Updated December 27, 2006

Sexual Wellness

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Lawrence Maguire, M.D.

Impaired circulation. High blood glucose, high blood pressure, and high cholesterol all raise the risk of developing atherosclerosis, or an accumulation of fatty material under the inner lining of the arteries. Atherosclerosis raises the risk of having a heart attack or stroke, and it can also lead to impotence and problems with arousal and orgasm (in men and women) if it impedes blood flow to the genital region.

Neuropathy. As many as 50% of people with diabetes eventually develop some type of nerve damage. While damage to the peripheral nerves is associated with burning, tingling, or numbness in the feet, damage to the nerves that regulate involuntary functions, such as those that relate to response or excitement from sexual stimulation, can contribute to sexual problems. The function of nerve fibers plays a vital role in one’s ability to experience sexual pleasure.

Prevention
Preventing diabetes complications, including sexual complications, involves controlling your blood glucose, blood pressure, and blood lipid levels. If your glycosylated hemoglobin (HbA1c) level is currently higher than 7% (or higher than the HbA1c goal recommended by your diabetes care provider), your blood pressure higher than 130/80 mm Hg, your low-density lipoprotein (LDL) cholesterol 100 mg/dl or above, or your triglyceride level 150 mg/dl or above, speak to your provider about bringing these levels into the recommended ranges.

Take a proactive role in your diabetes health by monitoring your blood glucose levels, taking action when they are too high (based on medical advice), and communicating regularly with your diabetes care team. Maintaining excellent health takes hard work, but the payoffs are many, including feeling better mentally and physically.

Getting help
If you’re experiencing persistent sexual difficulties, speak to your diabetes care provider about it. Based on your description of the difficulties you’re having as well as your previous medical history, including any drugs you may be taking, your provider may be able to rule out some possible causes or identify some likely ones. He may choose to treat you himself or may refer you to a specialist such as a urologist for care. If your diabetes control appears to be a contributing factor, your provider may recommend changes in your treatment plan or refer you to an endocrinologist or possibly to a diabetes educator for education and skills training. If your sexual problem appears to be primarily psychological in nature or your provider believes you may be experiencing depression, he may refer you to a mental health care provider such as a psychiatrist or psychologist for therapy and, if needed, antidepressant drug therapy.

No matter what their cause, sexual problems tend to have profound effects on emotional well-being and on relationships. Talking with a licensed psychotherapist or seeking the help of a marriage and family therapist can help you cope as you seek medical help or adjust to changes in your sexual function. In many cases, psychological counseling along with treatment of physical factors contributing to sexual problems offers the best solution to management.

Maintaining your relationship
While you seek medical help or mental health care, it’s important to keep the lines of communication open with your partner. Talking frankly about the problems you’re experiencing and your feelings about them, as well as listening to what your partner has to say, will most likely bring you closer. When you talk, keep in mind that what makes a relationship satisfying for the people involved is really up to them—not to some notion about what intimate relationships should be.

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Laura Hieronymus is the program coordinator for an American Diabetes Association–recognized education service, and Lawrence Maguire is a practicing internist. They are diabetes care and education providers at Drs. Borders & Associates, PSC, in Lexington, Kentucky.

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