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With chronic illness, sex often gets put on the back burner. But sexuality and sexual expression are at the top of the list when it comes to quality of life, no matter what problems a person may face.
People with type 2 diabetes are no different. It’s important to recognize and address sexuality issues that affect people with diabetes. Type 2 diabetes can cause sexual complications for both genders, and can also cause gender-specific issues.
A common sexuality problem in people with type 2 diabetes is a decrease in libido, or loss of a sex drive. This can be frustrating if someone had a thriving libido and satisfying sex life prior to a type 2 diabetes diagnosis. Causes of a low libido associated with type 2 diabetes include:
Diabetic neuropathy, a type of nerve damage associated with diabetes, can cause issues. Numbness, pain, or lack of feeling can also occur in the genitals. This can lead to erectile dysfunction. It may also inhibit orgasm or make it difficult to feel sexual stimulation. These side effects can make sex painful or unenjoyable.
Communication between partners about sexual issues is important. A lack of communication can impact the sexual and intimate side of a relationship. An illness can make it easy for couples to "check out" of the relationship sexually. Sometimes it may seem easier to avoid talking about this issue rather than seeking a solution.
If one partner becomes the primary caregiver of the other, it can also change how each person views the other. It’s easy to get caught up in the roles of "patient" and "caregiver" and let the romance can slip away.
The most widely reported problem men face is erectile dysfunction (ED). Some cases of diabetes are first diagnosed when a man seeks treatment for erection dysfunction. Failure to achieve or maintain an erection until ejaculation can be caused by damage to:
According to the Cleveland Clinic, about half of men with diabetes will experience ED at some point.
Side effects of certain medications can alter testosterone levels, also causing erectile dysfunction. Other conditions that accompany diabetes can also contribute to ED, including:
Retrograde ejaculation is also another sexual issue men may experience as a complication of type 2 diabetes. This is when semen is ejaculated into the bladder instead of out of the penis. It’s caused by your internal sphincter muscles not working property. These muscles are responsible for opening and closing passages in the body. Abnormally high glucose levels can result in nerve damage to the sphincter muscles, causing retrograde ejaculation.
For women, the most common sexual issue that comes with type 2 diabetes is vaginal dryness. This can be caused by hormonal changes or from reduced blood flow to the genitals.
Women who have diabetes have increased rates of vaginal infections and inflammation, both of which can make sex painful. Nerve damage to the bladder can cause incontinence and make sex embarrassing. Women with diabetes are also more likely to have more frequent urinary tract infections. This can make sex painful and uncomfortable.
Sexual problems that occur with type 2 diabetes can be frustrating, embarrassing, and cause anxiety. You may feel that giving up on sexual expression is easier than finding ways to cope or adjust. Here are some tips you can try to maintain an active sex life despite having type 2 diabetes:
If low energy and fatigue are a problem, try having sex at a different time of day, when your energy is at its peak. Nighttime may not always be the right time. After a long day, and with the added fatigue that comes with diabetes, the last thing you may have energy for is sex. Try sex in the mornings or afternoons. Experiment to see what works best for you.
Use lubricant liberally to deal with vaginal dryness. Water-based lubricants are best and there is a plethora of brands available. Don’t be afraid to stop during sex to add more lubricant.
Hormonal replacement therapy can help both men and women with issues such as:
Ask your doctor if this is a possibility for you. Hormone replacement can come in the form of:
Maintain good overall health for a healthy sex life. For people with diabetes, this includes maintaining proper blood sugar levels. Sex is exercise in the sense that is uses energy, so be aware of your glucose levels.
If you’re on medications that increase the amount of insulin in your body, hypoglycemia can also occur during sex. Consider checking your blood sugar levels before engaging in sexual activity.
Also keep in mind that what’s good for your heart is good for your genitals. Sexual arousal, vaginal lubrication, and erection all have a lot to do with blood flow. Engage in a lifestyle that promotes good heart health and proper blood circulation. This includes participating in regular exercise. This can also have the added benefits of improving your energy level, mood, and body image.
Many type 2 diabetes patients experience incontinence. Embarrassed? Don’t be. Everyone urinates. If you experience urine leaks and are uncomfortable sharing your body with someone sexually, you should feel free to talk about it. Padding the bed can go a long way to help. Lay down a couple of towels or purchase urine pads from a medical supply company to help ease the situation.
Discuss sexuality issues with your doctor. Sexual dysfunctions can be an indicator of disease progression or a sign that the disease isn’t under control. Don’t be afraid to discuss sexual side effects of medications. Ask if there are different medications that don’t have the same side effects.
Also, feel free to ask about erectile dysfunction drugs. Some men are candidates for ED drugs and some aren’t. Penile pumps may also be an option.
Pay close attention to your relationship. Find other ways to express intimacy when desire isn’t at its peak. You can express intimacy that doesn’t involve intercourse with:
Make time for each other to be a couple that is not focused on caregiving. Have a date night where the topic of diabetes is off limits. Communicate with your partner about your feelings and possible sexual issues that may occur. Consider support groups or counseling to help with the emotional issues associated with illness or sex.
Having a healthy and active sex life is important to your quality of life. Type 2 diabetes may make sexual activity more challenging. But it doesn’t mean you have to completely forgo sex and sexuality. If your diabetes is brought under control, sexual issues often resolve themselves. Be sure to stay healthy and communicate with your partner and healthcare provider about any issues and you can maintain a healthy sex life.
Written by: Kelly Connell, PhD, MS
Medically reviewed on: Sep 13, 2016: Peggy Pletcher, MS, RD, LD, CDE
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