Many people assume that when someone has a chronic illness, they have so many things going on managing the illness that sex automatically gets relegated to the back burner. However, research shows that sexuality and sexual expression rises to the top of the list when it comes to quality of life issues, no matter what other problems a person may be facing. People with type 2 diabetes are no different.
That’s why it is important to recognize and attempt to address the known sexuality issues that often accompany type 2 diabetes.
In some aspects, the effects of type 2 diabetes on sexuality are genderless, meaning both genders suffer the same problems. In other aspects sexuality and sexual problems are gender specific.
Sexuality Issues for Both Men and Women
One of the most common sexuality issues in patients with type 2 diabetes is decrease in libido, or loss of sex drive. This can be particularly frustrating if, prior to onset, the patient reports having had a thriving libido and satisfying sex life. Causes of low libido associated with type 2 diabetes include:
- sexual side effects of medication, such as those for high blood pressure or depression
- extreme fatigue
- lack of energy
- hormonal changes
- emotional health issues including stress, anxiety and relationship issues
Diabetic neuropathy can also be a problem as it can result in numbness, pain, or lack of feeling in the genitals. This can inhibit orgasm, make sex painful or unenjoyable as response to sexual stimulation can be lacking or absent.
Lack of communication between partners about sexual issues can impact the sexual and intimate side of a relationship. Sometimes couples just “check out” of the relationship sexually because avoiding discussion of the issues is easier than confronting them and seeking solutions. Instances when one partner becomes the primary care giver of the other can lead to a change in how each view the other. Often they get so caught up in the roles of “patient” and “caregiver” that romance slips away.
Sexuality Issues for Men
The most widely reported problem men face is erectile dysfunction. In fact, in some cases diabetes is diagnosed when the man seeks treatment for erection dysfunction—erectile dysfunction is a presenting symptom of diabetes, particularly for those under 45 years of age.
Failure to achieve or maintain an erection until ejaculation can be caused from nerve, muscle, or vascular damage. It is estimated that between 20 and 75% of men will have a problem with erectile dysfunction. . Changes in testosterone level can also affect erection, as can sexual side effects of medication. Co-morbid conditions that often accompany diabetes also contribute to erectile dysfunction. For example:
- high blood pressure
- emotional and psychological issues such as depression, low self esteem, and anxiety
- too little exercise
Retrograde ejaculation is also a possible sexual problem men may experience as a complication of type 2 diabetes. Retrograde ejaculation, which is when all or part of the semen is ejaculated back into the bladder instead of out of the penis, is caused when there is a problem with internal sphincter muscles. Sphincter muscles are responsible for opening and closing passages in the body. Abnormally high glucose levels can result in nerve damage to the sphincter muscles and the result is retrograde ejaculation.
Sexuality Issues for Women
For women, the most common sexual problem that comes with type 2 diabetes is vaginal dryness. This can be caused by hormonal changes or from blood flow problems to the genitals.
Women who have diabetes have increased rates of vaginal infections and inflammation, both of which can make sex painful. Another issue is that nerve damage to the bladder can cause incontinence making sex embarrassing. Women with diabetes are also more likely to have frequent urinary tract infections, which can also make sex painful and uncomfortable.
Tips and Tricks to Help Stop Type 2 Diabetes from Hijacking Your Sex Life
Sexual problems that occur with type 2 diabetes can be frustrating, embarrassing, and cause anxiety. Patients may feel that throwing in the towel and giving up on sexual expression is easier that finding ways to cope and that things can never be the way they once were. However, there are things you can try to help ease the problems and make maintaining the sexual and intimate part of your life easier.
Fighting Low Energy and Fatigue
If low energy and fatigue are a problem, try having sex at a different time of day when energy is at its peak. Nighttime may not always be the right time. After a long day—and with the added fatigue that goes along with diabetes—the last thing someone 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 lubes are best and there is a plethora of brands available. Do not be afraid to stop during sex to add more lube—sexual activity can often require a greater amount.
Hormonal replacement can also help both men and women with libido, vaginal dryness, and erection issues. Ask your doctor if this is a possibility for you. Hormone replacement can come in the form of pills, patches, creams, or injectable medications.
Staying Healthy Enough for Sex
Maintain optimal health overall for a healthy sex life. This includes maintaining proper blood sugar levels. Remember, sex is like exercise in the sense that is uses up energy, so be aware of your glucose levels. Hypoglycemia can occur during sex, as it does with exercise if you are on medications that increase the amount of insulin in the body. If you are, consider checking your blood sugar levels before engaging in sexual activity. Also keep in mind that what is good for the heart is good for the genitals. Sexual arousal, vaginal lubrication, and erection all have a lot to do physically with blood flow. Engage in a lifestyle that promotes good heart health and circulation.
Vibrators to Overcome Neuropathy
Did you know sometimes using a vibrator could help with neuropathy and increase stimulation? This is true for both men and women, although it can take several uses before a change is noticed. Consider getting a small vibrator and applying it to areas where you experience neuropathy for a few minutes each day.
Talking About It
Make discussing sexuality issues a priority with your health care provider. Sexual dysfunctions can be an indicator of the progression of a disease or a sign that a disease is not under control. Also, don’t be afraid to discuss sexual side effects of medication with health care providers. Ask if there is a different medication to help the problem that does not have the same side effects.
Also, feel free to ask about erectile dysfunction drugs. Some men are candidates for ED drugs and some are not. Penile pumps may also be an option for men who have problems with erections.
Pay close attention to your relationship. Find other ways to express intimacy when desire is not at its peak. Massage, baths, and cuddling are just three examples of ways to express intimacy that does not involve intercourse. Make time for each other to be a couple away from care giving. Get respite care if needed. 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 sexual problems.
Padding the bed can go a long way to help in case of urine leakage. Lay out a couple towels or ask your medical supply company for some pink pads. Embarrassed? Don’t be. Everyone urinates and if you are comfortable sharing your body with someone sexually, these are things you should feel free to talk about.
Type 2 diabetes may make sexual activity more challenging but it does not mean you must forgo the sexual side of life completely. Many times if the disease is brought under control, sexual dysfunctions resolve themselves. The most important thing is not to give up on what is an important quality of life issue.