When my neighbor Leon was diagnosed with diabetes, he had one fear. “Sex is very important to me,” he said. “And to my wife, Carol. Will I still be able to have sex with diabetes?”
Leon has a legitimate concern. According to some estimates, up to 75% of men and 50% of women with diabetes develop sexual problems at some point. But the answer is yes. Leon and Carol may have to make some changes, but they can have good sex with diabetes. You can too.
Diabetes’ effect on sex
Poorly controlled diabetes can hurt your love life in several ways.
• High blood sugars can block blood vessels and damage nerves in the genital organs. These complications can prevent or weaken erections and ejaculation in men. They can dry up lubrication, cause painful intercourse, or prevent orgasm in women.
• Hormonal changes such as low testosterone levels can take away sexual desire. Men with diabetes are twice as likely to have a low testosterone level as men without diabetes.
• Diabetes-related symptoms, such as fatigue, numbness, or pain, may make sex difficult or less pleasurable.
• The psychological effects of diabetes may stop people’s sexuality. “Such things as feeling unattractive, blaming yourself for diabetes, and depression may damage both sexual desire and function. So can stress over health, money problems, and family issues,” I noted after hearing a talk by sexologist Dr. Mitchell Tepper.
• Low blood glucose can also interfere with sexual experiences. Like any exercise, sex can cause blood sugar to drop. It’s hard to function with low blood sugar. Maybe check your sugar before starting to get romantic.
So there are a lot of potential problems, and they tend to get worse with time. The good news is that most of the sex problems of diabetes can be prevented and treated. Those that can’t be fixed can be worked around.
Prevention and treatment
• Improve glucose control. Studies show that getting glucose closer to normal improves erection function and energy levels. Lower sugars will improve nerve function and so relieve numbness and promote orgasm.
How to control glucose? There are many strategies you can see on websites like ours or learn from your health professionals. Exercise, lower-carb diets, and better medications will all help. Plant medicines, supplements, and increased fiber can lower glucose, too.
• For erectile dysfunction (ED), there are the drugs Viagra (generic name sildenafil,) Cialis (tadalafil), and Levitra (vardenafil). These often work, but if they don’t for you, there are penile suppositories and injections that create reliable erections. Some couples work these treatments into their foreplay.
If a man can get an erection but can’t keep it, a penis ring can be wrapped around the base of the penis when it gets hard. The ring keeps blood from flowing out of the penis but allows new blood in, so the erection can get better as sex goes on.
Hand-operated or electric pumps can create a vacuum around the penis, drawing blood in, creating an erection. Then you wrap a ring around it as above. Prostheses can be implanted in the penis and get hard with the push of a button implanted in your lower abdomen. All these things work well for over 80% of users surveyed.
• For female sexual dysfunction, painful intercourse and lack of orgasm can be treated with estrogen rings or suppositories in the vagina. Ask your gynecologist. Dryness can be managed with commercially sold personal lubricants. (Use a lot.) Changing positions may help; woman on top is often best for both partners.
• People who can’t feel touch or pressure in their genitals might get a lot of pleasure from a sex toy such as a vibrator. Nerves might then stay awake to enjoy other activity.
• If you are on antidepressant or blood pressure medicines, ask your doctor if they might be interfering with sex function or desire. Consider asking to be switched to meds with fewer side effects.
• Get your testosterone levels checked (both men and women). Testosterone levels can be raised with prescription hormone supplements.
Sex is more than intercourse
Sexual dysfunctions can push you to try other ways of being sexual, ways that might be better than what you had before.
Learn some sexual anatomy. In women, most pleasure nerves are outside of the vagina (the clitoris) or just inside, not deep inside. There are things you can do with hands, mouth, toys, or other ways.
Women have other very sensitive places, like the G-spot, just inside the vagina on the front side. Finding these places and learning to stimulate them can be much better than intercourse for many women.
Men also have many pleasure zones they may not know about that can be stimulated with hands, mouth, and toys. Again, use lubricants, try different strokes, and pay attention to your partner’s response. Men can enjoy sex and even have orgasms without an erection.
Thousands of couples have reclaimed their sex lives by expanding their range of sexual activities. And you can have pleasurable intimacy without being sexual at all. Learn more about medicines and self-management to restore sex and intimacy in diabetes in a more complete article in the September/October edition of Diabetes Self-Management magazine.