Sex and Diabetes


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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Joe Nelson: Joe is a psychotherapist in private practice in Minnesota, where he specializes in the psychology of chronic disease and sexual problems and works with couples, families, children, and teens. He has been a Licensed Psychologist since 1985 and has earned a master’s degree from St. Mary’s College Winona, a bachelor’s degree in social work from the University of Minnesota, and an associate’s degree in human services from the College of DuPage in Glen Ellyn, Illinois.

Joe has worked with troubled youth in Chicago and Minnesota and on a special project on Turtle Mountain Reservation in North Dakota. He was the first social worker hired by an affiliate of the American Diabetes Association. He worked at the International Diabetes Center for 20 years, directing psychological services there for 12 years. A Certified Sex Therapist, Joe co-developed the Sexual Health Center at Park Nicollet Clinic.

Having practiced meditation for over 30 years, Joe offers instruction in mindfulness-based meditation to patients in groups and as individuals. Joe is married, has a 23-year-old daughter, and enjoys scuba diving, motorcycling, golf, and being outdoors doing almost anything.

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