Mention “sex and diabetes” and those in the know immediately think of erectile dysfunction (ED). Compared with non-diabetic men, diabetics have three times the risk of ED. But diabetes’ effects on women’s sexuality have been less studied and less publicized. Fortunately, in recent years, that’s begun to change and a clearer picture of the disease’s substantial impact on women has emerged.

Sobering Statistics

From a public health perspective, diabetes is a major big deal. According to the federal Centers for Disease Control and Prevention, the disease now affects 26 million Americans—8 percent of the population, and 11 percent of adults. Rates are highest among African-Americans, Hispanics, and Native Americans.

In addition, pre-diabetes or “metabolic syndrome”—including blood sugar higher than normal but not quite diabetes—affects an astonishing 35 percent of adult Americans, some 79 million people. Half of American over 65 have pre-diabetes.

Diabetes substantially raises risk of several life-threatening conditions, notably heart disease, stroke, and kidney failure. It’s also a leading cause of blindness and foot and leg amputations. Diabetes care costs Americans $174 billion a year—$500 a year for every American.

Spilled Coke

Diabetes has two manifestations, Type 1 and 2. The former is an auto-immune condition that usually develops during childhood often after the flu. It knocks out the cells in the pancreas that produce the hormone insulin. To survive, Type 1 diabetics must inject insulin daily. But Type 1 accounts for just 5 percent of diabetes.

The rest—95 percent, 19 out of 20 diabetics—have Type 2. The pancreas makes sufficient insulin, but the body becomes “insulin resistant” and can’t use it properly, usually because of obesity. Some Type 2 diabetics can get off all drugs with substantial weight loss. Others control, the condition with a combination of diet, exercise, and medication. But some must inject insulin. Type 2 used to be called “adult onset diabetes,” but as obesity has affected increasing numbers of children, it can develop at any age.

Insulin allows the body’s main food, blood sugar (glucose), to move from the bloodstream into the cells. Type 2 diabetes disrupts the process, and blood levels of sugar become abnormally high.

Why does high blood sugar cause problems? Imagine spilling a Coke at the movies. What happens? The floor gets sticky. The same thing happens in the blood vessels. All that sugar makes the blood sticky, which gums up the circulatory system, especially the smallest blood vessels, the capillaries. When diabetes impairs the capillaries in the eye, the result is vision impairment and possibly blindness. Impaired capillaries in the lower legs may cause gangrene, possibly necessitating amputation. When diabetes affects the blood vessels in the heart and brain, risk of heart attack and stroke triples. And when diabetes impairs the nerves and blood vessels in the penis or clitoris/vulva/vagina, the result is sexual dysfunction.

As the duration and severity of diabetes increase, so do the number and severity of complications. Type 1 is usually diagnosed earlier in life than Type 2, so Type 1 diabetics generally develop complications at younger ages.

How Diabetes Affects Women’s Sexuality

  • Desire and/or arousal problems. In both men and women, sexual caresses open (dilate) the blood vessels of the genitals, increasing blood flow into the area and contributing to sexual desire and arousal. Diabetes interferes with both the nervous system’s ability to dilate these vessels, and the circulatory system’s ability to deliver extra blood. The result is difficulty with arousal and sexual function.
  • Vaginal dryness. When genital blood vessels dilate in women, some blood fluid (plasma) diffuses through the capillary walls into the vagina. That’s women’s natural vaginal lubrication. But in diabetic women, the blood vessels dilate less and the capillaries don’t function properly, so less plasma winds up in the vagina, and diabetic women are at higher risk of vaginal dryness.
  • Dryness makes sex less comfortable, and arousal difficulties make it less exciting. As a result, diabetes impairs women’s ability to have orgasms.

Iranian researchers surveyed 150 Type 2 diabetic women in their forties. Overall, 79 percent reported sex problems:

  • Desire problems: 50 percent
  • Arousal difficulties: 47 percent
  • Vaginal dryness: 50 percent
  • Orgasm difficulties: 42 percent

A Dutch study echoed these findings, showing that 70 percent of diabetic women report sex problems.

It’s not entirely clear how pre-diabetes affects women’s sexuality, but as blood glucose increases, so do risk of health issues, including sex problems.

Maintaining Sexual Function Despite Diabetes

If you’re a woman with diabetes or pre-diabetes, you are not fated to develop sex problems. The key is managing your condition by keeping your blood glucose as normal as possible.

In Type 1 diabetes, this involves self-testing several times a day and injecting different types of insulin depending on your diet and exercise profile. Work closely with an endocrinologist and a diabetes educator.

To best manage—or reverse—Type 2 diabetes, lose weight and keep it off through daily exercise and a low-calorie, low-fat diet. Eat at least five daily servings of fruits and vegetables, and cut way back on meats, cheeses, cream, cake, pastries, chips, and ice cream. Work up to exercising an hour a  day—walk, dance, bike, garden, housework, etc.

The studies in the References and others show that in Type 2 diabetes, daily exercise, weight loss, and a Mediterranean diet (lots of fruits and vegetables, little meat and dairy) help restore sexual function in both men and women. Italian researchers instructed 59 diabetic women to either live their lives as usual or adopt a Mediterranean diet. In the Mediterranean diet group, sexual function improved.

Here are some other ways to remain sexual despite diabetes:

  • Quit smoking. The combination of smoking and diabetes greatly increases blood-vessel damage. As soon as you quit, damaged blood vessels begin to recover.
  • Use a commercial lubricant (KY, Astroglide, etc.) available over the counter at pharmacies.
  • Use a vibrator. Vibrators intensify erotic sensation and may help compensate for diabetic genital nerve damage. Any vibe may help, battery-powered or plug-in, but plug-in models are more powerful (Hitachi Magic Wand). Vibrators are available at some pharmacies and through sex toy catalogues.
  • For desire/arousal problems, two recent books may help: A Tired Woman’s Guide to Passionate Sex (2009) by Laurie B. Mintz, Ph.D., a professor of psychology at the University of Florida, and Wanting Sex Again by sex therapist Laurie J. Watson (2012). Researchers surveyed 45 women complaining of low libido. Half worked through the program in A Tired Woman’s Guide. Among those who did not use the program, 5 percent reported increased desire, but among those who did, desire increased in 54 percent.
  • Consult a sex therapist. You don’t have sex with your therapist, nor do sex therapists watch you making love. Sex therapy is a form of talk-based psychotherapy with practitioners specially trained in sexual issues. Sex therapists guide individuals or couples to adopt a more communicative, more sensual, whole-body, massage-oriented approach to lovemaking. That helps compensate for diabetic sexual impairment. Therapy 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 $100 to $200 an hour. Health insurance may or may not cover it.  Check your policy. Some therapists have sliding scales.
  • Ask your physician for Viagra. Italian researchers assessed the sexual function of 32 women with Type 1 diabetes, then gave them Viagra (100 mg/day). After eight weeks, they reported greater arousal, more orgasms, and improved sexual satisfaction.
  • Ask your physician for a prescription for Addyi, a drug that boosts desire in some women.

Finally, in some men, erection problems are the first sign of diabetes, so it seems likely that the same is true for women. If you develop sexual difficulties for no apparent reason, especially if you’re overweight, ask your doctor to test you for diabetes.

References

Both, S. et al. “Sexual Response in Women with Type I Diabetes Mellitus: A Controlled Laboratory Study Measuring Vaginal Blood Flow and Subjective Sexual Arousal,” Archives of Sexual Behavior (2015) 44:1573.

Caruso, S. et al. “Sildenafil Improves Sexual Functioning in Premenopausal Women with Type 1 Diabetes Who Are Affected by Sexual Arousal Disorder: A Double-Blind Crossover, Placebo-Controlled Pilot Study,” Fertility and Sterility (2006) 85:1496

Elyasi, F. et al. “Sexual Dysfunction in Women with Type 2 Diabetes Mellitus,” Iranian Journal of Medical Science (2015) 40:206.

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