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Diabetes and Intimacy: The Guide to Reclaiming Your Love Life

Diabetes can bring a range of sexual side effects that threaten a couples' sex life, and therefore the foundation of their relationship. In this article, you'll learn how and why your diabetes could affect your intimate life. You'll also learn about treatment options, some tips for communicating with your partner around this topic, and some key questions you might want to ask your doctor.

Catch diabetes-related sexual dysfunction early, and you'll likely be able to prevent long-term damage and return to a healthy sex life with your partner.

What Sexual Side Effects Can Diabetes Cause?

Diabetes can damage nerves and blood vessels in multiple areas of the body. In turn, damage to area near the genitals can lead to impairment of normal sexual response. The effects are usually different for men and women, and there's quite a range:

For Men:
  • For men, diabetes-related sexual dysfunction tends to take the form of impotence or erections that are less firm than they used to be and don't last as long. This is due to diabetic neuropathy, or nerve damage. Unlike women, men with diabetes tend to retain their interest in sex and their ability to achieve orgasm.
  • Within 10 years of diabetes diagnosis, 50 percent of men will have problems with erectile dysfunction, and it has been shown that men with diabetes are three times more likely to have ED than are those without the disease.
  • In some cases, men may have difficulty ejaculating.
  • Some men also experience retrograde ejaculation as a result of diabetes, which means that some or all semen is released into the bladder rather than being allowed to exit the body through the urethra. The semen mixes with urine and exits the body during urination. Retrograde ejaculation happens when the sphincter of the bladder does not function as it should. This is the result of poor blood glucose control and the nerve damage that follows.
  • As with women, psychological issues account for some of the sexual dysfunction in men. Men who are worried they will not be able to achieve or maintain an erection may create a self-fulfilling prophesy for themselves. Increased stress or depression due to diabetes can also play a role.
For Women:
  • Many women with diabetes suffer from low sex drives, trouble becoming or remaining sexually aroused, or the inability to achieve orgasm, probably due to nerve damage and/or vascular disease.
  • Women with type 2 diabetes are more likely to experience sexual dysfunction than those with type 1 diabetes - probably about a fifth to a quarter of women with type 1 diabetes experience sexual dysfunction, while around 42 percent of women with type 2 diabetes do. Around 35 percent of women with diabetes report lowered or completely absent sexual response.
  • Women with diabetes are also likely to experience problems with lubrication and sexual response during sexual activity, probably due to reduced blood flow to the genitals.
  • Women may also experience discomfort or pain during intercourse, sometimes due to the chronic vaginal infections that many women with diabetes experience.
  • Hormonal changes may also be a factor in reduced sexual desire, as can be the fact that diabetes is simply tiring.
  • Psychological aspects also come into play, as many women with diabetes report feeling less attractive than those without diabetes. Diabetes can also lead to depression, anxiety and fatigue, which further lower libido.

For both women and men, sexual dysfunction as a result of diabetes does not happen overnight. It's a slow, gradual process. Overactive bladder and urinary tract infections are also common in both men and women.

Certain risk factors make sexual dysfunction more likely. Those with poor glucose and blood pressure control, for instance, are more likely to develop sexual dysfunction. Other risk factors include high cholesterol levels, being overweight, smoking, being over the age of 40 and lack of exercise. People with diabetes can lower their risk of sexual dysfunction by correcting those factors that are controllable.

Treatment of Diabetes-Related Sexual Dysfunction:

There are a wide variety of treatment options available for diabetes-related sexual dysfunction, which should come as no surprise given that there are a wide variety of sexual problems that diabetes can cause. The most important thing to keep in mind is that communicating with your partner about what you're going through can go a long way toward mitigating sexual problems you may be experiencing and bringing the two of you closer together.

Catch diabetes-related sexual dysfunction early, and you'll likely be able to prevent long-term damage and return to a healthy sex life with your partner.

In Men:

For erectile dysfunction:
  • Medication: Medications that dilate blood vessels allow for greater blood flow into the penis, increasing the strength of erections.
  • Penile implants: For a long-term solution, some men prefer having implants inserted into their penis that keep them in a permanent semi-erect state.
  • Vacuum devices: These devices allow men to pump blood into their penis by creating a vacuum, then put a ring on the base of the penis to hold blood in for the duration of sexual activity.
  • Pellets: Suppositories can be inserted into the tip of the penis that widen blood vessels and relax muscle tissue, which allow more blood to flow into the penis to create an erection.
  • Penile injections: A shot of medication in the base of the penis will provide a half-hour to one-hour erection, although too much medication can cause priapism, often-painful erections that last more than four hours.
  • Change medication: Sometimes erectile dysfunction results not from diabetes itself, but from the drugs that are prescribed to fight related conditions, such as drugs to treat high blood pressure or depression. Talk to your doctor about whether these drugs may be the culprit, and whether you can switch.
  • Testosterone: Men with diabetes often discover that they have low testosterone levels, which can account for lowered libido and/or erectile dysfunction. Taking testosterone supplements in the form of patches, pills, gels or injections can fix this issue.
  • Counseling or sex therapy: Impotency can be very difficult for men. If you're experiencing depression or anxiety as a result of impotency issues, you may benefit from professional counseling to see you through this difficult time. A sex therapist may also help you and your partner find new ways to be intimate together.
  • Patience: Although it may be hard sometimes, remembering that you and your partner are not to blame for erectile dysfunction is very important. Getting frustrated can lead to added stress, making ED more likely. Try to go into sexual situations without any expectations, then see what happens.
  • Find new ways to play: You can still have an orgasm without an erection. Discover ways with your partner that you like to be stimulated that don't involve penetrative sex.
For retrograde ejaculation:
  • Medication: A medication that strengthens the bladder sphincter muscle can help alleviate retrograde ejaculation.

In women:

For lubrication problems:
  • Vaginal lubricants: Over-the-counter or prescription lubricants may be a big help to women experiencing vaginal dryness.
For decreased sexual response:
  • Try new positions or types of stimulation: Experiment with your partner to try out new ways of being intimate. Changing position, switching to oral sex or using a vibrator may increase sexual response. Use this as an opportunity to get closer to your partner as you discover together what works for you.
  • Kegel exercises: This type of exercise strengthens the pelvic floor muscles, which may improve sexual response and strength of orgasm.
  • Counseling or sex therapy: Loss of sexual appetite or response can be difficult on a woman. Consider seeking professional counseling if you're experiencing depression or anxiety, or seek out a sex therapist to learn about other techniques you can use to try to boost your sexual response.
  • Fantasize: Allow yourself to think about sex as often as you want. You may find that fantasies make you more interested in sex when the time comes, or that eliminating the pressure of partnered sex for a period of time helps you restore your desire.
  • Change medication: Drugs used to treat conditions associated with diabetes, such as high blood pressure and depression, can often have the unfortunate side effect of lowering sex drive. Talk to your doctor about whether these medications may be the culprit, and whether you can safely switch to a different type.
  • Estrogen: Women who are low in estrogen can treat lack of sexual desire by taking an estrogen pill, or using a cream or vaginal suppository.
  • Treat infections: For women who avoid sex because it's painful, a vaginal infection may be the culprit. This is common in women with diabetes, and there are both prescription and over-the-counter treatments available, depending on the woman's preference and the type of infection.
  • In the future - prescription medication: Unfortunately, at this time there are no medications approved to treat female sexual response problems in the United States. However, studies of potential treatments are currently under way and have been approved in some countries, so in the future this may be a viable option for American women as well.

Sexual dysfunction as a result of diabetes is never easy. Remember that these are medical conditions that result from diabetes, and treat them as such. Seek help from your doctor as soon as possible, and don't ever assume that sexual dysfunction is your body's way of alerting you you're no longer attracted to your partner, or vice versa.

Communication with your partner

Diabetes and the resulting complications can be just as hard on your partner as they are on you. The most important thing you can do to keep your intimate relationship healthy and thriving is to communicate. Here are some tips for communicating and keeping your relationship on track, even when your body is thrown off:

  • Tell your partner you love him or her. When a woman loses interest in sex, or when a man is no longer able to achieve erection, it can be easy for the partner to assume there's no longer love in the relationship. Your partner needs to hear unequivocally that this is not the case. It may help to bring him or her with you to the doctor when you discuss your sexual health in the context of diabetes.
  • Show your love in other physical ways. If you're unable to have sex at the moment, it's important to retain a physical connection with your partner in other ways. Hug, kiss and touch your partner often. Give massages. Cuddle in bed on the weekends. Keep your physical connection strong, and never assume that your sex life is over forever.
  • Be honest and direct. Tell your partner how you're feeling about your sexual dysfunction, and how you're feeling physically as well. It may be hard to talk about, but the odds are great that your partner will appreciate knowing what you're going through. Also give your partner a chance to tell you how he or she is feeling. Getting comfortable discussing sensitive subjects can even bring you closer together.
  • Ask for what you need. Would you like your partner to stop trying to initiate sex for a couple of weeks while you look into solutions for your low libido? Would you like to engage in oral sex instead of attempting penetrative sex? Would you enjoy a night of cuddling in front of a movie at home without any expectations of sex? Tell him or her as specifically as possible what you need, and have him or her do the same. Discuss whether your requests seem realistic.

Communicating about sexual issues is sometimes difficult even in the best of circumstances, so it's no wonder that many people shut down when it's time to discuss touchier issues such as impotence and lack of desire. But keeping the lines of communication open is more important than ever in the face of intimacy problems related to diabetes. Communicate with your partner, and the reward may be a healthier, happier intimate life than you've ever known.

Questions to ask your doctor:

This guide is meant to provide general information on diabetes and intimacy, and should not be taken as a substitute for talking with your doctor. Your doctor will be able to provide information and solutions specific to your circumstances. You might choose to print this guide out to bring with you to your doctor's appointment as a starting point for the discussion. For males, if your endocrinologist or general practitioner is unable to provide help for sexual dysfunction, you may need to see a urologist.

Here are some questions you may wish to ask your doctor:

  • Could I have low testosterone/estrogen?
  • Could other medications I'm taking be causing my sexual dysfunction?
  • Given my particular circumstances, what treatment option do you recommend trying first?
  • Are there any lifestyle changes I can make that might help this issue?
  • What are the odds that this problem is reversible, to what extent, and how long will it take?

It's important to talk to your doctor when you're experiencing sexual problems as a side effect of diabetes - and it's important to do so as soon as possible. When tissue damage occurs as the result of diabetes, it's impossible to reverse, so your odds of recovering your sexual health and potency are much greater when you see your doctor before the problem gets worse.

Talking to your doctor and to your partner about sexual problems can be difficult for many people, but it's also extremely important. Being honest with your partner about what you're experiencing helps keep your relationship strong and allows you to work through difficult issues together as a couple. Even if diabetes is affecting your sexual health, there are things you can do to take control and regain intimacy in your relationship - maybe even improve your level of intimacy from where it was before diabetes. Get started today.