The answer could be yes, no or not yet but it is known that deterioration in sexual functioning is a major complication of diabetes. All the literature published on this topic agree that people with diabetes have a higher rate of sexual problems as compared to the non-diabetic population. What is the cause and what can we do to help lessen this risk or improve the harm that already exists?
Before I begin the discussion today, I have to admit I decided to do this topic after I read the blog by one of my colleagues titled "Sorry, dear, not tonight" which is a reply to one of her subscribers questions. Check it out at: http://jeanniebeaudin.wixsite.com/author.
Sexual dysfunction is common for both men and women with diabetes and more of the studies have been carried out in the male population. These studies have focused mainly on erectile dysfunction (ED) and far less studies have been done in women because of the complexity of the female sexual response. The World Health Organization (WHO) defines Female Sexual Dysfunction (FSD) as "the various ways in which a woman is unable to participate in a sexual relationship as she would wish". FSD and Diabetes Mellitus(DM) is often a neglected health issue and should be part of the overall diabetes management.
Hormones, psychological, interpersonal and social issues may be responsible for FSD. Some of the signs and symptoms could be:
Desire disorders- lack of desire or interest in sex, loss of libido
Decreased orgasm, lubrication and arousal
Pain during intercourse
Inability to relax the vaginal muscles enough to allow intercourse
The causes of the above signs/symptoms could be due to:(not extensive list)
Hyperglycemia- contributes to poor vaginal lubrication, pain with intercourse
Vaginal/urinary tract infections- discomfort resulting from itching, burning, irritation,vaginal dryness
Vascular complications- can decrease the blood supply to the genital area leading to problems
Nerve damage- resulting in reduced sensitivity and decrease sexual response; a stroke can cause significant effects in sexual functioning
Physchological- anxiety, stress, low self-esteem, fear of rejection, traumatic sexual experience in the past and/or history of abuse. One study points out that women with diabetes who reported sexual problems had a more negative appraisal of their diabetes and had more problems with emotional adjustment to their diabetes.
Depression- and diabetes have a close relationship. Depression may affect lifestyle choices, affect self-image that is already affected by having diabetes.
Sociocultural- financial/employment state, lack of knowledge in general and particularly diabetes knowledge, beliefs and limited interaction with others.
Medications- many prescription medications, recreational drugs and even alcohol could have a negative effect on sexual activity in both men and women. Some medications could also increase appetite and promote weight gain which may add to problems with diabetes management and add more stress. Please remember to ask your doctor/ pharmacist about any change you notice in your desire for sex or problems after starting a new medication or before you start the drug.
Treatment options:
Reduced vaginal lubrication- (http://jeanniebeaudin.wixsite.com/author) lubricants and hormone replacement therapy may be an option.
Genital infections- improve blood glucose management to decrease the risk of infections and practice good hygiene. Remember that when blood glucose is elevated, sugar gets excreted in the urine and this increases the risk of infections.
Support- from yourself by acknowledging there is a problem. Discuss this with your partner and seek sexual counselling. Ask your doctor to make a referral if this is necessary. Educate yourself to have a better understanding of the causes and options available for treatment.
Reduced libido- review your drug list with a pharmacist; manage depression, hormone replacement therapy and deal with any self-image issues.
Treating sexual dysfunction in patients with diabetes may need a multidisciplinary team of physicians and specialists. Lifestyle modification and improved glycemic control might not be enough to solve the problem. On the Diabetes Canada website there is a good article titled "Sex and diabetes-what you need to know" which might help answer some of your questions.
Future studies are needed to better understand the occurrence of sexual dysfunction in women with diabetes and the impact on their quality of life. Studies to introduce newer treatments are needed. However, until this happens we have to rely on what resources we have available. We should feel comfortable in talking about FSD with our partners, physicians and diabetes team. In the Diabetes Canada article I referred to above, one of the questions asked to Dr. Cheng (a well known and respected endocrinologist in the Diabetes world) was asked "Why is a sexual life important for our well-being?" Her reply is (and I quote) "From a psychological perspective, it brings pleasure and joy and exercise. The emotional aspect of sex impacts your most intimate relationship and also how you feel about yourself-your confidence level and self-esteem".
References:
1.Diabetes and Female Sexual Dysfunction; US Endocrinology, 2018: 14(1):35-38
2.Sexual Dysfunction in Women with Type 1 Diabetes- Diabetes Care 25:672-677,2002
3.Diabetes Canada- www.diabetes.ca
4.Diabetes and Female Sexuality- accessed on May 16th,2020 https://my.clevelandclinic.org/
5.Up-To-Date drug product monographs
#sex and diabetes. #sexuality
Thank you for your time today and I hope you all stay safe as we start to enjoy the warmer season(s). Remember to subscribe to my blog and then you will never miss an issue.
Comments