Sex and Diabetes

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I just finished reading an article in a consumer magazine about sex and diabetes. In my experience as both a diabetes psychology specialist and a sex therapist, the article was what I expected. The issues discussed were related to physical problems common in men and women who have diabetes. The solutions offered in the article were fairly simple and focused on medical treatments. These are definitely important areas for people with diabetes to be aware of and important solutions for them to understand. Bravo to this article for addressing such a sensitive area. However, I do have something to add. Sex, whether or not someone has diabetes, is not a simple topic.

If everything works well, sex is likely a pleasurable experience. But those things that need to work well aren’t just the physical aspects—they include communication, affection, energy, time of day, your interest, and your partner’s interest. These factors in turn can be interfered with by a host of other factors, including any stressors, family history, abuse, emotions about your partner, your aching back, or a headache (although research suggests sex has a positive effect on headaches). In other words, the experience of sex is more than the sum of its physical parts.

I’m afraid we are tempted to look for the simple solution even when the issue is so complex. My concern is that health-care professionals can end up over-simplifying treatment and, by doing so, can cause couples to believe there is something wrong with them instead of with the treatment. For example, the usual course of action to treat erectile dysfunction (ED) is to offer the patient a PDE-5 inhibitor such as sildenafil (brand name Viagra), vardenafil (Levitra), or tadalfil (Cialis). In many cases, this is a good choice—these medicines have helped millions restore their sex lives. However, if the medicine doesn’t help, a couple may think there is something wrong with them—after all, on TV it appears to work for everyone.

Those unfortunate couples who don’t get the right treatment may discontinue treatment altogether. In some cases, the medicine may be the right treatment, but the couple still needs to work on the relationship before the the medicine will help. I also know that the causes of sexual problems for people with diabetes are not just physical. People with diabetes have as much of an opportunity as anyone else to have psychological problems. The causes of sexual dysfunction are multidimensional, and a holistic approach to assessing and treating the problem is more likely to help people regain a healthy and fun sex life.

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