Diabetes can affect many aspects of your physical and mental health. Sexual health is something that can be difficult to talk about and often people suffer in silence. However it is very important that you do talk to someone about any sexual health problems or difficulties, as there are things that can help prevent and manage any issues.
Most importantly these problems can affect relationships, and as your partner is vital to your overall wellbeing, any issues need to be discussed and sorted out so you can feel united in your relationship and your lives.
Diabetes can affect both men and women’s sexual health. This page will give some information about women's sexual health. You can find out more about men's sexual health here.
Many women with diabetes experience sexual problems, although this is not often talked about. Research about sexual problems for women with diabetes is limited - one study found 27 percent of women with type 1 diabetes experienced sexual dysfunction. Another study found 18 percent of women with type 1 diabetes and 42 percent of women with type 2 diabetes experienced sexual health problems.
Sexual problems for women with diabetes may include:
- decreased vaginal lubrication, resulting in vaginal dryness
- uncomfortable or painful sexual intercourse
- decreased or no desire for sexual activity
- decreased or absent sexual response
- recurrent bouts of thrush.
Causes of sexual problems in women with diabetes include nerve damage, reduced blood flow to genital and vaginal tissues, and hormonal changes. Other possible causes include some medications, alcohol, smoking, psychological problems such as anxiety or depression, gynecologic infections, other diseases, and conditions relating to pregnancy or menopause.
If you experience sexual problems or notice a change in how you feel during sex, it may help to talk with a doctor or counsellor. They should ask about your medical history, any gynecologic conditions or infections, the type and frequency of sexual problems you are experiencing, medications, smoking and drinking habits, and other health conditions - to try and get to the cause of the problem.
They may also want to know whether you are pregnant, have had babies, or may have reached menopause. Your mental health and wellbeing can be closely connected to sexual health, so they will want to find out how you are feeling, whether you have experienced any signs of depression, or if you have recently experienced any other stress of difficulties in your life. A physical exam and laboratory tests may also help pinpoint causes of sexual problems. Finally your blood glucose can impact on sexual health and so it is important to chat about how this has been going and whether changes to your diabetes management might help. In situations where things like hormones are impacting on your diabetes, it can be very tricky and it is important not to feel like it is your fault. Managing diabetes is very complex.
Menstrual Cycles, Contraception and Pregnancy
Your menstrual cycle can affect blood glucose levels and many women with diabetes find that their levels are higher than normal at certain times in the cycle. During these days you may need to be extra careful about what you eat, your exercise, and insulin and medication dose. Seek advice from your doctor. If you are having problems with diabetes around your period, always seek input from your usual doctor.
Discuss the best method of birth control with your doctor. Sometimes birth control pills may cause problems with your blood glucose and other methods (diaphragm, intrauterine device, cervical cap, condoms, etc.) may be a better solution for you. Not all women find birth control pills a problem and it is very important to plan pregnancy as far ahead as possible, so this is a really vital part of your health plan. If you decide you want to have a baby, it is important to work on reaching the recommended targets of an HbA1c 6%, before starting to try for a baby. Of course sometimes women fall pregnant without planning it. In this case it is best not to worry and make an appointment to see your doctor ASAP. You can find more information here on our my diabetes pregnancy site.
Many women notice fluctuations in blood glucose at certain times in their monthly cycle, such as an increase in blood glucose a few days prior to the beginning of their period and then a decrease once the period begins. This increase usually occurs after ovulation and before menstruation. Changes are due to two hormones, estrogen and progesterone. When these hormones are at their highest level just before your period, they affect insulin, which may cause blood glucose to rise. Some women find their blood glucose rises considerably, while others do not notice a difference. In some women, blood glucose levels are lower before and during their periods. You can use a diary or app to track what happens for you.
Often it is the fasting blood glucose before breakfast that tends to fluctuate the most for women with type 1 diabetes, during the time just before a period begins. Adjusting your insulin may help - speak with your doctor about how to manage this - insulin pumps can offer great flexibility for management of changes during the cycle. When your period begins and your blood glucose levels go down, readjust your insulin to your usual doses. This sounds simple on paper, but it can be tricky to navigate. Sometimes it is a matter of doing what you can. Relaxation and exercise can really help your diabetes and your emotions.
If you have type 2 diabetes and do not take insulin, remember regular exercise can lower blood glucose, therefore it is important to maintain physical activity during this time of the month. Besides helping with blood glucose levels, you will have more energy and feel better generally if you are able to exercise.
If you notice fluctuations in your blood glucose and are not sure if these are related to your menstrual cycle, it is easy to find out. Keep a record book or online journal and mark when you start your period each month. Track your blood glucose levels, and watch for a relationship between the two. It is best to do this for a few cycles, to see if there is a pattern before making any changes to your diabetes management.
Diabetes and menopause: What to expect (via Mayo Clinic)
Menopause is the phase of life after your periods have stopped. The extended period prior to this is called perimenopause. Diabetes and menopause can cause difficulties including:
- Changes in blood glucose levels - The hormones estrogen and progesterone affect how your cells respond to insulin. After menopause, changes in your hormone levels can trigger fluctuations in your blood glucose levels. You may notice that your blood glucose is more variable or less predictable than before.
- Weight gain. Some women gain weight during perimenopause and after menopause. This can increase the need for insulin or oral diabetes medication.
- Infections. Even before menopause, high blood glucose levels can contribute to urinary and vaginal infections. After menopause — when a drop in estrogen makes it easier for bacteria and yeast to thrive in the urinary tract and vagina — the risk is even higher.
- Sleep problems. During perimenopause and after menopause, hot flashes and night sweats may keep you up at night. In turn, the sleep deprivation can make it tougher to manage your blood glucose.
- Sexual problems. Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of menopause, may compound the issue by causing pain during sex.
Diabetes and menopause: What you can do
Menopause may cause issues for your and you diabetes, but there's plenty you can do to try and stay as well as possible:
- Make healthy lifestyle choices - healthy foods and exercising regularly are probably already an important part of your diabetes management. If you can continue to maintain these things, you will feel much better.
- Measure your blood glucose more frequently - You may need to check your blood glucose more often than usual during the day, and occasionally during the night. Keep a record of your blood glucose readings and symptoms. You and your doctor may then use this information to adjust your diabetes management plan if needed, to try and stay as healthy as possible.
- Ask your doctor about adjusting your diabetes medications - If your HbA1c increases at this time of your life, you may need to increase the dosage of your diabetes medications or insulin, or begin taking a new medication. Likewise, if your average blood glucose level decreases, you may need to reduce the dosage of your diabetes medications or insulin - always seek help if things are confusing.
- Ask your doctor about cholesterol-lowering medication- If you have diabetes, you're already at increased risk of cardiovascular disease. The risk increases even more when you reach menopause. To reduce the risk, eat healthy foods and exercise regularly. Your doctor may recommend cholesterol-lowering medication as well and should keep a regular eye on this with your blood tests.
- Seek help for menopausal symptoms - If you're struggling with hot flushes, vaginal dryness, decreased sexual response or other menopausal symptoms, remember that there are things to help. For example, your doctor may recommend a vaginal lubricant to restore vaginal moisture or vaginal estrogen therapy to correct thinning and inflammation of the vaginal walls (vaginal atrophy). If weight gain is a problem, a registered dietitian can help you revise your meal plans. For some women, hormone therapy is an option.
Sometimes it is a matter of riding it out. Times of change in your body can be confusing and challenging. You can only do so much. Staying well and trying to be relaxed and pursue things in your life that make you happy, is probably the most important part of managing.
Who can help me if I have diabetes and sexual and reproductive health problems?
Speaking to a doctor about sexual and reproductive health problems is important for all women, and particularly for those who have diabetes as these problems are more common. Your doctor can also check for any other serious health conditions and talk about whether there are options to help. Your local doctor may also refer you to a specialist or sexual therapist if needed. Looking after your wellbeing and the way you feel about yourself is very important as many women with diabetes suffer mood swings and even depression. You can seek counselling around these issues with us as well - head here.