Couple in BedEncountering problems with sexual response is a common experience for both men and women with diabetes. Not only can diabetes affect your physical functioning, there can also be psychological factors that interfere with a full and rewarding sex life. Problems with sexual function can be very distressing and affect the quality of your life as well as your relationships. Although help is available, many people (both with and without diabetes) find sexual difficulties an embarrassing topic to talk about in the context of a health appointment, and therefore refrain from being open with their doctors or nurses about their difficulties. This article will help you to become more familiar with the different ways your sexual responses may be affected, give you strategies to help you tackle the psychological difficulties that might be getting in your way, and empower you to talk to your doctor or nurse about how they can help you.

Male Sexual Problems

Erectile dysfunction (also known as impotence) means you are not able to obtain or keep an erection long enough for sexual intercourse. An erection is caused by the flow of blood into the penis and the blocking of the small blood vessels, making the penis hard. In one study more than 50% of males with diabetes admitted difficulties with sexual function, rising to more than 75% for men over the age of 70. To put this into context, about 1 in 10 men over 40 years old have erectile dysfunction, whether they have diabetes or not. Many factors along with diabetes can contribute to difficulties with sexual response. These include:

  • Drinking alcohol.
  • Smoking.
  • Taking illegal drugs.
  • Medications such as certain antidepressants.
  • Injury to the penis.
  • Damage to the spinal cord.
  • Nerve damage caused by operations to the bladder, bowel, or prostate gland.
  • Poor blood supply to the penis due to blockage of the artery caused by peripheral arterial disease.
  • Producing less testosterone than your body needs.
  • High blood pressure.

Female Sexual Problems

Women with diabetes are also at risk from difficulties with sexual response, and although these are visually not as obvious as for men, they are just as upsetting and difficult to contend with.

Physical problems are:

  • Dry vagina caused by high blood glucose levels.
  • Greater proneness to yeast infections, making sexual intercourse uncomfortable.
  • Loss of skin sensation around the vagina area, reducing the pleasure experienced.

In addition to physical explanations for sexual difficulties, there are also emotional reasons why you may be encountering problems relating sexually to your partner. These affect both men and women. Some of these are:

  • Stress.
  • Depression and low mood.
  • Anxiety and worry.
  • Conflict with your partner.
  • Issues regarding how sex is viewed in your religion or culture.
  • Homosexuality.
  • Bereavement.
  • Illness or ill health.
  • Being in an accident.
  • Previous abuse.
  • Infertility.
  • Disability.

Gain Support for the Physical Side of Sex

The first step is to have a physical examination by your General Practioner or healthcare team, and take advantage of medical treatments or aids they recommend to you. For men with diabetes, Viagra and similar prescription medications can be incredibly helpful and they have no adverse impact on diabetes control. Do not buy any medicines to treat erectile dysfunction over the Internet. It may seem appealing as you can get help anonymously without having to approach a potentially embarrassing topic at clinic, but there is no guarantee what you are buying is genuine. It is also important your healthcare team is aware of all the medications you are taking.

Other general guidelines for improving sexual response for both men and women are:

  • Weight loss, smoking cessation, and cutting down on alcohol intake.
  • Improving glucose control or changing some of your medicines. If the sexual difficulty coincided with a sudden worsening of your glucose control or with starting a different drug, it is important to look at these factors.

It is natural to feel embarrassment about discussing sexual problems with healthcare professionals. Remember, they have heard similar problems before and will not be fazed by them. Indeed, they will respect you are able to be open about it and seek help. Remember, the first line will be the most challenging; once that is done, the clinician will steer the conversation for you. Some ideas for conversation starters are in the box below.

Conversation Starters for Discussing Sexual Problems

  • I’m having problems in bed.
  • I’m struggling with sex/my sex life.
  • My [penis, ‘equipment’, etc.] isn’t working as it should.
  • I’ve got something I’m a bit embarrassed to mention …. (The clinician may pre-empt what you are about to say.)
  • I was hoping you might be able to help me with this problem I am having.
  • I think I’ve got ED/erectile dysfunction.
  • I can’t get a hard-on.

How to Manage the Emotional Impact of Sexual Difficulties

If your healthcare team has checked you out and there are no obvious physical problems, then shifting focus to psychological strategies can be helpful. Enjoyment of sex goes beyond the act of intercourse that culminates in an orgasm. Enjoyment of the sexual experience involves a whole range of factors, including your experiences of sex, your appearance, and your confidence physically and sexually, and so on. Early traumatic experiences involving sex and negative beliefs about sex inherited from family values and attitudes can hinder the sexual experience.

I’ve worked with many people with diabetes who had resigned themselves to not having the sexual relationship they really wanted; however, by working together, we figured out how they relate to sex and what’s getting in the way of them having a fulfilled sexual relationship. I have a five-step programme (which works just as well over the phone/by Skype as in person) for tackling the emotional side of sexual difficulties and would love to support you (and/or you and your partner) with finding freedom in your sexual relationship. If you are currently struggling with sexual difficulties (or any other emotional issue related to your diabetes), remember you can take advantage of a totally free “Diabetes Clarity Session” — a 30-minute telephone/Skype call with myself or a member of my team to get clear on a plan for getting better. I really want to do all I can to help you achieve your best health and wellbeing this year.

You may use this article on your website, or for your own e-zine; however, there's one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit