ADA Advice on Sex

As my article “When Diabetes Affects Your Sex Life” in the May/June 2008 issue of Diabetes Self-Management would suggest, sex and intimacy are two of my favorite topics, so I made sure to attend the panel on sexuality at June’s ADA Scientific sessions. It wasn’t great, but I learned some things.


Dr. Irwin Goldstein of the University of California, San Diego, and Editor-in-Chief of The Journal of Sexual Medicine gave the hard science look. Dr. Goldstein listed some ways that diabetes can interfere with sex. At the top of the list were circulation problems, which can affect lubrication and erections, and nerve damage, which may interfere with sensation or cause pain. Many people have both circulation and nerve problems.

People with diabetes, especially Type 2, tend to have lower-than-normal levels of sex hormones, especially testosterone. In both men and women, low levels of testosterone often cause low levels of desire. Goldstein said that birth control pills can also lower testosterone levels in women. Taking supplemental testosterone or DHEA (a testosterone precursor) can help some men and women regain desire.

Psychological Factors
Psychologist Mitchell Tepper, founder and president of The Sexual Health Network and, is one of the nation’s leading sex educators. He talked about psychological issues affecting sexuality. Such things as feeling unattractive, blaming yourself for diabetes, and depression may damage both sexual desire and function. So can stress over health, money problems, and family issues.

Helping Partners Cope
I really got a lot from Dr. Lawrence Fisher of the University of California, San Francisco, who stressed the problems and needs of partners of people with chronic illness. In the work my partner and I do with sexuality and disability, we have found that partners’ needs are usually ignored. It was good to hear a doctor talking about these problems.

Partners as well as patients may feel unattractive. They may also find their partners unattractive. Patients and partners may blame each other for health-related problems. When one member of a couple can’t get an erection or has vaginal dryness or pain with intercourse, partners may blame themselves. Dr. Fisher said that studies show that partners of people with diabetes get almost as much depression as the people with diabetes themselves do.

Both partners may grieve the loss of sexual spontaneity that diabetes may bring—for example, the need to check blood glucose or deal with an insulin pump.

Dr. Fisher pointed out that all these issues can be dealt with by talking openly about them. This may sometimes involve a professional counselor. But some cultures do not approve of talking openly about sex, which makes it harder. He recommends educating both partners and seeing couples together at appointments.

Donna Rice, former president of the American Association of Diabetes Educators, pointed out that low testosterone levels increase risk of heart attacks and strokes, so people should get their testosterone levels checked. She strongly encouraged the use of the erectile dysfunction (ED) drugs such as Viagra, Cialis, and Levitra. She said these drugs can safely be used every day by most people.

But I had to ask. The major sexual problems in diabetes seem to relate mostly to intercourse—either poor erections or lubrication or painful intercourse. So why aren’t we teaching about nonintercourse sex (my and my wife’s specialty)?

Things lovers can do to each other with their hands, mouths, and other parts can create some of the best, closest sexual experiences of their lives, and these acts are safe and don’t require drugs. They may call for lubricants, but those are cheap and safe.

Everyone on the panel said that alternative ways of having sex were a good idea, and Dr. Tepper even suggested noncontact sex as a possibility. I’ll have to find out more about that.

Do you think partners’ needs are addressed by the medical system or by the providers you have seen? Has diabetes brought you and your partner closer together or pushed you apart? When it comes to sex, have you been able to maintain your sex life with diabetes? Have you tried any new approaches to sexuality? Would you consider trying some new things? Let us know with a comment below.

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  • KAT123

    My husband was diagnosed with type 2 diabetes about 10 years ago. We have not had sex or any kind of intercourse for at leat 8 of those years. He told me that he has lost all desire and dosen’t want it or need it. Before we had a very active sex life, we enjoyed expermenting and just having fun. I know that alot of our health problems are from lack of intimacy..what can I do? I don’t feel that it is fair to me to be left high and dry..and I want to do something to help him.

  • David Spero RN

    Hi Kat,
    Yours is a sad (and very common) story. Your husband seems to really be hurting, but he is not being fair to you at all, and you should not have to put up with it.

    I wonder how good his diabetes control is—perhaps high sugars are dragging him down. How physically active is he otherwise? Maybe he needs to get his body moving.
    Most likely he is depressed. Is he being treated for that, and if so, how?
    Quite possibly, he is reacting to erection problems by withdrawing, without admitting that’s the reason. A lot of men do.

    You have to let him know (in a nonthreatening, “I-message” kind of way) that he may not “want or need” intimacy, but you do. If he used to be open to new things, he should be willing to try new sexual things now, IF he wants to.

    In some couples with chronic illness, one partner may find other ways to get his or her sexual needs met, if the other can’t or won’t. I’m not suggesting this, but it does work for a lot of people.

    Good luck and keep in touch,

  • bslima2002

    My husband was diagnosed some time ago with diabetes and was being treated with oral medications, but has recently been given insulin to control this. Prior to the insulin we were having sexual problems, now that he is on the insulin sex is just obsolete. He has the desire but the erections are just not there. He has been prescribed Viagra, but that simply does not work and he does not like the side effects. He asked his doctor about it and he told him to wait a month to be on the insulin before trying to fix this problem. That is okay but he really feel awful about this. How can we get the help we need and what kink of help is out there? He feels kind of bashfull about talking to someone strange about the problem, but if he spoke with someone who may have had the same type of problem it may be a little easier. I really do not know what to do at this point.

  • mjw

    Depression, guilt, anger, and poor self esteem are emotions that are common to many people with diabetes. They are also emotions that can destroy sexual function in otherwise completely healthy people. Sometimes it is difficult to sort out the physical problems from the psychological. I am a middle aged man with type 2 diabetes. I have been diabetic for many years. I suffer from mild depression. I have been and remain angry about being diabetic.
    So what to do??
    I believe that the best thing we can do is accept the diabetes as a fact in our lives… just like the fact that we need to breathe to live… and just move on. Focus on what we can do to make our lives better and make our relationships more fullfilling; both for you and your partner. Because we ARE diabetic, it may be more challenging…but be patient and be loving. Also be mentally flexible and adaptive.

    The next thing is to get good health care. Don’t be afraid to talk about sex with a doctor or counsellor. You’re not going to tell them anything they haven’t already heard. Several years ago I had my first colonoscopy. After that I decided that I didn’t need to be embarrassed about any health issue ever again!!

    I take some testosterone and it helps. I had to try several depression medications before I found one that helped my depression without making me impotent. There is a bottle of Viagra on my bedstand. Sometimes my wife and I can have intercourse without it. When we use it, it usually works just fine. Occasionally, we use it and it doesn’t work. That’s a litte disappointing, but we’ve kind of moved past letting intercourse alone be the focal point of our intimate experience. It took a while for me to get where I could feel that way. It came about during a time when I was trying out an anti-depression drug and Viagra wasn’t helping at all. I was pretty upset, angry and frustrated. My wife and I avoided sexual contact. Finally, I realized that though things might not ever get any better for me, I still wanted intimate contact with my wife. This led to a few conversations, some creative exploring…nice massages and what-not… Fortunately, I got a better depression med and the sex function improved quite a bit. Still there was a valuable lesson learned..and I think my wife and I are closer because of it.
    This has rambled. I hope someone can benefit from my experience.

  • Ivannia

    I have type 1 diabetes and a positive attitude towards my pump (pumping 9+ years). When I have sex with my husband I usually don’t disconnect from the pump, I just use a long infusion set that allows the pump to be moved out of the way.

    Once in a while, during the action the pump gets in the way, we laugh and called it: a ménage à trois (a threesome).


  • hypnodeb

    I read the above blogs (Kat123 & bslima); they are exactly what has happened to me..I encourage an article on NON INTERCOURSE SEX…USING HAND, MOUTH AND OTHER PARTS…for the partner who wishes sexual fulfillment…..
    My partner needs a roadmap for me to show him to fulfill my needs….

  • j.s.

    Great article.

  • Eve

    I was glad to read this on sexual problems with diabetes. I myself am a type 2, and have been for the past 3 years. I was just diagnosed with a very low level of testosterone. It was so low I barely had in at all in my system. My doctor put me on a testosterone cream which for women has to be made in a special lab. And as of right now hasn’t been approved by the FDA to help with desire in women. But it has been approved for the use in men. I was told it could take up to at least 6 to 8 months before the desire could or would return. It has been very frustrating for my husband to understand this since I have no desire and feels hurt. Only after several years of complaining to my doctor and when my husband was then put on Viagra did he decide to check on my levels. It really was a blessing that if it wasn’t for my husbands male problem, this would of never of been found out for me. Maybe more doctors need to listen to their patients. Thanks.

  • tigger551

    Hi, I’m in my 50’s. Very healthy and young for my age. I’ve been on the pump over 10 yrs. My husband passed a while ago and some friends talked me into one of the on line dating sites. The problem I’m having is I want to be honest with the person I’m mailing to, but all I have to do is mention the pump and no more mail!! Have any of your readers ever had this problem before? Is there a special site for singles with diabetes? Its very sad that people are so uneducated about diabetes. The average person dos’nt believe you when you tell them you’re not going to pass out from dancing or any other activity. If anyone has any suggestions, please write back. Stress is NOT good for diabetics!!

  • David Spero RN

    Hi Tigger,
    As far as when to tell people about your diabetes and your pump – I would wait until they get to know you and appreciate how wonderful you are. And maybe also until you’ve had a chance to dance or hike or something so they can see you’re not fragile. So not by e-mail.

    But then tell them. Obviously you don’t want to wait until you’re on your way to bed with them. 2nd or 3rd date is usually the time, but it varies. So this implies no jumping into bed on the first date, probably a good thing.

    I’m not sure about sites for singles with diabetes, but there are a LOT of social networking sites for people with diabetes. One is Perhaps our readers could suggest others.


  • ann

    My husband is diabetic and takes lots of prescription medicine. He is also quite a bit overweight and seems to want to eat indiscriminately more than we wants to do anything about his weight or exercise. He has had ED for at least three years. We have no physical contact at all. We are both 59 years old. If he waits until morning to shower, I can smell a strong urine odor at night, probably from his underwear. Also, the few times we tried to be intimate, his secretions had a very strong urine odor which were totally repulsive to me. We are drawing farther and father apart. Any suggestions? (He is very offended if I mention odors or showering, so I usually just keep quiet.)

  • jharris

    My wife and i are 59yrs old. She has had diabeties for 20yrs. We have not been intamenint for 15yrs. She has know desire and pushes me away and i’m tired. I love her, but she does not think that sex in any other form is right. I’ve tried consilers,doctors,pricthers. She won’t try any thing new, because it’s nastey she says. What should i do, before i lieve. I love her! We have been married for 32yrs, and it has been very hard!!!! Thank You

  • David Spero RN

    Hi JHarris,

    It’s tough being married to a partner who doesn’t like or want any kind of intimacy. She is not being fair to you. I wonder if she would be open to couples counseling, although it’s hard to find a counselor who knows about diabetes and is also open about sex.

    Before leaving her, or arranging to get your sexual needs met elsewhere, I wonder about having your wife’s estrogen levels checked. Low hormone levels are very common in diabetes and would cause her to act the way she’s acting. If needed, the hormones can easily be raised. But she would need to see a doctor first.


  • David Spero RN

    And JHarris, If you want to talk about this a bit more — e-mail me off the group at [email protected]

  • niki3

    my husband is been diag. with type 2 and is on medicine, had been helping the sugars but noticing his moods up and down. He is on a antidepressent but feel it’s not working. How can a spouse cope with helping him if he doesn’t know what is wrong.. also the sex life has become less and less. I love intimacy but that has even become less. Any advice for a woman who is just turned 30 and feels like she is beating her head up against a wall. I am so in love with my husband… I want to help.. support for spouse’s?

  • David Spero RN

    Hi Niki,

    Your husband’s testosterone level is probably low, and should be checked. His antidepressants may not be working for him. Those medicines can interfere with sex, but one of them (bupropion) causes fewer sex problems.

    His diabetes medicines could be causing the mood problems, or it could be blood glucose going up and down that is doing it. He could be depressed or very scared about what is happening to him.

    You and he should go to his doctor’s appointments together and bring up the issues you are having. You don’t say how long ago he was diagnosed, but it takes time to learn how to manage. Maybe you two just need more time. Keep trying things, looking for answers, and getting help. Living with a partner with a chronic illness is not easy.

  • Tom

    Married for 30 years. My wife has diabetes. For 11 years there has been no sex. Although she still seems to enjoy orgasims.She refuses to satisfy me. I believe in god and follow the ten commandments. So this frustrates me to no end.
    My beliefs don’t allow me to cheat,And I’m thinking of leaving her. We cannot afford
    counceling.(If she would even go)It feels like she doesn’t loves me anymore.I have also thought
    that she may of had an affair before all this
    started, And think she be ashamed to have sex with me.Well too much info. HELP ME!!!

  • ravichandran

    dear sir i[43yrs] found your article. still i need some information.i[pharmacist] am a diabetic patient.presently i take actos 30.amaryl3.0 glucophage1000.nearly3months even viagra ,cialis give very short time[2 min] errection what drug should i take to increase erectile partner like only vaginal sex.can you help me?

  • David Spero RN

    Dear Ravichandran,

    I don’t have better drugs than Viagra and Cialis, but if you can get hard for two minutes, you could use a constricting device and wrap it tightly around the base of your penis after you’re hard. That will keep the blood from flowing back out and maintain the erection much longer. Even a tight rubber band works for this. Don’t leave it on more than four hours.

    There are also herbal medicines you could try. Damiana, ginseng, fenugreek, and cinnamon have all shown some benefit for sexual function and also for blood sugar control. (Editor’s note: Speak with your doctor before adding any herbal medicine or supplement to your regimen.)

  • Kyleigh

    I just started dating a man that is 47, I am 27 he has diabetes he was diagnosed 4 years ago. It isn’t that he isn’t interested in sex, he can not get an erection. We talked about it and I convinced him to see a doctor. What are the chances that even medicine won’t help? I can not be in a relationship without sex any information you can give me would be greatly appreciated

    • Julie

      Done been there may times you are to young to live a lonely life with this man. I am truly sorry to say don’t get involved this man will not be able to have a close relationship with you, you will and up like brother and sister. If he’s over weight and wants you he needs to lose the weight first and get this diebetis in remission.

  • David Spero RN

    Kyleigh, much has been written about reversing erectile dysfunction. Do a search for that on the Web. And meanwhile, don’t forget that there is more to sex than intercourse. You can have some serious fun (including amazing orgasms) without the man’s having an erection, if you’re willing to try some new things.

  • Anne

    My husband was diagnosed with type 1 diabetes at the age of 15, he is now 27. We have been together for 5 years. When we first got together we had a very active sex life. Sadly, since marrying, things have changed. My husband is no longer interested in sex. We have not had sex now for 8 months now, not even when we were on holiday. He is still loving and will always want to cuddle in bed but if I suggest or try to have sex he gets upset. When I tell him it makes me feel unloved he tells me not to be silly and gets upset saying that he loves me and we have a lot of love in our relationship. I’ve asked him if it’s because of his diabetes but he never answers. I’m lost at what to do!

  • David Spero RN

    Hey Anne,

    You and your husband need to talk seriously, and not in bed. Counseling would be helpful, whether from a therapist, clergy or whomever. This may or may not have anything to do with diabetes, but to reject sex at age 27 is not usual and indicates that something is wrong. Whether it’s physical or emotional, I can’t say. Get help.

  • Dawn

    Hi, my name is Dawn and I’m 27 years old. My husband was diagnosed with diabetes when he was only 15 months old and has always took shots for his diabetes. He is now 33 years old and we’ve been together now for 9 years. We have never experienced the so called “honeymoon phase” we’ve never had a lot of sex. I getter turned down at least 98% of the time. Crying and begging has done me no good. He says, “I just don’t have to have it all the time like you do.” I went from wanting him almost daily to only approaching him 1-3 times a week. I’m only able to get him to be intimate 1-2x a week. Here have been times that we have went 3 weeks to a month without sex. It’s is very very hard for me, because I love him very much and need him badly and feel so alone. I have told him how lonely I I feel for the last 5 years. He has no desire for me. He doesn’t have a problem getting erections the majority of the time, but does have a hard time maintaining one. He would always rather be left alone to sleep or do whatever. He never annitiates sex and the one time we do make love a week I have to still beg and get upset and wait 30 minutes for him to join me in the bedroom. He’s never affectionate with me either. He has had his testosterone checked and it was fine. He has tried Cialis before and it worked to maintain his erection, but still no desire and he say’s that it cost to much. I’m at a loss. I’m desperate to find some sort of comfort in all of this. We are due to have our 4th child in June so, leaving is the last thing that I want to do. Any advice for our situation would be very much appreciated.

  • David Spero RN

    Hi Dawn,

    I’m sorry you are going through such a hard time. Low desire is sometimes tough to change, but I would start by checking his testosterone levels. There are also herbal approaches. And couples therapy might be a good idea.

    But it may be that you can accept two times a week as enough, IF the two times are really good. If they are, he might want more.

    The maintaining erections issue might be taking away his desire. If he’s worried about staying hard, he might not be having much fun. He could try one of the erection drugs; they work well — or, since you say he can get erections but can’t always keep them, he could try a “cock ring.” Look them up. If he can get an erection for even 10 seconds, he could roll or wrap a ring around the base of his penis and stay hard for a long time.

    So there’s two or three places to start. Hope it helps.

  • 10 years of marriage, I AM A 39 years old female, my husband says he loves me but has pushed me away from his bedroom saying that he like sleeping in separate beds, I don’t snore, i am attractive and I always like to look my best.

    We have not had sex for 8 years and the second year of marriage we only had sex twice, one of those times i got pregnant and had a baby.

    I am sad , depressed, feel worthless, is impacting my physical and mental health as I don’t know where to turn , I don’t want to be married anymore but dad does not want me to divorce and I don’t want to hurt him and have stayed but I feel sad about the loss of intimacy and the fact that I feel my husband does not love me and prefers to spend time with his so call friend and who know if he is seeing him or having a good time with another woman. I feel sad….

  • Mia

    Married for 22 years, and we used to have a very active sex life. My husband was diagnosed with diabetis 12 years ago. He started having problems getting erection and maintaining erection about 2 years ago. I’m in my forties and miserable. He is unwilling to try other things. He has tried cIalis and lately that has not worked either. Don’t know what other options we have, but I’m not happy.

  • sheila

    Ive been with my husband 25 years he has type 2 diabetes for the last 10 years our sex life is nil now I’m so unhappy he won’t do anything about it

    • MrsSteven Puryear Zrp

      I’ve been seeing my husband for 15 years now off and on. We just got married in January of this year and I’m so sexually frustrated that I’ve considered numerous times cheating. I know how you feel honestly. My husband won’t go to the doctor to get any medication on his off days and he had yet purchased any viagra for the bedroom. I really don’t know what to do. Hearing you speak on this topic only worries me more about what my future wool be like if I continue to stay in this marriage.

      • Dear Sheila and Mrs. Zrp, You have to do something about this. If husbands won’t talk about or do anything about sex problems, you need couples counseling and/or individual counseling. It starts by honestly telling your partner how you feel about the lack of intimacy. If you have done that in a loving way, and he still hasn’t responded, you should get outside help. Before “cheating” though, I would have you ask him how he would feel about you getting your needs met somewhere else. That might open up a conversation.

  • Gemma

    Me and my husband have been together 8 years and married for 5 my husband has type 1 diabetes and it’s been 7 months since we made love I hate it I feel fat and ugly and feel he don’t love me anymore I lost my 4 year old daughter 4 years ago and was really depressed I’m feeling the same now then I Did then

    • Gemma, it’s probably his diabetes stopping him, not you. You haven’t changed that much in 7 months. Read some of the other comments here. You would get the same advice they got. Talk to him honestly, get outside help if you need to. I am sorry about your daughter — if you are depressed, that could make it hard for either you or your husband to feel sexy. Have you been to a counselor or a grief group for help with your grief?



  • Blr

    I have been married 45 years to my husband who has had type 2 diabetes for 25 years. He is very overweight by 85 pounds. We have had no sex, or intimacy, kissing or hugging for the last 20 years. He won’t use Viagra and doesn’t want to talk about our relationship. He is good man. I have given up asking to do anything physical together like walking etc. He has a food addiction, and can’t stay on a diet although he tries. He is not interested in monitoring his blood glucose levels. He is now blind. And has difficulty walking. I now have to take on the roll of a caregiver and Mr fix it. I am disappointed that the years have flown by and I have deferred things I wanted to do and intimacy I craved. Now it is too late what’s the point. We have the very best brother / sister relationship. In sickness and health…..

  • Sadie

    We have been married 30 years and over the last 6 months my husband has changed completely. He has recently been diagnosed with type 2 diabetes which explains his erectile dysfunction but does this explain the fact that he feels he doesn’t love me the same anymore? Is this due to him coming to terms with everything I just don’t know what to do

    • Sadie, a new diagnosis of diabetes and ED symptoms could throw anyone for a loop romantically. Marriages also change over time; they have their ups and downs. Hopefully you can find a way to talk things over with him, either on your own or with help from a counselor, a friend, or clergy person.