“Intimacy is being seen and known as the person you truly are.”—Amy Bloom
Researchers believe that up to 50% of people with diabetes will experience some sort of sexual dysfunction at some point. But even if diabetes doesn’t directly cause sexual dysfunction, other diabetes-related health issues can influence your sexual desire and may be a threat to intimacy within a relationship. It is important for you to be educated and aware of these issues, both to prevent health or sexual problems as much as possible and to be prepared to cope if they arise.
Types of sexual problems
Sex experts have divided sexual dysfunction disorders into four categories: desire disorders, arousal disorders, orgasm disorders, and pain disorders. One type of disorder can and often does coexist with another. None of these types of disorders is unique to people with diabetes, but diabetes can contribute to some of them. Sexual problems can occur at any stage in a person’s life and can occur suddenly or gradually over time.
Desire disorders. Decreased libido, or a persistent lack of desire for sexual activity, is called a desire disorder. Common predisposing factors include changes in testosterone production (in both men and women) and a decrease in estrogen level in women, most commonly associated with menopause. Psychological or relationship problems can also lead to desire disorders.
Testosterone is a sex hormone that plays an important role in puberty. In men, testosterone is produced primarily in the testes, the reproductive glands that also produce sperm. As men age, their testosterone level tends to decrease, along with their sex drive. In men with diabetes, however, a decrease in testosterone production may occur at a much younger age. Men with diabetes as young as 45 are twice as likely to have a low testosterone level as men who don’t have diabetes.
In women, small amounts of testosterone are produced primarily by the ovaries and adrenal glands. While the role of testosterone in women is poorly understood, it is believed to have an effect on sexual desire and function. Menopause and certain medical conditions may cause a woman to have a low testosterone level, possibly contributing to lowered sexual desire.
Women with polycystic ovary syndrome (PCOS), a disorder characterized by menstrual irregularities and infertility, however, tend to have the opposite problem: a high testosterone level. Like Type 2 diabetes, PCOS is associated with insulin resistance, in which the body is unable to use insulin efficiently. In fact, about 50% of women with PCOS eventually develop Type 2 diabetes.
A high testosterone level in a woman—whether or not she has PCOS—can cause development of male sex characteristics, including an increase in body hair and facial hair, a deepening of the voice, male-pattern baldness, and clitoral enlargement. High testosterone is not directly associated with a lack of sexual desire, but the physical changes it can cause can affect a woman’s self-esteem and cause her to feel unattractive and sexually undesirable.
The decline in estrogen levels that occurs with menopause similarly may not directly affect a woman’s level of sexual desire, but other aspects of menopause, such as hot flashes, may affect how she feels about sex. In some women, hot flashes can contribute to fatigue and sleep deprivation. In others, hot flashes can alter mood and consequently affect the quality of their sexual relationship.
In addition to these hormonal changes, the following can contribute to lack of sexual desire:
- Physical changes that often occur with aging, including lack of energy, loss of strength, and stiffness with body movement, can affect both sexual function and sexual desire.
- 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).
- 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.