It’s not often discussed, but diabetes can lead to sexual dysfunction in both men and women. Erectile dysfunction, decreased sex drive, a decline in fertility, and vaginal dryness may all result from damage to the small blood vessels and nerves caused by chronic hyperglycemia. The body’s sexual response depends on nerve signals that communicate with the brain and adequate blood flow, both of which can be compromised by high blood sugar.
If you have diabetes, one of the best ways to avoid or manage sexual dysfunction is to stay on top of your blood sugar levels as best as possible. Stable, healthy blood sugar can preserve nerve function and may stop symptoms from getting worse.
Poorly managed diabetes can lower feelings of sexual desire in both men and women. This can happen both in the short term and over a longer period of time. In males, chronically high blood sugar can lower testosterone, a hormone that directly impacts libido, says Justin Houman, MD, a urologist in private practice and an assistant professor of urology at Cedars-Sinai Medical Center in Los Angeles. Experts say men with diabetes are twice as likely to have low testosterone as men who don’t have blood glucose issues.
Dr. Houman says high blood sugar can also cause hormonal imbalances in women, reducing levels of testosterone and estrogen, which also plays a role in sex drive. “Fatigue from uncontrolled diabetes may also reduce interest in sex,” he adds.
Research suggests that men with type 2 diabetes are more than three times as likely to have erectile dysfunction (ED) as men without type 2 diabetes. ED, which is defined as the inability to get or maintain an erection during sex, is a common complication of diabetes.
“Erectile dysfunction (ED) is the most common sexual dysfunction in men, including those with diabetes,” says Sharon J. Parish, MD, a professor of medicine who specializes in sexual medicine at Weill Cornell Medical College in New York City. And, while ED becomes more likely in older age, men with diabetes tend to get ED 10 to 15 years earlier than men without diabetes.
Testosterone not only plays a role in libido but also in getting and maintaining an erection. When testosterone levels drop, men with and without diabetes often develop ED. But diabetes increases the risk of other complications that can contribute to ED.
For example, diabetes can accelerate the buildup of plaque in the arteries, a condition known as atherosclerosis. This causes the arteries to become narrower, which reduces blood flow to the penis and makes it more difficult to achieve and maintain an erection, says Houman.
In addition, some medications used by people with diabetes to treat related conditions can hinder erectile function, including beta-blockers, a class of high blood pressure drugs. Antidepressants, which are prescribed to many people with chronic conditions, also are linked to ED, says Houman.
Beyond those health and medication issues, other conditions may cause or contribute to erectile dysfunction, such as alcohol or drug abuse, smoking, and vascular disease. A healthcare provider can help you get to the root cause.
Treatments for ED
For men with diabetes, there’s a significant ED remedy at hand: better blood sugar control. If your ED is ultimately caused by hyperglycemia, your complications can be lessened or reversed if you can keep your blood sugar in a healthy range.
There are also many other treatments for erectile dysfunction. A doctor will likely first suggest a prescription oral medication known as a PDE5 inhibitor:
avanafil (Stendra)
sildenafil (Viagra)
tadalafil (Cialis)
vardenafil
If oral medication is ineffective or not tolerated, there are other options, including a medication called alprostadil that is either injected or inserted into the penis, as well as penis pumps or penile implants.
Beyond ED and low testosterone, there are other sexual complications in men with diabetes.
Retrograde Ejaculation
A complication in men whose diabetes has progressed, retrograde ejaculation occurs when some or all of a man’s semen goes into the bladder rather than exiting the tip of the penis. It’s not necessarily as uncomfortable as it sounds — you may not even realize you have it. Retrograde ejaculation is typically identified after a person notices how little semen is discharged during ejaculation. It can lead to fertility problems.
Like erectile dysfunction, retrograde ejaculation is caused by nerve damage from prolonged high blood sugar levels, says Houman. It can also be precipitated by prostate surgery and certain medications. If the condition is suspected, a urine sample is used to detect semen and diagnose retrograde ejaculation. There are both pharmaceutical and surgical treatments available.
Peyronie’s Disease
This condition, characterized by an extreme curvature of the penis, is common in men with poorly controlled diabetes. The hyperglycemia associated with diabetes appears to make Peyronie’s disease both more common and more severe. Peyronie’s disease often coexists with erectile dysfunction, and it can lead to physical pain and discomfort during sexual intercourse.
Women with diabetes also commonly experience sexual dysfunction, though the issues aren’t as well understood as men’s.
Research suggests that women with diabetes can experience the following sexual dysfunctions:
Reduction or loss of sexual interest or desire
Arousal difficulties or vaginal dryness
Loss of the ability to reach orgasm
Women with diabetes may also suffer from dyspareunia, which is discomfort or pain during intercourse, and recurrent yeast and urinary tract infections (UTIs), says Houman.
The causes of sexual dysfunction are essentially the same for women with diabetes as those for men, but sexual dysfunction in women may also be attributed to gynecologic infections, pregnancy-related issues, menopause, and other health problems, says Dr. Parish.
Treatment for Issues in Women With Diabetes
Hormone therapy, including vaginal estrogen, may relieve vaginal dryness and painful intercourse, and drugs like flibanserin (Addyi) and bremelanotide (Vyleesi) are approved by the U.S. Food and Drug Administration (FDA) to treat low sexual desire in premenopausal women. Other treatments and therapies that may help include:
Vaginal lubricants and moisturizers, which are available both over-the-counter and in prescription strength, can help with dryness
Learned techniques such as certain positions or stimulation during sexual interactions
Kegel exercises for stronger pelvic muscles to help with sexual response
Counseling to help manage any underlying anxiety, depression, or sexual performance worries
Researchers have suggested that sexual dysfunction in women may be more likely caused by social and psychological factors than the side effects of diabetes.As a result, women experiencing dissatisfaction in the bedroom may want to address distress, depression, or other mental health issues to improve their sex life.
Sexual issues related to diabetes can strain intimate relationships, so it’s important to communicate well with your partner.
“Open and honest discussions about sexual concerns can reduce stress and help find alternative ways to maintain intimacy,” Houman says.
He adds that mental health therapy or couples’ counseling can help facilitate these conversations and address anxiety, depression, or relationship stress that can make problems in the bedroom even worse.
It’s also helpful to remember that sexual dysfunction in diabetes is common and treatable. This may encourage you to seek solutions rather than withdraw from intimacy, Houman says.
Diabetes is a common cause of sexual dysfunction in both men and women due to poor blood flow, nerve damage, and hormonal imbalances.
For men, diabetes increases the risk of erectile dysfunction, retrograde ejaculation, and low testosterone. Women may experience low libido, painful intercourse, and difficulties with arousal and orgasm.
These conditions are treatable with blood sugar management, medical advice, prescription medications, and lifestyle adjustments that can restore sexual health and improve intimacy.
Improving communication with your partner can also help you deal with sexual dysfunction and strengthen your relationship.
