Diabetes Self-Management Articles

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Sexual Wellness

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and Lawrence Maguire, MD

  • Fatigue or tiredness, whatever its cause, can profoundly affect a person’s interest in sexual activity.
  • Pregnancy and the tiredness, discomfort, changes in body image, and changes in hormone levels that go with it can lower sexual desire.
  • A well-known side effect of antidepressants in the selective serotonin reuptake inhibitor (SSRI) class is reduced sexual desire in both men and women. The SSRIs include fluoxetine (brand name Prozac), sertraline (Zoloft), and paroxetine (Paxil, Pexeva), escitalopram (Lexapro), and citalopram (Celexa).
  • Depression can contribute to a lack of interest in sex or lack of energy associated with sexual desire. Depression is common among those living with a chronic illness such as diabetes.
  • Arousal disorders. The inability to become aroused or to maintain sufficient sexual excitement is called an arousal disorder. In women, sexual arousal disorder involves an inability to attain or maintain swelling and lubrication of the genitals. In men, it involves difficulty attaining or maintaining an erection. Arousal disorder may appear to stem from an avoidance or aversion to sexual contact with a partner. But in fact, the roots of the problem can be physical as well as psychological.

    Orgasm disorders. A persistent delay in or absence of orgasm following a normal sexual excitement phase can occur in both men and women. Use of SSRIs commonly contributes to this problem. (If you have been prescribed one of these drugs, however, do not discontinue it without first consulting your prescriber.) Diabetic neuropathy (nerve damage associated with diabetes) may also contribute to the lack of ability to achieve orgasm.

    Pain disorders. Pain associated with sex is more common in women than in men, but it can affect both sexes. Its causes can be physical, psychological, or both. In some cases, women experience pain with intercourse because of vaginismus, an involuntary spasm of the vaginal wall muscles. While the cause of vaginismus is not clear, trauma such as rape or abuse may play a role.

    Poor lubrication and vaginal dryness can also contribute to painful intercourse in women. The possible causes of poor lubrication and vaginal dryness are many, and they include the hormonal changes that occur with pregnancy and breast-feeding. With menopause and the accompanying decrease in estrogen production, the vaginal lining becomes thinner, which can cause vaginal dryness and pain with sexual activity. In women with diabetes, these symptoms can often be exaggerated, especially during periods of less than ideal blood glucose control.

    If you or your partner is experiencing pain during sex that appears to be related to vaginal dryness or irritation, your health-care professional may suggest taking time for adequate stimulation prior to intercourse, using a vaginal estrogen cream or water-based lubricant, and avoiding contraceptive foams and creams that may be irritating to the vaginal lining.

    Is it my diabetes?
    The physical health issues that are commonly associated with diabetes can contribute to sexual problems, so when any form of sexual dysfunction develops in a person with diabetes, it should be considered as a possible cause. However, diabetes should not automatically be assumed to be the problem; other potentially relevant health issues, many of which are not diabetes-specific, should be examined as well.

    Most diabetes complications are related to high blood glucose, and sexual problems are no exception. In the short term, high blood glucose can negatively affect your energy level as well as your mood, which can cause any relationship to suffer. Your body’s cells require glucose for energy; high blood glucose levels usually indicate that glucose is not being moved into your body’s cells, and you therefore have less energy than usual. The higher your blood glucose levels, the more tired you will typically feel.

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    Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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