There are two myths about sex and diabetes: Men with the disease are fated to develop erectile dysfunction (ED), while women with diabetes suffer few, if any, sexual effects. Both are wrong. Diabetes can impair sex in both men and women, but people with the condition can also enjoy great sex despite diabetes.
Sex Problems In Diabetic Men
Almost as soon as men get diagnosed with diabetes, they begin hearing dire warnings about their high risk of ED. In a classic case of self-fulfilling prophecy, the anxiety this engenders can cause the problem. Diabetes may, indeed, impair erection. But ED is by no means inevitable, and if it occurs, several safe, effective treatments are available. With the right treatment, any diabetic man can enjoy satisfying sex.
Syracuse University researchers reviewed 23 studies of erection impairment in diabetic men. Their conclusion: About 30 percent suffer severe ED, about twice the risk of nondiabetic men, but these findings also show that men with diabetes are not fated to develop ED.
There are two causes of erection impairment in diabetic men: cardiovascular complications (atherosclerosis) and nerve damage (neuropathy). Diabetes accelerates arterial clogging, which reduces erection-producing blood flow into the penis. And neuropathy damages the nerves involved in erection.
Risk factors for diabetic ED include:
• Duration of diabetes. Cardiovascular disease and neuropathy develop over time. The longer you've had the disease, the greater your risk. ED is more likely in men diagnosed with type 1 diabetes in childhood or young adulthood than in men diagnosed with type 2 diabetes later in life.
• Other diabetic complications. Men with other complications, especially cardiovascular disease, are more likely to develop ED.
• Use of blood pressure medication. One side effect of many blood pressure medications is erection impairment.
• Obesity. It’s associated with cardiovascular disease.
• Smoking. It accelerates the development of cardiovascular disease.
If you suffer diabetic erection impairment, don’t despair. Today, numerous treatment options can help:
• First, see your doctor. Your physician can review your medications to see if they have erection-impairing side effects, and test for hormone imbalances that might cause problems. Doctors can also prescribe erection medications. The drugs work best in men whose ED is related to cardiovascular disease. But if you’re taking nitrate drugs to manage angina, you cannot take erection medication. The drugs don’t help men whose erection difficulties stem from neuropathy. You might also ask your doctor about drugs derived from a traditional aphrodisiac, the African yohimbe plant: Yocon, Yohimbine, and Aphrodyne. They’ve received much less media attention than Viagra, Levitra, and Cialis, but they’re FDA-approved and may help.
• Next, consult a sex therapist. Compared with doctors, sex therapists are generally better informed about all the possible causes of erection impairment, including its psychological dimensions, among them: depression, relationship problems, and anxiety caused by worrying about the sex-impairing effects of diabetes. Sex therapy enjoys considerable success helping diabetic men. The therapist works with both partners, teaching the couple to adopt a more communicative, more sensual, whole-body, massage-oriented approach to lovemaking. Treatment typically takes a few months of weekly or biweekly sessions. To find a sex therapist near you, contact the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology. Sex therapy usually costs about $100 to $200 an hour. Health insurance may or may not cover it. Check your policy.
• Vacuum constricting devices. These gadgets create a partial vacuum around the penis that draws blood into the organ, resulting in temporary erection. Models differ, but all include a plastic tube that fits over the penis fitted with a squeeze-bulb pump. Squeezing the bulb evacuates the air from the tube and draws blood into the penis. Once men raise erections, they slip rubber rings over their erections to compress the veins that drain blood from the penis. This helps maintain the erection. One recent study evaluated the effectiveness of vacuum constricting devices in 21 men—six with diabetes. Seventeen (81 percent) reported full erections or semi-erections sufficient for intercourse. Sex toy catalogs offer several models, but for best results, urologists can help you obtain custom-fitted devices.
• Surgery. If your ED is more the result of cardiovascular than neurological complications, a penile artery bypass can improve blood flow into your penis. Similar to bypass heart surgery, the surgeon removes a piece of unclogged artery from somewhere else in your body, and uses it to construct a detour around the blockage in your penile artery. Two newer surgical procedures—aortoiliac reconstruction and dorsal vein arterialization—also increase penile blood flow. One evaluation showed that after recovery from penile surgery, about half of men can raise erections either from lovemaking alone, or a from combination of lovemaking and medication or vacuum devices.
Sex Problems in Diabetic Women
So little is written about the effects of diabetes on women’s sexuality that you’d think the disease has none. But it does. Its effects in women are more subtle than those in men. Nonetheless, they are quite real, and deserve more attention than they receive.
The main problem is vaginal dryness. Production of natural vaginal lubrication depends on healthy blood flow into the vaginal wall. Just as diabetes-related cardiovascular disease reduces blood flow into the penis, it does the same to vaginal blood flow. The solution is a commercial lubricant available over-the-counter at pharmacies—look near the condoms.
Neuropathy in diabetic women can reduce clitoral responsiveness to erotic touch, impairing ability to enjoy erotic touch and have orgasms. Lubricants may also help this problem by increasing sensitivity to touch. Another way to increase clitoral stimulation is to use a vibrator. Any vibe may help, but plug-in models are more powerful and offer the most intense stimulation, for example, the Hitachi Magic Wand. Vibrators are available at some pharmacies and through sex toy catalogues.
El-Bahrawy, M. et al. “Noninvasive Vacuum Constriction in the Management of Erectile Dysfunction,” International Journal of Urology and Nephrology (1995) 27:331.
Weinhardt, LS and MP Carey. “Prevalence of Erectile Disorder Among Men with Diabetes Melllitus: Comprehensive Review,” Journal of Sex Research (1996) 33:205.
DePalma, R.G. et al. “Vascular Interventions for Impotence: Lessons Learned,” Journal of Vascular Surgery (1995) 21:576.