Uncontrolled diabetes affects sexual health at all ages, causing erectile dysfunction in men and discomfort in women. It damages nerves and blood vessels, which are critical for healthy sexual functioning, regardless of age or gender
Published Nov 25, 2024 | 7:00 AM ⚊ Updated Nov 25, 2024 | 8:58 AM
Representative image of a woman checking blood sugar with test strip (iStock)
Diabetes isn’t just about sugar levels—it impacts much more, including your sexual health. From erectile dysfunction and low libido to infections and arousal difficulties, diabetes can affect both men and women in ways people may not realise. Dr Sunita Sayammagaru, a renowned specialist in diabetes care and sexual health from Hyderabad speaks to South First on the physical and psychological impact of uncontrolled diabetes leading to sexual health problems.
Q. How does diabetes affect sexual health across different age groups?
A. Diabetes impacts sexual health at all ages, from teenagers to individuals in their 70s, provided they are sexually active and they have uncontrolled diabetes. In young adults, the challenges often include issues like erectile dysfunction (ED) in men or dryness and discomfort during intercourse in women. For older individuals, the problems tend to compound due to age-related changes in blood flow and nerve health. Across the board, uncontrolled diabetes is the main culprit. It damages nerves and blood vessels, which are critical for healthy sexual functioning, regardless of age or gender.
For men, common complaints include erectile dysfunction and ejaculatory problems. Women often report issues such as vaginal dryness, infections, and a lack of libido. These problems, while prevalent, remain largely unaddressed because many patients are hesitant to discuss sexual health with their healthcare providers.
Q. What are the physiological reasons behind these issues in uncontrolled diabetes?
Dr Sunita Sayammagaru.
A. Diabetes can lead to diabetic neuropathy, a condition where high blood sugar levels damage nerves. This includes autonomic neuropathy, which affects the nerves controlling sexual response. For proper sexual functioning, the communication between the brain and the genital nerves is crucial. When this connection is disrupted, individuals may experience issues like reduced sensation, difficulty in achieving arousal, or erectile dysfunction in men.
Blood Flow. High blood sugar damages endothelial cells lining the blood vessels, leading to a condition called endothelial dysfunction. This reduces the ability of blood vessels to dilate properly, affecting blood flow to the genital region. Reduced blood flow can result in erectile dysfunction in men and decreased clitoral engorgement or vaginal lubrication in women, both of which are essential for sexual arousal.
Hormonal Balance. Diabetes, especially when poorly managed, can alter hormone levels. In men, it can lower testosterone levels, contributing to decreased libido and erectile dysfunction. In women, fluctuations in hormones like estrogen can lead to issues such as vaginal dryness and a lack of desire, particularly if diabetes is coupled with postmenopausal changes. Hormonal imbalances further compound the effects of nerve and blood vessel damage, making sexual dysfunction more likely.
Q. Some common sexual health problems that male and female experience due to uncontrolled diabetes?
A. In any sexual response cycle consists of four phases:
Desire phase:
This is where individuals feel the urge or interest in sexual activity. Diabetes, particularly when uncontrolled, reduces libido in both men and women. Hormonal imbalances, psychological stress, and physical fatigue from high blood sugar levels contribute to this lack of desire.
Arousal phase:
In men: Erectile dysfunction is a common issue. Men either cannot achieve an erection or cannot maintain it long enough for penetrative intercourse. This results from poor blood flow and nerve damage.
In women: Arousal difficulties manifest as insufficient blood flow to the clitoris and a lack of lubrication, making intercourse painful and unfulfilling.
Orgasm phase:
In men: Ejaculatory problems are common. These include premature ejaculation (ejaculation occurs too quickly), delayed ejaculation (difficulty or inability to ejaculate), and retrograde ejaculation (semen flows backwards into the bladder instead of exiting).
In women: Orgasmic disorders are multifactorial. While diabetes affects nerve sensitivity, psychological factors like stress and intimacy issues also play a role.
Recovery phase:
Diabetes doesn’t typically affect this phase directly but can prolong the time needed for recovery between sexual activities.
Q. What infections are common among diabetic individuals that affect sexual health?
A. Diabetic individuals are more prone to infections because high blood sugar creates a conducive environment for microbial growth.
Fungal Infections (Candida):
In women: Candida causes vaginal discharge, itching, and inflammation, leading to discomfort during intercourse.
In men: The tip of the penis may develop inflammation, cuts, and redness. Although Candida is not classified as a sexually transmitted infection, it can pass between partners during intercourse.
Urinary Tract Infections (UTIs):
Sugar in the urine provides an excellent breeding ground for bacteria and fungi, leading to recurrent UTIs. Symptoms include a burning sensation while urinating, frequent urination, and pelvic pain. These infections can severely affect sexual health if not treated promptly. People with diabetes must maintain good hygiene and control their blood sugar levels to prevent such complications.
Q. What role does alcohol play in the sexual health of people with diabetes?
A. Alcohol can worsen sexual health issues in diabetics in several ways. Like diabetes, excessive alcohol consumption damages nerves, further impairing sexual functioning.
Hypoglycemia: Alcohol consumption, especially on an empty stomach, can lead to low blood sugar levels during or after sexual activity, causing dizziness, fatigue, or even fainting.
Reduced Libido and performance: Alcohol may temporarily boost confidence but often impairs arousal and performance, especially in chronic alcohol users.
Diabetic individuals should monitor their alcohol intake and be cautious about consuming it before sexual activity.
Q. Are there safe treatment options for sexual health problems in people with uncontrolled diabetes?
A. Yes, but treatment depends on the root cause. While I have stated earlier as well that sexual health problems are multifactorial some of the some common approaches for treatment options are:
Erectile Dysfunction in men:
Medications like Viagra (sildenafil) can help improve blood flow to the penis, but they are effective only when diabetes is well-controlled. Counselling or psychotherapy may be necessary for psychological causes.
Vaginal dryness in women:
Lubricants like KY Gel can address dryness in women who have not attained menopause yet. Hormone replacement therapy (HRT) may be prescribed for postmenopausal women experiencing severe vaginal dryness.
Low libido:
In men, testosterone replacement therapy may be effective if low testosterone levels are identified. For both genders, addressing psychological factors like stress and intimacy through counselling can be beneficial.
Premature ejaculation:
Techniques and medications are available to help men delay ejaculation and sustain arousal. Counselling for the couple is often recommended to improve understanding and cooperation.
Regardless of the issue, the first step is controlling blood sugar levels. In many cases, patients report significant improvements in sexual health simply by managing their diabetes effectively.
Q. What precautions should individuals with diabetes take during sexual activity?
A. Sexual activity is a physical exercise, and people with diabetes must take precautions similar to those for any other form of exertion like in running, cycling, playing any sport:
Monitor blood sugar levels: Always check glucose levels before and after sexual activity to prevent hypoglycemia or hyperglycemia.
Keep snacks nearby: Have a fast-acting carbohydrate like glucose tablets or juice at hand in case of low sugar levels.
Practice safe hygiene: Good genital hygiene can prevent infections.
Communicate with your partner: Open conversations about health and comfort can make the experience more enjoyable and less stressful.
Q. How important is it for doctors to address sexual health in diabetic patients?
A. It is crucial but often neglected. What I’ve noticed is that sometimes doctors themselves have this barrier. They are a bit hesitant to approach the topic, perhaps due to a lack of time or because they themselves are not comfortable discussing sex with a patient unless the patient initiates the conversation.
Sometimes, patients don’t ask either, and doctors may feel they are crossing a boundary or opening a Pandora’s box by bringing it up. However, if the doctor is comfortable, they are more likely to address it. For instance, I am comfortable discussing it. When a young patient comes to me with uncontrolled diabetes, especially if it’s a male, I definitely touch upon the topic of sex, saying, “Keep your sugars under control.”
Most doctors would advise keeping sugars under control to prevent heart attacks, eye problems, or kidney issues. I add the risk of sexual problems to that list because I’m comfortable doing so. Sometimes, that alone is enough to make a young man take notice. A 30-year-old man may not worry much about heart or kidney issues, which seem far off, but the thought of experiencing sexual problems within five years grabs his attention.
This approach has worked. Being open and addressing the issue directly has had a positive impact. I believe in being open with my patients, and it has made a difference.
(Edited by Ananya Rao)
