Sexual dysfunction is more common than you think among people with diabetes. In fact, approximately 50% of people with diabetes experience some type of this disorder.
Janis Roszler, RD, CDE, LDN, and Donna Rice, MBA, BSN, RN, CDE, authors of ADA’s new book Sex and Diabetes: For Him and For Her, answer some of the most common questions on the topic.
What concerns should I have about taking medications for erectile dysfunction?
Pills such as Viagra, Levitra, and Cialis are effective in 50-60% of all men with diabetes. They are generally well tolerated. Occasional side effects include back pain and blue tinge to vision. There have been rare reports of permanent vision loss due to clotting of a blood vessel to one eye. Note that if you’re taking nitroglycerin or any other nitrate-containing medicine oral erectile dysfunction medications, are not recommended. Talk to your provider about which ED treatment is best for you. You may want to research alternative ED solutions, for example: injections, suppositories, and devices such as constriction bands and vacuum pumps.
I experience vaginal dryness the makes sex with my partner difficult. What should I do?
Nerves that tell the body to release lubricant into the vaginal area can become damaged if you have diabetes. In addition, vaginal dryness occurs after menopause in many women. The solution? There are many brands of water-based lubricants on the market to replace the lubrication you lack. If you plan to become pregnant, however; review your lubricant choice with your pharmacist or obstetrician. Certain brands may damage sperm and reduce your ability to conceive. In certain post-menopausal women, estrogen supplementation can help reduce vaginal dryness, but discuss the risks and benefits of estrogen use with your doctor.
How does diabetes affect sexual libido and the ability to orgasm in women? I'm not able to have orgasms although I do enjoy sex with my partner.
Problems with libido and orgasm seem to be more common in women with diabetes. First, focus on normalizing your blood sugar level and maintaining a healthy blood pressure. You may need more time or stimulation to become aroused. Communicate with your partner --- more romance, cuddling, and foreplay are in order, and planning ahead helps. Create moments that enable you and your partner to relax and enjoy each other.
Are there cautions or issues around taking birth control medications?
Oral contraceptives that contain high doses of estrogen and progestin are associated with an increased risk of complications such as high blood pressure and blood clots. Pills that contain less than 35 mg. estrogen are generally recommended, and in general are safe for women with diabetes.
Depo-Provera shots can cause menstrual irregularities, an increase in lipids, and insulin resistance. If you chose to use this, you may need to adjust your diabetes medication doses. Other devices, including the diaphragm, condoms, intra-uterine devices, and cervical caps should not affect your diabetes control.
Have your health care provider help you and your partnerchoose a contraceptive method or combination of methods to fit your lifestyle and be compatible with your diabetes. If you do ultimately plan to start a family, it’s important to plan pregnancy so that you get your diabetes under the best control possible before you stop using contraception. In addition, some diabetes medications need to be changed if the woman becomes pregnant.
Should I remove my insulin pump before having sex?
This is a personal decision. Some people find that removing the pump frees them to respond more enthusiastically during intimate activity - a pump can be safely removed for about 45 minutes to an hour. Others leave the pump on and just move it out of the way. If you remove your pump, check your blood glucose level when you reconnect the pump and take a correction dose as needed. If a pump is accidentally pulled out during sexual activity, it isn't harmful, even if some blood appears at the infusion site. Couples should do what feels right for them.
