with diabetes have sex at least two or three times a month, according to a study published in the journal Diabetes Care. That frequency is comparable to people in the same age group without diabetes.
"Don't give up and assume sex is just another thing diabetes will take from you," says Janis Roszler, R.D., C.D.E., M.S.F.T., author of Sex and Diabetes: For Him and For Her (American Diabetes Association, 2007). "Reliable treatments and coping strategies are available for physical as well as psychological issues." Rediscover your sexual self with the help of these expert tips.
1. Balance Blood Sugar
The first step in addressing sexual problems (and most other diabetes complications) is to make sure your glucose levels are well-controlled. High blood sugar levels can cause nerve damage (neuropathy) and impair circulation, which can lead to decreased erections in men, lack of lubrication in women and difficulties in achieving orgasm for both. Controlling blood sugar also keeps chronic vaginal infections—a common complaint in women with diabetes—at bay.
"Plus, when your blood sugar level is too high, you often feel lousy, which hardly puts you in the mood for sex," says Joel Zonszein, M.D., director of the Clinical Diabetes Center at Montefiore Medical Center in the Bronx, NY. Always check your blood sugar prior to making love, just as you would before any other form of exercise. This helps you avoid symptoms of hypoglycemia, such as feeling shaky or confused.
2. End Erectile Dysfunction (ED)
About half of men who have had diabetes for more than 10 years experience erectile dysfunction (ED), also called impotence. The reason: Over time, diabetes can damage blood vessels and nerves, including those in the penis. This makes it more difficult to achieve or maintain an erection.
Other factors that can contribute to ED include smoking, excess weight and inactivity. ED can also be a side effect of some medications, such as those used to treat hypertension or depression. The good news? Drugs for treating ED, including sildenafil (Viagra) and tadalafil (Cialis), are effective in about half of men with diabetes, says Roszler.
Talk to your doctor before filling a prescription, however: ED drugs can cause dangerous interactions with certain heart disease therapies. If medications aren't appropriate for you, alternatives include vacuum pumps, which draw blood into the penis, and constriction bands, which help keep the penis erect. Devices that allow you to achieve an erection can also be surgically implanted under general anesthesia.
In addition, testosterone supplementation is available for men whose ED is caused by low levels of the hormone. Your doctor can help you decide what's most likely to work for you.
3. Address Vaginal Dryness
Over-the-counter vaginal lubricants provide an easy, effective solution. If you find that you need additional help—common for postmenopausal women—ask your doctor whether you are a candidate for the vaginal method of estrogen replacement therapy (ERT), which delivers the hormone via a ring placed in the vagina. This type of ERT carries fewer potential risks than oral drugs and patches, which have been linked to an increased risk of breast cancer and stroke.
4. Treat Depression
To put it simply: "If your head is not ready, then your tail is not ready," says Lois Jovanovic, M.D., C.E.O. and chief scientific officer of the Sansum Diabetes Research Institute in Santa Barbara, CA. One major stumbling block for getting in the mood is depression. And women with diabetes are 30 percent more likely to have depression than people without the condition, according to recent research published in the Archives of Internal Medicine. Plus, taking insulin doubles your risk of developing depression.
Also, feeling self-conscious about wearing an insulin pump, being overweight or having bruises at injection sites can contribute to low self-esteem—a major component of depression. Antidepressants and psychotherapy, separately or in combination, can be very successful at relieving depression, studies show—though some antidepressants have sexual side effects of their own. Ask your doctor about finding one that doesn't dampen your desire.
5. Talk to Your Doctor
One of the biggest obstacles to resolving sexual problems is getting past embarrassment and bringing the topic up to your doctor. It turns out only 19 percent of women and 47 percent of men discuss sexual issues with their physicians, according to a study published in Diabetes Care. To get the conversational ball rolling, Roszler suggests writing down pointed questions, such as "Which of my medications might be affecting my erections?" before your office visit. And ask questions at the beginning of your appointment so you don't chicken out.
6. Communicate with Your Partner
Sorting out relationship challenges is critical for a satisfying sex life, especially when you are dealing with a chronic illness like diabetes. The ability to be spontaneous takes a hit when one person has to monitor his or her blood sugar, medications and food intake continuously.
Couples also need to remember that women often need more time than men to become aroused. Roszler's advice is to be patient and communicative with each other. "Sure, you may have to schedule sex, but so do a lot of busy people without diabetes," she says. If kick-starting a sex talk with your partner feels too difficult, ask your health care provider for a referral to a couples counselor who can help you communicate more effectively. Above all, Roszler urges you to reach out. "You're not alone, and there is help, but you can only get it if you ask for it."
Adapted from our sister publication Diabetes Focus (Summer 2012).