Diabetes affects 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 might help. 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 men's sexual health. You can find out more about women's sexual health here.
Men, diabetes and sexual health
( From Andrology Australia http://www.andrologyaustralia.org/docs/Factsheet_Diabetes_08.pdf)
Men with diabetes are at greater risk of sexual and reproductive health problems including:
- Erectile problems
- Testosterone (or androgen) deficiency
- Lack of libido (sexual desire)
- Retrograde ejaculation (semen flows back into the bladder)
- Balanitis (inflammation of the head of the penis)
Diabetes and Erectile Dysfunction
What is erectile dysfunction?
Erectile dysfunction means that a man can not get or keep an erection that allows sexual activity with penetration. Erectile problems are not a disease, but a symptom of some other problem, either physical, psychological or a mixture of both.
How common is erectile dysfunction in men with diabetes?
Very common. Estimates suggest that up to four in every five men with diabetes will experience erectile problems, and they are twice as likely to have erectile problems as men without diabetes. Age also increases the risk of getting both diabetes and erectile dysfunction. Often erectile problems develop after a man has had diabetes for several years.
How can diabetes cause erectile dysfunction?
Diabetes can cause erectile problems by:
- Reducing blood flow to the penis or by affecting the function of blood vessels in the penis, making it more difficult for a man to get and/or keep an erection. This is more common in men with high blood pressure and high cholesterol, conditions both linked with diabetes.
- Damaging the nerves in the penis, which are essential for erections to happen.
- Lower levels of testosterone (the male sex hormone).
- Some men with diabetes can have erectile problems as a result of psychological issues, including performance anxiety, and not as a direct result of the diabetes, which is a common problem for men in general.
Can erectile dysfunction be prevented in men with diabetes?
Erectile problems are more likely to happen when your blood glucose levels are not staying in target. Trying to maintain blood glucose and blood lipids (cholesterol and triglyceride) in the target ranges for people with diabetes is important to help prevent nerve and blood vessel damage to the penis. This can be easier said than done, and sometimes this happens, despite your best efforts. Diabetes is a very difficult condition to manage.
Sometimes no matter what you do, your blood glucose levels can be challenging. Get as much support as possible to work through these times. Remember it is not your fault. Worrying about your diabetes and sexual problems together, is a recipe for high distress. Seek counselling and help to work out what you can and can't change.
Not smoking and limiting alcohol intake may also help make erectile problems less likely, and are things you can change.
How is erectile dysfunction treated in men with diabetes?
It is important to stay as healthy as possible. This includes staying on track with your diabetes as far as possible, and managing any other health conditions such as high blood pressure, first. When your blood glucose levels are going well already, most doctors will start treatment for erectile problems with oral medications (PDE5 inhibitors) such as Viagra®, Cialis® or Levitra®. These tablets work in about half of men with diabetes. New research has shown that for men with diabetes and erectile problems, taking a low dose of these medications everyday can have better results. If oral medications do not work well, other treatments can be given and include vacuum devices, penile injections and surgery. Always seek help from your doctor as there are options to help.
Talk about it
One of the biggest issues many men experience in relation to erectile dysfunction is the fear of seeking help or talking about the problem. Many men and indeed their partners, suffer in silence. This creates problems for your relationship, and can lead to issues with your self-esteem and wellbeing. It is important to talk about it. When you do you will find there are things that can be tried to make a difference.
There is nothing to be ashamed about.
In many cases just being able to let go of some of the stress and anxiety that builds up around erectile dysfunction makes a difference.
If the problems are ongoing, there are also ways of having a loving relationship, despite this. Counselling can help you to work out ways of dealing with the problems and working on having happy and fulfilling partnership.
Diabetes and testosterone deficiency
What is testosterone deficiency?
Testosterone (or androgen) deficiency is when the body is unable to produce enough testosterone to function normally. Testosterone is the most important androgen (or male sex hormone) in men and plays a key role in reproductive and sexual function. Testosterone is also important for the good health of many non reproductive tissues in the body. It plays an important role in the growth of bones and muscles, and affects mood, sex drive and certain aspects of mental ability.
What are the signs of testosterone deficiency?
The signs of testosterone deficiency are different depending on what age you are when testosterone levels fall below the normal range. Many of the symptoms and signs are not specific and may happen with other medical illnesses too - which can make it tricky. In adult men, the symptoms of testosterone deficiency include mood changes, poor concentration, low energy, decreased libido, and reduced body hair growth.
How can diabetes cause testosterone deficiency?
Production of testosterone is affected by type 2 diabetes. Testosterone production is triggered by luteinizing hormone (LH) in the brain. High blood glucose levels in men with diabetes can reduce the amount of LH released, which may then lower testosterone levels. Obesity can also result in low testosterone levels.
Worrying that this is your fault is unhelpful. It is never your fault.
Managing diabetes is complex and not always possible. Being overweight is also a very complicated thing and losing weight when you have diabetes can be hard.
Seek support around these things. Even a small weight loss can have benefits.
There are often things that can help in lowering your blood glucose, but this does not mean you will not have up and down days.
Can testosterone deficiency be prevented in men with diabetes?
Staying as healthy as possible and exercising regularly can help improve tosterone levels.
How common is testosterone deficiency in men with diabetes?
Testosterone deficiency is common in men with diabetes and about one in three men with type 2 diabetes have low serum testosterone levels. Men with type 2 diabetes are more likely to have low testosterone levels if they are also obese.
How is testosterone deficiency treated in men with diabetes?
If you have testosterone deficiency you need to seek help from your doctor to see if there are any changes that can be made, and if you have any other health conditions first - because once you do, your hormone levels may return to normal and testosterone therapy may never be needed.
Get help to try and lose some weight if you are overweight or obese. A dietitian, exercise physiologist and even a counsellor, can be helpful in this, because losing weight is not as easy as it sounds, and keeping it off can be even harder.
However, for men with diabetes and low testosterone levels caused by genetic problems or other conditions, testosterone therapy can be used to return testosterone levels in to normal. The available forms of treatment are testosterone injections, implants, oral capsules, skin patches, creams and gels.
Diabetes and lack of libido
What is lack of libido?
Lack of libido means a lack of interest in sexual activity. Libido (sexual desire) is a complex condition produced by a combination of biological, personal and relationship factors.
How can diabetes cause lack of libido?
Low testosterone levels can cause lack of libido, therefore some men with diabetes and low testosterone levels may have a lower libido. Psychological problems are also a common cause of lack of libido. In men with diabetes and erectile problems, the psychological impact of sexual dysfunction may also lower their interest in sexual activity. Depression is another major cause, so counselling is a very important part of the picture.
How is lack of libido treated in men with diabetes?
As with other sexual health problems, staying as healthy as possible is always the first management option for low libido. When you are at your healthiest and feel positive about your life, you are more likely to be interested in sex and enjoy a healthy relationship with your partner. Sometimes taking the pressure off yourself and your partner, and finding other ways to be intimate for a time, can reduce this pressure as well.
Men who have lack of libido due to testosterone deficiency diagnosed by a doctor may need testosterone replacement. In addition, it is important that a doctor checks for any other possible underlying physical or psychological causes.
Often, lack of libido in men with diabetes can hide a desire for more non-sexual intimacy and sharing. Individual or couple counselling can be helpful in identifying and addressing any issues to improve sexual desire, and other ways of being close to your partner.
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 men, 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 any new management options for your diabetes. Your local doctor may also refer you to a specialist or for counselling. Looking after your wellbeing and the way you feel about yourself is very important as many men with diabetes suffer mood swings and even depression. Remember that these are common problems, with many different solutions, that is is never your fault, and you should never feel ashamed to speak up and ask for help.