Sex and Diabetes: How Diabetes Impacts Sexual Health
By Alan Uphold
It’s not always easy to talk about sex, regardless of whether you have diabetes or not. If you are a person living with diabetes, here are some important things to bear in mind in the bedroom.
When I was in college in the mid-1980s, there was a popular dance hit that we frequently played at our fraternity called “Let’s Talk About Sex” by the hip-hop duo Salt-N-Pepa.
The song was a lot of fun to dance to, but unfortunately, none of us ever actually talked about sex.
How come?
Any credible mental health specialist will tell you that healthy sexual relations between consenting adults are an important aspect of physical and emotional well-being.
And while everyone experiences some form of sexual anxiety at some point in their lives, people with diabetes have an added level of stress.
Having said that, Dr. Helen Baron, diabetes and metabolism specialist, admits that her first priority for patients with diabetes is not sexual health.
Her most important priority is to minimize diabetes complications that can cause the most harm, including heart attacks, stroke, cardiovascular disease, vision problems, and renal failure. Basically, her goal first and foremost is keeping her patients alive.
Baron acknowledges that for her (and presumably for many of her colleagues), “sexual dysfunction may be considered to be more a quality of life issue than a length of life issue.”
The bottom line is that extending your life is, understandably, likely to be higher on your endocrinologist’s priority list than addressing any sexual issues you may have.
That is all the more reason why people with diabetes should be proactive about mentioning any sexual dysfunctions to a healthcare provider.
So to quote those brilliant lyricists, Salt-N-Pepa, “Let’s talk about sex, baby.”
How does diabetes affect sexual health?
Urologist and sexual health specialist, Dr. Joshua Gonzalez, explains that diabetes affects the microvascular system, which is responsible for delivering hormones to the body’s reproductive organs.
The microvascular system is part of the circulatory system – one of the most commonly affected systems among people with diabetes. It’s not surprising that those living with diabetes may experience changes to the microvascular system (like blood vessel damage), which could result in sexual dysfunction at some point.
While sexual issues might feel uncomfortable and embarrassing, they're actually quite common. In a 2021 study, roughly 36% of men and 31% of women with diabetes reported having some type of sexual dysfunction.
Both men and women with diabetes also reported a higher rate of impaired physical well-being, lower emotional well-being, and moderate to severe anxiety compared to people without diabetes.
Before specifically addressing the mental health issues that people with diabetes experience as a result of sexual problems, let’s review different types of sexual dysfunction.
Issues that men might experience include:
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Erectile dysfunction (ED). According to a 2017 article, men with diabetes are three times more likely to experience ED than men without diabetes. Diabetes can decrease blood flow to the penis, which can inhibit the ability to achieve and maintain an erection.
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Decreased libido. Men with diabetes may have decreased testosterone levels, which may lead to decreased libido and sexual desire.
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Pain when having sex. Men with diabetes are more likely to develop a condition known as Peyronie’s disease, which is a curvature or bend in the penis. While the condition is rare, it can result in painful sex.
Fewer studies have been done about the sexual health of women with diabetes compared to the number of studies for men.
That said, women with diabetes have their own specific sexual issues that can affect mental health. And of course, women’s issues are no less distressing than those experienced by men.
Some of these issues include:
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Vaginal dryness. Many post-menopausal women experience vaginal dryness, but women with diabetes across all age groups report this problem more often than those without diabetes.
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Urinary tract infections and yeast infections. Women with diabetes are at a higher risk of developing (often chronic) UTIs and yeast infections, which can result in painful sex.
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Decreased libido. While decreased libido can be an issue for both men and women, it tends to be more problematic for women. Roughly 50% of women with diabetes reported decreased libido, which can lead to feelings of depression and low self-esteem.
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Difficulty achieving orgasm. One study found that women with diabetes between the ages of 40-80 were 80% more likely to have trouble reaching orgasm compared to women of the same age without diabetes.
How to have better sex with diabetes
Experts agree that the most important thing that people with diabetes can do to reduce sexual anxiety and improve mental health is to take control of their diabetes.
Watching your diet, exercising regularly, taking your medications, and maintaining a healthy lifestyle (like quitting smoking, monitoring your alcohol intake, and getting regular check-ups for your feet, eyes, and teeth) are good for general health as well as your sexual health.
Experts stress the importance of keeping your diabetes in check and maintaining a healthy A1C. This, in turn, can contribute to achieving a happier, more fulfilling sex life.
“When someone’s blood sugar goes high or low it can cause emotional distress. Glycemic management with diabetes has a large impact on preventing complications, as well as improving the person’s mental health,” said Edward Ruiz, diabetes care and education specialist and dietitian at Eisenhower Medical Center in Rancho Mirage.
Lifestyle changes aside, there are lots of treatments available that can improve performance and sexual arousal. Drugs like Viagra (for men), Cialis (for both men and women), and hormone therapies are effective at maintaining and achieving erections and increasing blood flow to the genitals.
For people experiencing vaginal dryness or pain during sex, there is a plethora of over-the-counter lubricants that can increase sexual stimulation and make the overall experience more enjoyable. This has the added benefit of improving self-esteem and making you feel more confident in the bedroom.
If you prefer a non-medical approach to treating sexual performance issues, there are natural supplements for both men and women that may help.
“Many cultures use libido-enhancing herbs in their folk medicine traditions,” said Dr. Myles Spar, an integrative medicine specialist and author of the book Optimal Men’s Health. Some examples include maca root, which is used in Native American and Latin American medicine, and Tribulus, an Ayurvedic herb.
While anecdotal evidence and early research show promise for some of these natural treatments, it's important to note that supplements are not rigorously tested and approved by the FDA for sexual dysfunction.
Spar stressed that before starting any new drug or supplement therapy, you should always check with a healthcare provider. This is especially important for people with diabetes or other chronic health conditions who may already be taking medication.
The bottom line
Even when treating the root causes of our sexual health anxieties, some people may still feel sexually insecure or inadequate.
That's why Gonzalez encourages seeking help from a mental health professional. He works closely with psychotherapists and sex therapists to help his patients overcome the mental health issues related to sexual health.
The American Diabetes Association also has some good tips about sexual health.
So, to review: work with your health team to manage your diabetes and blood sugar levels as best you can. If you're experiencing sexual dysfunction, talk to your doctor and ask about treatment options including drugs, hormones, or supplement therapies that can improve sexual function.
And finally, consider reaching out to a mental health expert who can help you manage the emotional issues related to sexual dysfunction.
As endocrinologist Baron suggests, “If your medical provider is not asking the right questions about your health concerns – general, sexual, mental, or otherwise – then speak up!”
Learn more about diabetes, sexual health, and relationships here:
