If your sex life is stalled, you are not alone.

People with diabetes have a higher rate of sexual problems than the average Canadian. But there are steps you can take to improve your sex life,

beginning with identifying and dealing with a range of issues, including low blood sugar, vaginal dryness or erection challenges, weight gain, and depressed mood.

To learn more about these issues, Diabetes Dialogue spoke with Dr. Alice Cheng, an endocrinologist at Credit Valley Hospital in Mississauga, Ont., and at St. Michael’s Hospital in Toronto; and Dr. Richard Bebb, an endocrinologist and clinical associate professor at the University of British Columbia.

Why is a sexual life important for our well-being?

Cheng: From a psychological perspective, it brings pleasure and joy—and exercise! The emotional aspect of sex impacts [your most intimate] relationship and also how you feel about yourself—your confidence level and self-esteem.
 

Bebb: Sexual activity is a normal human activity, and the lack of it can decrease quality of life and can also affect the quality and dynamics of the relationship with your partner.

How common are sexual problems among men and women with diabetes compared to the average population?

Cheng: Various studies report a wide range of sexual dysfunction in women with type 1 or type 2 diabetes—about 35-70 per cent. Among women who do not have diabetes, the average rate of sexual dysfunction is about 40 per cent.
 

Bebb: Erectile dysfunction (ED) [which refers to a man’s inability to get or keep an erection] affects approximately 35-45 per cent of men with diabetes. Studies suggest that after 20 years of [living with] type 1 diabetes, approximately 50 per cent of men will have ED. In the general population, about five per cent have ED by age 40, and this increases to 15-20 per cent by age 70.

What causes sexual dysfunction in men and women with diabetes?

Cheng: There are a number of factors for women, including reduced lubrication and reduced response due to nerve damage. Poorly controlled diabetes can lead to recurrent urinary tract infections and yeast infections. And low desire can sometimes be attributed to weight gain, depression, and/or anxiety, which are more common in women with diabetes.

Bebb: Men with type 2 diabetes have generally had years of [living with] prediabetes. During this state they may develop damage to the small blood vessels of the penis. They also frequently have hypertension [high blood pressure] and high cholesterol [as well as diabetes].

What kind of help is available?

Cheng: For women, it depends on the underlying cause. If they are experiencing vaginal dryness, prescription and over-the-counter lubricants can be [useful]. If decreased sexual response is an issue, it may [be a good opportunity] to experiment with activities other than intercourse. If there are problems in your relationship, a psychologist or sex therapist can help. Kegel exercises, which strengthen the pelvic muscles, can also improve sexual response.

Bebb: For men, the main treatment is PDE5 inhibitors [available in Canada under the brand names Viagra, Cialis, and Levitra]. Approximately 70-80 per cent of men will find these medications helpful. Many men with ED describe a feeling of ‘having failed.’ This sentiment can be lessened by avoiding a focus on penetrative intimacy as the only method of emotional and sexual connection with one’s partner.

Why is it so important for people to talk to their doctor about any sexual problems they may be facing?

Cheng: [When it comes to women,] this is a topic that’s not on the radar of most health providers. We are taught to ask about ED for every male patient with diabetes, but we are not routinely taught to talk about female sexual dysfunction. I suspect that’s because we aren’t always sure what to do about it once it’s been identified. Even though we live in a very sexualized culture, talking about female sexuality is still considered taboo. But it’s important to talk about it.

Bebb: It’s important that physicians take the lead on this. But if [your] physician has not done this, it’s necessary to be proactive with your own care and bring up the subject. [You] should be aware that sexual dysfunction is a common complication of diabetes, and successful treatment is available for the majority of men [with] ED.

What kind of effect does good management of blood sugar levels have on sexual health?

Cheng: Managing your diabetes well—drinking alcohol in moderation, getting enough exercise, ensuring you have a nutritious diet, and not smoking—can improve all areas of your life, including your sex life.

Bebb: Good control of blood sugar levels can lessen the risk of ED. While there is a genetic predisposition to type 2 diabetes, weight gain and a sedentary lifestyle [are also risk factors for the disease]. Paying attention to these factors not only helps in the overall management of type 2 diabetes, but can help prevent it or cause it to go into remission, and can lessen the risk of complications such as ED.

What else do you want people with diabetes to know about this issue?

Cheng: Women with diabetes who want to get pregnant need to know there is a checklist of things to be aware of before they start trying to conceive: Their sugars have to be well controlled with an A1C [a measure of average blood sugar levels over the last two or three months] below 7%; they need to be off any offending drugs (the only acceptable glucose-lowering drugs in pregnancy are insulin, metformin, and glyburide); they must have an assessment for any potential complications (such as an eye exam); and they need to [take] folic acid prior to conception. All of this is important because the risk of congenital abnormalities is reduced if conception occurs when these things have been accomplished.

Bebb: When sexual function deteriorates, this can indicate that a man is at risk for other diabetes-related complications—in particular, cardiovascular disease, including heart attack and stroke. ED may be the earliest warning that his cardiovascular system is being damaged, and awareness of this complication is a window of opportunity to work toward lessening the risk of heart attack or stroke.

The last word

Cheng: If [you are experiencing] sexual dysfunction issues, they need to be investigated. Don’t give up. Many of these issues are reversible. Step one is to identify them, then investigate and get referred to the appropriate people.

Bebb: The ability to be sexually intimate is a normal part of human relationships. A lack of this ability may affect one’s sense of self-worth. For some men, it may also remove a unique sense of closeness with their partner.

(This article appeared in Diabetes Dialogue, Winter 2019)