Diabetes & The Body

Sexual function and diabetes

Diabetes is a very commonly found complication and it is responsible for many disorders. It may affect the sexual function of both men and women. Generally, diabetics have problems related to sexual function earlier in life than people who do not have the disease.

Many men who have diabetes have a problem with impotence. In fact, impotence, along with the need to urinate often, may be an early sign of diabetes. Impotence occurs in men with type 1 diabetes as well those with type 2 diabetes. Changes may more be subtle in women with diabetes. It may become harder for them to have an orgasm.

Impotence is the failure to achieve an erection, a condition faced by an increasing number of men. In order to diagnose the potential problems that lead to this condition, it is useful to describe what conditions must be present for erection to take place. The first component you need to achieve an erection is a normal, intact male sexual organ. Secondly, a normal amount of circulating hormones is necessary. Third, a man must have an intact nerve supply and blood flow to the male sex organ. Finally, normal erections require a healthy psychological response to the arousing stimuli, coupled with a relaxed state of mind.

Impotence is almost always treatable, a resounding majority of patients will respond to one of the available treatments. Unfortunately, many men (some estimates are as high as 1/3) will not seek treatment due to the nature of this problem. Impotence is an extremely common condition and is very treatable.

Since an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases--such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease--account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.

In addition, many common medicines--blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug)--can produce ED as a side effect.

How much diabetes affects sexual function may depend on how severe the disease is and how old you are when the disease begins. Men diagnosed after age 40 may have more mental and emotional adjustments to make than those who have learned to live with diabetes in their teens and early 20s.

Diet and medication to regulate blood sugar levels are very important in controlling diabetes and preventing further problems.

Diabetes in men can lead to hardening and narrowing of the blood vessels that supply the erectile tissue of the penis. This spongy tissue swells and stiffens the penis during an erection. Decreased blood flow to the penis may cause erectile problems. For example, the penis may be less rigid during erection.

In women, diabetes can lead to hardening of the blood vessels of the vaginal wall. Decreased blood flow due to diabetes may cause the vagina to be too dry, both normally and during arousal. It also may cause a woman to be at much greater risk of getting recurring yeast infections.

In women, the combination of diabetes and menopause may cause a 50% decrease in vaginal blood supply due to low estrogen levels, vaginal secretions that are less acidic and less protective, which lowers the resistance to bacteria in the vagina and increases the risk of yeast infection, levels of glucose in vaginal mucus that may help cause yeast infections

Women may notice that they are not as easily aroused. They may be less sensitive to touching and stroking, which can result in decreased interest in sex.

Treatment for the menopausal, diabetic woman includes estrogen replacement therapy (ERT), which is important in keeping blood flowing in vaginal tissues. Estrogen also provides an acid level adequate to protect against vaginal infections in women past menopause. ERT does pose risks for some women. Discuss the risks and benefits with your doctor.

If a woman is having pain with intercourse, the best treatment, together with ERT, includes early diagnosis of the diabetes and a pelvic exam, including a Pap smear and maturation index (shows the level of estrogen in your body), treatment for any vaginal infections, use of lubricants such as KY jelly for women with vaginal infections until ERT has taken effect (Vaseline should not be used.), control of the diabetes with diet, if possible, in addition to medication or insulin.

Treatment for the older, diabetic man may include, having intercourse only when well rested -- early morning hours may be better because testosterone levels are higher then, having certain tests such as a Doppler study to check for adequate blood flow in the penis or sleeping in the hospital to see if erections occur during sleep, injecting medication into the erectile tissue of the penis to produce erections that can result in intercourse, considering implanted penile devices that improve the function of the penis if blocked blood vessels leading to the penis continue to cause problems, using a vacuum device to draw the blood to the erectile tissues. A temporary device (band) to constrict blood flow can then be used to maintain the erection for long enough to have sex one time. This can be repeated as needed. The device should not be left on for longer than 20 to 30 minutes at a time. The penis will become soft again when the device is removed. Ejaculation response varies.

Despite the availability of many treatment options for erectile disorder, early intervention and prevention should be emphasized, as many of the diabetes-related complications leading to erectile dysfunction are irreversible.

Lately when people think about the treatment options for impotence, their mind naturally wanders to the new "wonder drug" Viagra. Viagra is a good treatment for many types of impotence and it's ease of use is very appealing to most men. What is often not reported however, is that Viagra will work on about 1/3 of new patients. For these men, other treatment options must be explored.

Self-injection is another option. Prior to intercourse, the male takes a tiny needle and injects it into his penis. Patients learn how to administer this treatment under the direct supervision of their doctor. Shortly after application, a natural-feeling erection occurs.

Finally, people having erectile dysfunction from diabetes should try to control diabetes and their blood sugar levels. They should also consult their doctors without any hesitation and at the earliest possible for better treatment options.