For health professionals 
In a society where sex is omnipresent, it’s surprising to realize that it’s still a taboo topic. Although we openly discuss about many of the complications of diabetes, there’s very little talk about sexual problems, which occur more frequently and earlier in people living with diabetes.
Blood glucose levels are sometimes behind this, especially if they’ve been poorly managed for years. The inflammation, nerve damage and circulatory problems caused by improper blood glucose management can hinder libido. There’s also a link between diabetes and low testosterone, a hormone that’s closely related to sexual desire and which is, contrary to widely held beliefs, found in both men and women. Finally, the heart of the problem may lie in psychological factors, lifestyle habits or medication, which means the treatment will vary based on the cause.
Despite experiencing sexual desire, men and women with diabetes may have difficulty reaching orgasm. In women, this is sometimes due to a diabetes-related nervous or hormonal problem that results in a loss of sensation. In men, they can be unable to ejaculate or experience retrograde ejaculation (with sperm ending up in the bladder) due to blood flow or internal muscle contraction issues. Many other factors may be involved, both physically and psychologically. Again, measures to deal with the problem will depend on what caused it.
On one hand, women living with diabetes are twice as likely to suffer from vaginal dryness, the causes of which can include nerve damage, low estrogen or hormonal disorders. They are also more likely to develop urinary or yeast infections, often linked to chronic hyperglycemia. On the other hand, men living with diabetes are more likely to contract Peyronie’s disease, a condition characterized by the formation of scar tissue in the penis causing curved and painful erections. It should be noted that all of these painful situations have a solution (lubricants, medication, physiotherapy, surgery, etc.).
Erectile dysfunction is the most common sexual disorder in men living with diabetes. It is defined as the inability to have or maintain an erection. Besides age, several factors increase the risk of erectile dysfunction, such as overweight, high cholesterol, smoking, alcohol, hypertension, medication and poor blood glucose management. One side effect of hyperglycemia is to damage blood vessel walls, which hinders the flow of blood to the penis. Fortunately, several treatments can help regain a fulfilling sex life—for example, lifestyle changes, medication and physical aids (constriction rings, pumps, etc.).
To limit the effect of diabetes on your sexual health, you can:
Nowadays, we have plenty of solutions to address sexual problems. There is no need for you to suffer in silence, and most importantly, you have no reason to be ashamed. Talk to your doctor or healthcare professional. They can help you find the right treatment by asking you questions, performing a physical exam and conducting additional tests as needed. Diabetes is part of your life, but it certainly doesn’t have to be a guest in your bedroom!
References
American Diabetes Association (2012). Sex and Diabetes: What You Wanted to Know. Retrieved from: https://www.diabetes.org/diabetes/complications/sex-diabetes. Accessed May 11 2021.
American Diabetes Association (n.d). Sexual Implications of Emotional Health. Retrieved from: https://www.diabetes.org/living-with-diabetes/treatment-and-care/women/sexual-health.html?referrer=https://www.google.ca/. Accessed May 11 2021.
Canadian Diabetes Association (n.d). Sexual Dysfunction and Hypogonadism in men with diabetes. Retrieved from: https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-33#panel-tab_FullText . Accessed May 11 2021.
Diabète Québec (2019). Female sexuality and diabetes. Retrieved from: https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/complications/female-sexuality-and-diabetes/. Accessed May 11 2021.
National Institute of Diabetes and Digestive and Kidney Diseases (2018). Diabetes, Sexual & Bladder Problems. Retrieved from: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/sexual-bladder-problems?dkrd=/health-information/diabetes/overview/preventing-problems/sexual-urologic-problems. Accessed May 11 2021.