- Diabetes can be an uninvited third wheel in the bedroom, affecting blood flow, nerve function, hormones, desire, arousal, and even the Big O.
- Sexual issues are extremely common for both men and women with diabetes. Most people will experience at least one in their lifetime, so if this is happening to you, congratulations – you’re normal!
- The usual suspects for men are ED, low T, low libido, and reduced sensation. Women can experience vaginal dryness, pain during sex, reduced desire, and more frequent yeast infections and UTIs.
- Many sexual problems linked to diabetes are treatable, manageable, or improvable, so push through the awkwardness and talk to your HCP about any new or changing symptoms.
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You may think you’ve never been part of a threesome, but if you have diabetes and you’ve “done the horizontal tango”, chances are diabetes has crashed the party at least once.
Sexual challenges affect both men and women with diabetes, and they’re way more common than most people realize. In fact, over the course of a lifetime, more people with diabetes will deal with some kind of sexual issue than won’t.
But you aren’t destined for a lifetime of disappointing sex…at least not from diabetes!
So let’s pull back the covers and take a closer look at the most common sexual challenges linked to diabetes (and what you can do about them) so you can get busy getting back to getting busy.
In the words of Salt-N-Pepa… let’s talk about sex, baby! 💃🕺
First Things First: Why Diabetes Can Be a Buzzkill in the Bedroom
Diabetes impacts two of the major players that help make the magic happen – blood flow and nerve function. Elevated blood sugar levels can damage blood vessels over time and affect circulation everywhere in your body – including “down there.” When blood flow is less effective, nerves get affected too. This can result in dampened desire, reduced arousal, less sensation, and a hampered finale (aka the Big O).
Diabetes and Sex: What Men Need to Know
ED often steals the spotlight when it comes to men’s sexual health, but diabetes can also affect libido, testosterone levels, sensation, and orgasm. Below are the most common sexual issues men with diabetes face – and how they can be treated or improved.
Diabetes and ED: When Your Flag Won’t Fly
Does diabetes cause ED? Erectile dysfunction (ED) is one of the most common complications for men with diabetes. When circulation isn’t working like it should, blood has a harder time making its way to the pleasure zone. Diabetes-related nerve damage can also interfere with the signals that trigger and maintain an erection. An occasional “off night” is nothing to worry about, but if it becomes an ongoing problem, it’s time to seek help.
ED meds like Viagra and Cialis are often the first line of treatment, but they don’t always work for all men. If you try ED pills and you still have erection issues, there are other options, including vacuum pumps, penile injections, suppositories, penile sleeves, testosterone treatments, implants, and counseling when stress, anxiety, or performance pressure is part of the picture.
ED Treatment Options Beyond Oral Meds:
- Vacuum Pumps: A vacuum pump, also called a penis pump, uses gentle suction to draw blood into the penis. Once an erection forms, a tension ring is placed at the base of the penis to help maintain the erection during sex.
- Constriction Rings: Constriction rings work by gently slowing blood from leaving the penis, which can help an erection last longer. They’re commonly used alongside a penis pump or on their own for men who can get an erection but have trouble maintaining it.
- Urethral Suppositories: A urethral suppository is a small pellet of medication inserted into the urethra to improve blood flow and trigger an erection.
- Penile Injections: Penile injections involve injecting a small amount of medication into the shaft of the penis to enhance blood flow and create an erection. The injections take some getting used to but are generally not painful, even though they sound like a torture device!
- Penis Sleeves: Penis sleeves are external devices worn over the penis to provide additional firmness or length (we’ll take an extra large!). They don’t treat the underlying cause of ED, but they can help some couples have satisfying sex when erections are difficult to achieve or maintain.
- Implants: A penile implant is a surgically placed device that allows a man to have an erection when desired. It’s typically considered when other ED treatments haven’t worked or aren’t an option.
Fun fact: Did you know that ED meds have one of the best adherence rates of any drug? No one wants their results falling flat! 😉
Low Testosterone: When You’ve Lost That Lovin’ Feeling
Low testosterone is the cause of ED in only a small percentage of cases. Signs of low testosterone (low T) can be vague and show up as fatigue, depression, and brain fog, so it’s easy to blame symptoms on something else. But there’s one dead giveaway for low T – a noticeable drop in sex drive. If your interest in sex has taken a nosedive, you should have your testosterone levels checked.
If your levels are low, testosterone replacement therapy is a common treatment. It comes in many forms, including gels, patches, pills, and injections. Work with your doctor to find the right option and have your levels checked regularly. While it might be tempting to supersize your dose, too much T can be dangerous, and you don’t want to turn into The Hulk with a micropenis!
For more info on testosterone, watch this Dose of Dr. E:
Low Libido: Is Your Mojo MIA?
Low libido and low T are often confused, but they’re different conditions. When you have low T, you also have low libido, but you can have low libido with normal testosterone levels.
Low libido can be influenced by lots of things like hormones, blood sugar, stress, sleep, depression, nerve health, certain medications like antidepressants, and being married for over ten years (kidding).
Treatments for low libido depend on what’s driving it. Options include treating low testosterone, improving blood sugar, adjusting medications, counseling, sex therapy, and lifestyle changes like reducing stress, losing weight, and cutting back on alcohol. ED medications can help performance, which can boost confidence and indirectly improve desire.
Reduced Sensation: If You Didn’t Feel It, You Didn’t Cheat on Your Partner!
Diabetes-related nerve damage (autonomic neuropathy) can sometimes reduce sensation in all the wrong places.
How autonomic neuropathy affects penile sensation:
- Nerve damage can dull sensation: Autonomic neuropathy damages small nerves that carry sensation from the penis to the brain, which can cause numbness or reduced feeling.
- Messages between the brain and penis don’t travel well: When these nerves are damaged, the signals needed for arousal, erections, orgasm, and ejaculation can get disrupted, so the body doesn’t respond the way it used to.
- Awareness can be reduced: Some men may have trouble feeling touch, temperature, or even noticing things like urine or stool passing because the same nerve network affects the penis, scrotum, and anal area.
- Sexual problems are common: Nerve damage can lead to ED, less pleasure during sex, difficulty reaching orgasm, or changes in ejaculation.
- Other causes exist too: Heavy alcohol use, certain medications, autoimmune conditions, and neurological disorders can also affect these nerves.
Medications that improve blood flow, like Viagra and Cialis, and addressing hormone imbalances can help.
Diabetes and Sex: What Women Need to Know
Women with diabetes have just as many sexual health challenges as men, but they’re talked about far less. Too often, women don’t connect their symptoms to diabetes, which can often lead to frustration, confusion, and self-blame.
Vaginal Dryness and Painful Sex: When Slip and Slide Turns Into Sandpaper
Vaginal dryness and pain during sex are common for women with diabetes. High blood sugar can reduce blood flow and damage small nerves, which means less natural lubrication and sensitivity right where you want it most. Hormonal changes (particularly during perimenopause and menopause) can add to the dryness and irritation.
Many women find relief using vaginal moisturizers or lubricants. If hormonal symptoms are ongoing, vaginal estrogen or other prescription treatments can help restore vaginal tissue health without significantly affecting the rest of your body.
Low Libido: When You Just Don’t Wanna
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Low sexual desire is common for women.
Oh, did you want us to keep going?!
Low sexual desire is common for women, and very common for women with diabetes. Diabetes can affect your energy, hormones, blood flow, and the nerve signals involved in wanting to get it on. Stress, fatigue, body image, insulin resistance, and PCOS may also play a role.
Treating low libido in women is a bit more complicated than it is for men. Improving blood sugar management, addressing vaginal discomfort with lubricants or vaginal therapies, prioritizing sleep and stress relief, counseling or sex therapy, and having open conversations with your doctor and partner can help.
Two medication options for women with low libido include flibanserin (Addyi) and bremelanotide (Vyleesi), but they are not magic meds for libido, and both can have side effects.
Some studies suggest testosterone therapy for women may improve sexual desire, but it’s an area that’s still being studied, so don’t start using your husband’s testosterone cream as a moisturizer!
Reduced Arousal: When Your Engine Won’t Rev
Desire and arousal are two different things. Desire is the feeling of wanting to have sex, and arousal is when your body gets into gear with increased blood flow and lubrication.
Arousal relies on healthy blood flow to the vagina and vulva. Diabetes-related blood vessel damage can limit that flow, making it harder for your body to respond the way it usually would with natural lubrication. Medications like antidepressants can also play a role.
Unfortunately there aren’t a lot of treatment options, but addressing vaginal dryness, optimizing blood sugars, lifestyle changes like exercise and stress management, medication adjustments, working with a therapist, and looking at pictures of Jason Momoa can help.
Difficulty Reaching Orgasm: When the Grand Finale Never Comes
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Orgasms don’t just happen by magic – they rely on healthy nerves, strong blood flow, and balanced hormones. When blood flow is reduced or nerve signals aren’t firing on all cylinders, sensation may be weaker and slower to build… or fizzle out before the grand finale.
Fatigue, stress, certain medications like antidepressants, and worries about pain can make it even harder to relax and let go.
Maintaining healthy blood sugar levels, addressing vaginal discomfort, pelvic floor physical therapy, sex therapy, hormone treatment when appropriate, and medication adjustments can help. There’s also a topically applied product nicknamed “scream cream” that’s designed to increase blood flow, but it’s not FDA approved.
Increased Risk of Yeast Infections & UTIs: There’s a Fungus Among Us!
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When it comes to diabetes and yeast infections, the struggle is real. Women with diabetes have a higher risk of yeast infections and urinary tract infections because elevated blood sugar creates an environment where bacteria and yeast love to grow.
Extra glucose in urine can feed germs in the urinary tract, while high blood sugars can disrupt the normal balance of healthy bacteria in the vagina. On top of that, diabetes can affect immune function, making it harder for the body to fight off infections.
Keeping blood sugars in range, staying well hydrated, urinating regularly, practicing good genital hygiene, and seeking prompt treatment at the first sign of symptoms can all help. If infections keep coming back, your HCP can help identify triggers and create a prevention plan.
FAQs
Do I need to see a specialist for diabetes-related sexual problems?
A primary care provider or endocrinologist can help with many conditions, or refer you to a specialist if needed. For men, urologists often evaluate issues like ED, low T, and ejaculation problems. For women, gynecologists can help with concerns such as vaginal dryness, pain with sex, arousal difficulties, and recurrent infections.
Is ED permanent?
The majority of ED cases are very treatable today. Most people see improvement with medications, and if those don’t work, then surgery with a prosthetic implant is an option. But whether or not ED is treatable depends on the underlying cause. In very few cases it’s irreversible and can lead to permanent erectile dysfunction, such as older prostate surgery techniques or a failed implant surgery. That said, ED is very treatable for the vast majority of people.
How do I find a good counselor or sex therapist?
Start by looking for a licensed therapist who has experience with chronic illness or diabetes – directories like Psychology Today let you filter for these specialties. For sexual concerns, seek out a certified sex therapist (look for credentials from organizations like AASECT), and don’t be afraid to ask about their experience working with conditions like diabetes. Some therapists are trained in both areas, but if not, it’s okay to work with two providers who can complement each other. Most importantly, choose someone you feel comfortable talking to. Good therapy depends as much on trust and ease as it does on credentials.
The Big Finish…er, Takeaway
Diabetes gets in the way of a lot of pleasurable things in life, like eating Pop-Tarts with reckless abandon. But like everything else we have to deal with, we find a way to work around it.
Diabetes and sexual dysfunction are more items on the “things we have to deal with” list, but sexual issues aren’t inevitable, and thankfully many of them are treatable. And let’s face it, even sex you have to plan for, take a pill for, put some cream on for, or remove a device for is still…sex!
Sexual complications can show up in more than one way for people with diabetes. If you are experiencing one (or more) of the situations mentioned in this article, discuss it with your doctor. If you are not satisfied with the answers you receive, see if you can see a specialist.
We know that bringing up sexual concerns with your doctor can be weird and uncomfortable. But if there’s something that can be fixed, treated, or improved, the benefits are likely “O” so worth it.
Pushing past the awkwardness and having the conversation can be the first step toward a happy ending.
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