So who’s uncomfortable? Good, glad we’re all on the same page. As Jerry asked George on Seinfeld, “What is it about sex [that’s so awkward]? Is it the touching? Is it the nudity?” Sex is something both primal and intimate, in our faces all the time (usually selling us beer) and yet shunned and talked about in silly euphemisms. The sexual drive is something nearly every human being shares (there are those who have no interest, but such predisposition is certainly a rarity), perhaps the MOST universal thing we all share. But because we have so many disagreements on what should be done with that drive, this thing we all share often becomes a divisive issue between us. It’s a mess.
Unfortunately for those of us living with diabetes, sex is also something that our disease can interfere with. Sex involves the whole body, the nerves, the circulatory system, and the muscle system. It involves the mind, as well — after all, as cliché as it is to write this, arousal starts in the mind! And all of these are things diabetes can affect! So, let’s just go ahead and dive into the awkward pool and tackle this, shall we?
What can go wrong?
In both men and women, the potential nerve damage can impact our ability to achieve arousal. The nerves, after all, are what transport our sensations of touch. The nerves also dictate to our muscles, and muscles are intimately involved in both the male and female sexual response.
In men, nerve damage can contribute to erectile dysfunction (ED). ED affects a lot of men as they grow older (as many as one in three men between the ages of 40 and 70 have the condition), and diabetes increases those odds — by some estimates up to 75% of men with diabetes will experience ED in our lives!
In women, the nerve damage that can result from uncontrolled high blood sugar can cause an inability to reach orgasm. The nerves in the genital region simply aren’t able to fully function and feel the sexual experience as they are intended to.
In addition, women may experience lack of vaginal lubrication during sex. This may not only impair the ability to experience pleasurable sensations, but can cause sex to become simply painful.
It’s also important to understand the role our mind plays in all of this. Like I said before, arousal is a result of the nervous system relaying information back to the brain, where those electrical impulses are decoded, deciphered, and rendered into thoughts, feelings, emotional urges, and motivations for actions. People living with diabetes are at a higher risk for depression, anxiety, and other mental health issues, all of which can severely dampen our desire and appetite for sexual activity. In men, a decrease of testosterone can also factor in here, further dampening our libido.
So, what can we do?
As with everything else in this fantastical world of diabetes, the number one thing we can do to help avoid these issues is to keep our blood sugars in control. An HbA1c of less than 7% is the target for tight control, and tight control has always and will always correlate with decreases in every category of complication.
We should also be monitoring our blood pressure. High blood pressure is another risk factor for ED in men, and contributes to insufficient vaginal lubrication for women, as both of these are highly dependent on the proper circulation of blood within the body.
Exercise, of course, addresses all of the above, helping improve circulation, increase the effectiveness of our insulin, and lower our weight (which, in turn, lowers blood pressure). Finding a way to get in some aerobic exercise on a regular basis is a starting point for pretty much any of us living with diabetes (I type this as much as a reminder FOR MYSELF as for the readers).
If lifestyle changes don’t help, medications are available that can help address all of these issues. Of course, that will mean bringing all of this up to your doctor. And that brings us back to where we started — it’s hard to talk about this stuff! But remember, doctors are here to help us, not judge us. And I’d be willing to bet that whatever it is you’re avoiding talking about to your doctor, she has heard it times over and 100 times worse! So don’t be shy if your sexual health is suffering because of diabetes.