How are diabetes and sexual dysfunction related?

Diabetes may affect the sexual function of both men and women. Generally, diabetics have problems related to sexual function earlier in life than people who do not have the disease.

Many men who have diabetes have a problem with impotence (the ability to have and maintain an erection). In fact, impotence, along with the need to urinate often, may be an early sign of diabetes. Impotence occurs in men with type 1 diabetes as well those with type 2 diabetes.

Changes may more be subtle in women with diabetes. It may become harder for them to have an orgasm.

How much diabetes affects sexual function may depend on how severe the disease is and how old you are when the disease begins. Men diagnosed after age 40 may have more mental and emotional adjustments to make than those who have learned to live with diabetes in their teens and early 20s.

Diet and medication to regulate blood sugar levels are very important in controlling diabetes and preventing further problems.

How does diabetes affect sexual function?

Diabetes in men can lead to hardening and narrowing of the blood vessels that supply the erectile tissue of the penis. This spongy tissue swells and stiffens the penis during an erection. Decreased blood flow to the penis may cause erectile problems. For example, the penis may be less rigid during erection.

In women, diabetes can lead to hardening of the blood vessels of the vaginal wall. Decreased blood flow due to diabetes may cause the vagina to be too dry, both normally and during arousal. It also may cause a woman to be at much greater risk of getting recurring yeast infections.

If diabetes is controlled by diet and/or medication, you can expect nearly normal sexual response. The more closely your diabetes is controlled and treated, the less severe and immediate the problems, including those that affect sexual function.

In women, the combination of diabetes and menopause may cause:

• a 50% decrease in vaginal blood supply due to low estrogen levels
• vaginal secretions that are less acidic and less protective, which lowers the resistance to bacteria in the vagina and increases the risk of yeast infection
• levels of glucose in vaginal mucus that may help cause yeast infections

Women may notice that they are not as easily aroused. They may be less sensitive to touching and stroking, which can result in decreased interest in sex.

How is the sexual dysfunction treated?

Treatment for the menopausal, diabetic woman includes estrogen replacement therapy (ERT), which is important in keeping blood flowing in vaginal tissues. Estrogen also provides an acid level adequate to protect against vaginal infections in women past menopause. ERT does pose risks for some women. Discuss the risks and benefits with your doctor.

If a woman is having pain with intercourse, the best treatment, together with ERT, includes:

• early diagnosis of the diabetes and a pelvic exam, including a Pap smear and maturation index (shows the level of estrogen in your body)
• treatment for any vaginal infections
• use of lubricants such as KY jelly for women with vaginal infections until ERT has taken effect (Vaseline should not be used.)
• control of the diabetes with diet, if possible, in addition to medication or insulin.

Treatment for the older, diabetic man may include:

• having intercourse only when well rested (early morning hours may be better because testosterone levels are higher then)
• having certain tests such as a Doppler study to check for adequate blood flow in the penis or sleeping in the hospital to see if erections occur during sleep
• injecting medication into the erectile tissue of the penis to produce erections that can result in intercourse
• considering implanted penile devices that improve the function of the penis if blocked blood vessels leading to the penis continue to cause problems
• using a vacuum device to draw the blood to the erectile tissues. A temporary device (band) to constrict blood flow can then be used to maintain the erection for long enough to have sex one time. This can be repeated as needed. The device should not be left on for longer than 20 to 30 minutes at a time. The penis will become soft again when the device is removed. Ejaculation response varies.