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Diabetes
There are two main forms of diabetes, type 1 and type 2. They are completely different diseases but have the same effect.
In type 1, your immune system attacks your pancreas so it no longer makes enough insulin. So you have to inject insulin. (They’re working on insulin nasal spray so you don’t have to inject it!) In type 2, the tissues in your muscles are ‘insulin resistant’, so you have plenty of insulin but it doesn’t work. Type 1 used to be called ‘juvenile diabetes’ because it started mostly in childhood, and type 2 used to be called ‘adult onset diabetes’ because it starts mostly in older people. But either kind can start at any time.
What is insulin? Insulin is a hormone that regulates how your muscles use the sugar in your blood to produce energy. If you are diabetic, you’re not using that sugar and it builds up in the blood. Over a period of time, high blood sugar causes damage in your body. It can cause blindness, kidney failure, and damage to your nerves called ‘neuropathy’. It damages your circulation so you can get gangrene and lose toes, feet, even legs. Diabetes is the leading cause of blindness, kidney failure, and amputation in the US. It also can cause atherosclerosis (hardening of the arteries) and lead to heart disease.
The key to treating diabetes is diet and exercise. You have to be careful about the carbohydrates you eat, because this is what causes blood sugar to rise. And you have to get some exercise, because this burns off blood sugar, and it also builds muscle, and more muscle tissue burns more blood sugar. You measure your blood sugar several times a day to keep it in control. And there are some good drugs these days that help keep blood sugar in control.
If you keep your blood sugar in control, you have a much lower chance of getting ‘complications’ like blindness, kidney failure, etc. You have to take care of -yourself-, a doctor can only help. You have to change habits and lifestyle, and that can be hard, but it’s worth it.
If everything works well, sex is likely a pleasurable experience. But those things that need to work well aren’t just the physical aspects—they include communication, affection, energy, time of day, your interest, and your partner’s interest. These factors in turn can be interfered with by a host of other factors, including any stressors, family history, abuse, emotions about your partner, your aching back, or a headache (although research suggests sex has a positive effect on headaches). In other words, the experience of sex is more than the sum of its physical parts.
I’m afraid we are tempted to look for the simple solution even when the issue is so complex. My concern is that health-care professionals can end up over-simplifying treatment and, by doing so, can cause couples to believe there is something wrong with them instead of with the treatment. For example, the usual course of action to treat erectile dysfunction (ED) is to offer the patient a PDE-5 inhibitor such as sildenafil (brand name Viagra), vardenafil (Levitra), or tadalfil (Cialis). In many cases, this is a good choice—these medicines have helped millions restore their sex lives. However, if the medicine doesn’t help, a couple may think there is something wrong with them—after all, on TV it appears to work for everyone.
Those unfortunate couples who don’t get the right treatment may discontinue treatment altogether. In some cases, the medicine may be the right treatment, but the couple still needs to work on the relationship before the the medicine will help. I also know that the causes of sexual problems for people with diabetes are not just physical. People with diabetes have as much of an opportunity as anyone else to have psychological problems. The causes of sexual dysfunction are multidimensional, and a holistic approach such as tantric massage and or counslling in assessing and treating the problem is more likely to help people regain a healthy and fun sex life.
Women, Sex, and Diabetes
Men aren’t the only ones who experience sexual problems as a result of diabetes.
reviewed by Louise Chang, MD
When most people hear the words “diabetes and sexual dysfunction,” they automatically think it’s the man’s problem. But women with diabetes can also experience sexual problems related to their blood sugar levels.
For diabetes educator Ann Albright, PhD, RD, that’s not only a medical fact, it’s a fact of life.
Living with type 1 diabetes for 41 years, Albright says that when glucose isn’t under good control, a woman’s sex life can suffer.
“It’s not diabetes per se that harms your intimate life. It’s the complications of uncontrolled blood sugar levels that cause problems for both men and women — the only difference is that many women simply aren’t as aware of this complication as men are,” she tells WebMD. Albright also is the president of health education for the American Diabetes Association.
Albright says women are getting better at coming forward with intimacy issues, but when it comes to diabetes, most are still reluctant to talk to their doctor.
Endocrinologist Loren Wissner Greene agrees. “Women aren’t talking to their doctors about it, doctors aren’t talking to women about it, and so for many it remains a silent problem that goes undiagnosed and untreated.” Greene is a clinical associate professor at NYU Langone Medical Center in New York City.
When Glucose and Intimacy Collide
Although women with diabetes may be slow to admit there is a problem between the sheets, the medical community has been even slower to study the issue. It wasn’t until 1971 that a groundbreaking study was published on this subject in the journal Diabetes.
In the study, 35% of women with diabetes reported being unable to have an orgasm during intercourse, compared to just 6% of the women who didn’t have diabetes.
Albright says one reason women with diabetes may have trouble achieving orgasm is that high blood sugars can affect vaginal lubrication.
“The lubrication issues not only can impact sensation, they also can make sex very uncomfortable, even painful,” she says.
In a 1986 study now considered a cornerstone of research on the topic, nearly half the women in the study had a sexual problem. Of these, 32% of women reported experiencing problems with lubrication. Eighty-nine percent said the problems started after their diabetes diagnosis.
Albright says there are many health benefits of good blood sugar control, but many women don’t realize that better lubrication, and, ultimately, a better sex life may be among them.
Blood Sugar and Sexual Desire
Lubrication can be a huge intimate issue, but it’s not the only one women with diabetes may have. Endocrinologist Spyros Mezitis, MD, says there are also important links between glucose levels and genital stimulation — a factor that affects not only how pleasurable sex feels, but also a woman’s desire for it.
“It all comes down to microcirculation,” says Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. “When blood glucose is uncontrolled, it impacts the tiny blood vessels that feed our nerves and allow a woman to experience the full spectrum of intimate sensation.”
When microcirculation is impaired in men, erectile dysfunction occurs — so the impact is obvious to both partners, he tells WebMD. In women, the effect isn’t as apparent. It’s all about arousal and sensation in the genital area, which frequently no one but the woman herself must acknowledge.
Greene says the longer sugar levels remain uncontrolled, the more likely it is for circulation problems to interfere with intimacy.
“Over time, increased glucose in the blood begins to destroy myelin — a protein that covers nerves,” Greene says. When this happens, it leads to neuropathy — a type of nerve damage.
The most frequent type is peripheral neuropathy. It commonly results in foot problems such as numbness and tingling. Another type of neuropathy — autonomic neuropathy — affects nerves in areas such as the stomach and urinary tract and may also impact the nerves in the pelvis — nerves that are directly connected to sexual stimulation.
“Again, it’s damage to the tiny blood vessels supplying the nerves that are at the root of the problem,” she says.
“Some people believe only those with type 1 diabetes, which develops at an early age, are at risk for these kinds of problems, but in reality many people with type 2 diabeteshave it for many years before they are diagnosed, and when they are diagnosed, most of the time some damage has already occurred,”