Sexual dysfunction in diabetes

Sexual dysfunction can arise as a complication from living with diabetes. It is important to address any issues with your health care team as sexual dysfunction can create difficulties with intimacy in the bedroom, affecting relationships outside the bedroom and your quality of life.

What is sexual dysfunction?

Sexual dysfunction is defined as the inability to achieve or maintain an adequate sexual response to a sexual encounter or intercourse resulting in a satisfactory orgasm or pleasure. Sexual dysfunction affects both males and females and their partners due to:

• Diminished libido (not wanting to have sex)
• Emotional issues leading to problems such as achieving orgasm, erectile dysfunction in men, and pain and lubrication in women
• Body image
• Medications

Men and erectile dysfunction (ED)

Erectile dysfunction (also called impotence) is a persistent inability to achieve or maintain an adequate erection in order to have a satisfactory sexual encounter. For men with diabetes reduced blood flow and nerve damage can be the underlying issue of erectile dysfunction. Erectile dysfunction may or may not affect ejaculation. Mental health, body image and high blood glucose levels can affect libido reducing the desire to engage in sex.

Erectile dysfunction is often considered a condition of older males. However, 20% of men with diabetes experience significant ED from their late forties. Up to 58% of young men with type 1 diabetes may also experience ED.

Other causes of ED

Other factors that may contribute to or cause erectile dysfunction in men include:

• Being tired, stress, depression and alcohol
• High blood pressure, cholesterol, smoking, unhealthy weight, heart disease
• Medications including blood pressure meds such as beta blockers, various groups of antidepressants, antipsychotics, antiepileptics and cancer medications
• Spinal cord injury, pelvic surgery, multiple sclerosis

Lifestyle modifications

Making lifestyle modifications may help improve sexual dysfunction:

• Stop smoking
• Maintain a healthy weight
• Increase healthy eating
• Decrease alcohol intake
• Keep blood glucose levels in target
• Start exercising

It is important to recognise that men who exercise regularly have a 70% risk reduction in erectile dysfunction compared to men that don’t exercise.

Treatment options

Medications called phosphodiesterase 5 inhibitors are the most commonly available treatment for erectile dysfunction and include the drugs sildenafil and tadalafil. These medications are prescription only and need to be taken about one hour before the desired effect. They do have some side effects and are not suitable for all men.

Other treatments include vacuum pumps, injections or inflatable prosthesis.

Women and sexual dysfunction

Sexual dysfunction (SD) is not as well reported in women, as the diagnosis is harder to identify than in men and there are multiple factors that affect women more.

Women living with diabetes experiencing sexual dysfunction may experience vaginal dryness, a decrease in sexual desire, pain during sex and trouble having an orgasm. Women may experience higher rates of issues with sexual health and body image.

Up to 33% of women living with type 1 diabetes have reported experiencing some form of SD. This study included younger women with the average age of participants being 42 years old. Up to 68% of women living with type 2 diabetes also experience issues.Common symptoms that women in both groups experience include decreased:

• Sexual desire
• Problems with orgasm
• Vaginal lubrication
• Arousal and pain

Other causes of sexual dysfunction

Other causes of SD in women include:

• Damage to nerve and blood vessels
• Low oestrogen levels
• Mental health
• Body image

Treatment options

Treatment options for women living with diabetes include:

• Lubricants to help with vaginal dryness and reduce pain when sexually intimate
• Antidepressants to help with depression and improve mental health
• Healthy lifestyle modifications

A drug approved in the US, the first ever drug to treat low sexual desire in women, has been approved for use in premenopausal women with low sexual desire. The drug is called Fliberanserin. It is not yet approved in Australia.

Body image and mental health

People living with type 1 or type 2 diabetes can experience body image and mental health issues that can impact on self-esteem and relationships.

• In people with type 1 diabetes, issues may present such as feeling embarrassed for partners to see insulin pumps and CGMs, bruising and scarring from injection sites, or it may be the issue of trying to negotiate pump sites when being intimate.
• In people living with type 2 diabetes, they may feel weight stigma surrounding type 2 diabetes, as they are told it is a lifestyle condition. Issues with self-image regarding bruising and scarring can also occur if people are injecting insulin as part of their treatment.

Diabetes distress and the ongoing issues when dealing with daily diabetes decisions impacts significantly on people’s mental health, causing depression and anxiety. Medication prescribed for depression can affect sexual dysfunction as a side effect. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have been reported to cause sexual dysfunction in between 20-70% of people.

Issues that both men and women face each day dealing with diabetes, can impact on confidence. These issues need to be discussed in any healthy relationship. Talking to a psychologist about any concerns is a good place to start.

Raising concerns with your health team

Often people do not raise concerns regarding sexual dysfunction because they either are embarrassed to raise the issue, consider it a normal part of getting old, do not know what they experience can be a complication of diabetes and are not aware of treatment options. Other barriers also include gender, age and cultural issues.

Health professionals may have difficulties addressing sexual dysfunction due to time constraints, lack of knowledge, training or resources. If you experience problems having topics addressed by your health team you should request a referral to a health professional that is able to help.

Identifying areas that you may need help in is key; understand what you want to discuss with your health care team and make a list:

• Talk to your partner about your concerns and take them to appointments so you have support to address them with your health team
• Talk to your doctor about your issues
• Take a note with what you want to talk about and list your symptoms
• If you cannot get satisfactory help from your healthcare team ask for a referral

Lastly, if you experience depression, anxiety, body image or mental health issues, seek help from a  psychologist.

By Alison Crow, Pharmacist and Credentialled Diabetes Educator