Sex and Type 1 Diabetes

     When a person is diagnosed with diabetes, their doctor will typically walk them through the steps of how to deal with this medical issue in the following years; however, sex is rarely addressed, often leaving the patient feeling left in the dark.  The journal Diabetes Care found that only half of all men and 19 percent of women with diabetes had broached the topic of sex with their doctors.1  It is crucial that individuals with Type I Diabetes become aware of the sexual problems associated with this health condition because certain symptoms can be assumed an effect of Type 1 diabetes, but be caused from an unrelated medical condition. For people that already have diabetes, sexual problems can indicate nerve damage, blocked arteries, and irregular hormone patterns.2 People who keep their diabetes under control can lower their risk of developing these sexual and urologic problems in the future.

Talk to Your Partner

     Establishing a strong system of communication with your partner is a crucial component of every relationship. Along with discussing sexually transmitted infections (STIs) and contraception usage, Type 1 diabetics should express how diabetes affects their sex life.  Many Type 1 diabetics may feel self conscious about their condition and try to hide it from their partners. If you do this, however, you may not feel comfortable asking your partner for a break from sex in the case of a low blood sugar and put yourself in a dangerous situation. Sex is an intense physical activity and as any Type 1 diabetic knows, this can cause a fast drop in blood glucose level. Make sure your partner knows how to care for you in case you experience a severe low blood sugar level and are unable to care for yourself. It is your responsibility as a diabetic to protect yourself and give the people around you the tools to help you.

In The Bedroom

     It is essential for someone with Type 1 diabetes to be constantly aware of their blood glucose level, how they are feeling, and what their limits are. To prevent low blood sugar, diabetics should test their blood sugar before and after sex, and if necessary, during. Low blood sugars easily disguise themselves as fatigue from physical activity, which can cause an individual to be unaware of a substantial drop in their blood sugar during sex. Treat sex as you would any physical activity: test your blood sugar and have a snack before you start, and be mindful of how your body feels while you are 'exercising'. If you feel like your blood sugar may be dropping, don't be afraid to take a break, check your blood sugar and have a snack if necessary. Every Type 1 diabetic's bedside table should contain three things: condoms, glucose tablets/juice/food bars, and a blood glucose meter. In the unfortunate event that your blood sugar drops during sex, having food within reach of the bed will allow you to get your blood sugar up and get you back in action in no time.

     Many people who use insulin pumps will disconnect their pumps before having sex. During sex, pump cords may become tangled and/or pulled, which can be uncomfortable and distracting. If you chose to disconnect your pump, don't forget to reattach it as soon as you can. It is easy to cuddle with your partner and fall asleep with your pump unattached and wake up several hours later with a blood sugar of 500 mg/dl!

 

Low Libido

     Many people, both with and without diabetes, experience low sexual desire, or “low libido”. A decreased interest in sex can be a sign that blood glucose levels are too high. Also, medications such as antidepressants can lower sexual desire. Talk to your doctor if you taking medications and notice a decrease in sexual desire.1 Low libido is commonly caused by low testosterone, a common side-effect experienced by individuals with Type 1 diabetes.

Males: Studies have shown that men with diabetes, especially those who are overweight, have about twice the risk of low testosterone as their peers without the disease.1 Low testosterone can lead to difficulty achieving erection, less firm erections and difficulty achieving orgasm.4 Typically, if low testosterone is treated through weight loss techniques or testosterone therapy, sexual desire is renewed.

Females: Studies suggest that women who take testosterone supplements experience an increase in sexual desire, but the long-term effects of this treatment are understudied.  It has been particularly difficult for scientists to determine whether low libido in women is a result of diabetes, emotional issues, or some other outlying factor because low libido is a very common in women, regardless of whether they have diabetes or not.1

Sexual Dysfunction

     Sexual dysfunction is a common issue encountered by diabetic individuals and more often than not, is caused by chronic high blood glucose.1  These high levels of blood glucose can cause damage to nerves over time, affecting the extremities, digestive system, heart muscles and sex organs. The body’s response to sexual stimuli is governed by the autonomic nervous system, and damage to these nerves reduce blood flow and hinder normal function.3

Males: Erectile dysfunction is defined as a consistent inability to have an erection firm enough for sexual intercourse. This includes the total inability to have an erection and the inability to sustain an erection for the length of time desired by the individual. It is estimated that the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent.3 Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes3. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger. Erectile dysfunction treatment options include PDE5 inhibitors (Viagra, Cialis), testosterone injections or gels, constriction rings that sit at the base of the penis, vacuum pumps, support sleeves and penile implants.1 These methods seek to increase blood flow to the genital region, which will assist in attaining an erection. Be aware however, that that each of these treatments have health risks. Discuss treatment with a doctor before pursuing treatment.

     The nerve damage caused by poor blood glucose control can also cause ejaculate to go into the bladder instead of out the penis during ejaculation, a process called retrograde ejaculation.2 Retrograde ejaculation forces some or all of semen to mix with urine in the bladder and leave the body through urination. A man experiencing retrograde ejaculation may notice that a small quantity of semen is discharged during ejaculation or may become aware of the condition if fertility problems arise.3

Females: Just as nerve damage in men causes decreased blood flow to the genital region, women with Type 1 diabetes can experience vaginal dryness as a result of damaged nerves caused by hyperglycemia.1 Research regarding women with Type 1 diabetes is limited, but one study found that 27 percent of women with this condition experienced sexual dysfunction.3 Often times, the vaginal dryness experienced by women is a result of menopause or post-menopausal symptoms, in which a lack of estrogen is the culprit. In these cases, problems may be treated with prescription estrogen, which is available in the form of pills, patches, or creams used in the vagina. For younger women who experience vaginal dryness, lubrication is recommended to prevent painful intercourse.1 Regularly performing Kegel exercises can strengthen the pelvic floor muscles and improve a woman’s sexual response.

 

Urological Problems Associated with Type 1 Diabetes

     More than half of men and women with Type 1 diabetes experience bladder dysfunction as a result of nerve damage.3 Overactive bladder, sphincter muscle damage, and urine retention are common symptoms experience by Type 1 diabetic individuals. If the main problem is urine retention, treatment may involve medication to promote improved bladder emptying. Sometimes people need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. If urinary leakage is the main problem, medications, strengthening muscles with Kegel exercises, or surgery can help.

     Because sugar spills into the urine during high blood sugar episodes, diabetic women with poorly controlled blood sugars experience higher rates of urinary tract infections than most women. Thus, it is especially important for diabetic women to urinate after sex and avoid lubricants that contain glycerin.

In Closing

     If you are experiencing anxiety about sexual performance, consider counseling to help relieve stress and other emotional issues that are hampering your sex life. It’s important to explore all possible solutions with your diabetes medical team to be sure that you are able to enjoy all aspects of your life. Sexual health is often pushed aside when medical conditions arise, but it is an extremely important aspect of a person’s life and with enough patience and understanding, these problems can be overcome.

Last Updated 22 04 2015

 

References:

  1. Neithercott, Tracey. "Sex and Diabetes: What You Wanted to Know." Diabetes Forecast. The Healthy Living Magazine, Nov. 2012. Web. 26 Mar. 2015.
  2. McCoy, Krisha. "Sexual Issues and Type 1 Diabetes." EverydayHealth.com. N.p., Nov. 2011. Web. 26 Mar. 2015.
  3. "National Diabetes Information Clearinghouse (NDIC)." Sexual and Urologic Problems of Diabetes. U.S. Department of Health and Human Services, 29 June 2012. Web. 22 Apr. 2015.
  4. Wittert, G. "Male Sex Drive: Is The Mighty Testosterone Alone Responsible For Libido?" Medical Daily. N.p., 13 June 2013. Web. 22 Apr. 2015.

UCSB SexInfo Copyright © 2017 University of California, Santa Barbara. All Rights Reserved.