Diabetes affects many aspects of our physical and mental health. Sexual health is something that can be difficult to talk about and often people suffer in silence.
It is very important to address these problems as there are things that can help prevent and manage complications with sexual health. Most importantly issues with your sexual health can affect relationships. Your partner is vital to your overall wellbeing and diabetes management and 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 women’s sexual health. You can find out more about men’s sexual health here.
Many women with diabetes experience sexual problems although this is not often talked about. Although research about sexual problems in women with diabetes is limited, one study found 27 percent of women with type 1 diabetes experienced sexual dysfunction. Another study found 18 percent of women with type 1 diabetes and 42 percent of women with type 2 diabetes experienced sexual dysfunction. Women with diabetes are much more likely to experience recurrent bouts of thrush.
Sexual problems may include:
- decreased vaginal lubrication, resulting in vaginal dryness
- uncomfortable or painful sexual intercourse
- decreased or no desire for sexual activity
- decreased or absent sexual response
Decreased or absent sexual response can include the inability to become or remain aroused, reduced or no sensation in the genital area, and the constant or occasional inability to reach orgasm.
Causes of sexual problems in women with diabetes include nerve damage, reduced blood flow to genital and vaginal tissues, and hormonal changes. Other possible causes include some medications, alcohol abuse, smoking, psychological problems such as anxiety or depression, gynecologic infections, other diseases, and conditions relating to pregnancy or menopause.
Women who experience sexual problems or notice a change in sexual response should consider talking with a health care provider. The health care provider will ask about medical history, any gynecologic conditions or infections, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions.
The health care provider may ask whether the patient might be pregnant or has reached menopause and whether she is depressed or has recently experienced upsetting changes in her life. A physical exam and laboratory tests may also help pinpoint causes of sexual problems. The health care provider will also talk with the patient about blood glucose control.
Prescription or over-the-counter vaginal lubricants may be useful for women experiencing vaginal dryness. Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations.
Kegel exercises that help strengthen the pelvic muscles may improve sexual response. Studies of drug treatments are under way.
Menstrual Cycles, Contraception and Pregnancy
The menstrual cycle can affect blood glucose levels and many women with diabetes find that their levels are higher than normal at certain times in the cycle. During these days you may need to be extra careful about diet, exercise more than usual and/or increase insulin or medication with the advice of your doctor. If you are having problems around this time always seek input from your usual doctor or team.
If you are in the reproductive age, discuss the best method of birth control with your doctor also. Sometimes birth control pills may cause problems with your blood glucose and other methods (diaphragm, intrauterine device, cervical cap, condoms, etc.) may be a better solution for you. Not all women find birth control pills a problem.
If you have diabetes and wish to become pregnant, it is important to attempt optimal control of your blood glucose even before conception if possible. Sometimes women fall pregnant without planning it. In this case it is best not to worry and make an appointment to see your doctor ASAP.
Your medical team should follow you closely throughout your pregnancy and support you in adjusting your insulin/medications where necessary. Some women with diabetes have more complications during pregnancy and delivery than women without the disease. Babies often tend to be larger, and sometimes your Obstetrician will choose to deliver the baby a few weeks before your actual due date. You can find out more about pregnancy and diabetes on our “Diabetes and Pregnancy” pages.
Many women notice fluctuations in blood glucose at certain times in their monthly cycle, such as an increase in blood glucose a few days prior to the beginning of their period and then a decrease once the period begins. This increase usually occurs after ovulation and before menstruation.
Changes are due to two hormones, estrogen and progesterone. When these hormones are at their highest level just before your period, they affect another important hormone, insulin, which may, in turn, cause blood glucose to rise. Some women find their blood glucose rises considerably, while others do not notice a difference. In some women, blood glucose levels are lower before and during their periods. Each woman needs to discover her own pattern.
Often it is the fasting blood glucose before breakfast that tends to fluctuate the most in women with type 1 diabetes during the time just before a period begins. Adjusting your insulin often helps – speak with your doctor about how to manage this – insulin pumps can offer great flexibility for management of changes during the cycle. When your period begins and your blood glucose levels go down, readjust your insulin back to its former level.
If you have type 2 diabetes and do not take insulin, remember regular exercise can lower blood glucose, therefore it is important to maintain physical activity during this time of the month. Besides better blood glucose levels, you will likely have more energy and have fewer unpleasant side effects from menstruation if you can be active on a regular basis.
If you notice fluctuations in your blood glucose and are not sure if these are related to your menstrual cycle, it is easy to find out. In some kind of record book or online journal mark when you start your period each month and watch for a relationship between the two.
Some women suffer more from premenstrual syndrome (PMS) than other women. It does not seem to be related to the type of diabetes you have nor is it more common in diabetes. Women commonly experience moodiness, bloating, water retention and food cravings at this time. Food cravings for carbohydrates and fats combined with a reduction in activity may contribute to fluctuations in blood glucose.
Here are a few suggestions that may help to minimize food cravings:
Diabetes and menopause: What to expect (via Mayo Clinic)
Menopause is the phase of life after your periods have stopped. Diabetes and menopause may team up for varied effects on your body, including:
- Changes in blood glucose levels – The hormones estrogen and progesterone affect how your cells respond to insulin. After menopause, changes in your hormone levels can trigger fluctuations in your blood glucose levels. You may notice that your blood glucose is more variable or less predictable than before.
- Weight gain. Some women gain weight during the menopausal transition and after menopause. This can increase the need for insulin or oral diabetes medication.
- Infections. Even before menopause, high blood sugar levels can contribute to urinary and vaginal infections. After menopause — when a drop in estrogen makes it easier for bacteria and yeast to thrive in the urinary tract and vagina — the risk is even higher.
- Sleep problems. After menopause, hot flashes and night sweats may keep you up at night. In turn, the sleep deprivation can make it tougher to manage your blood sugar level.
- Sexual problems. Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of menopause, may compound the issue by causing pain during sex.
Diabetes and menopause: What you can do
Menopause can wreak havoc on your diabetes control! But there’s plenty you can do to better manage diabetes and menopause.
- Make healthy lifestyle choices. Odds are, healthy lifestyle choices — such as eating healthy foods and exercising regularly — are already an important part of your diabetes management. Healthy foods and regular physical activity can help you feel your best after menopause too.
- Measure your blood glucose frequently. You may need to check your blood glucose more often than usual during the day, and occasionally during the night. Keep a record of your blood glucose readings and symptoms. Your doctor may use the details to help you to adjust your diabetes management plan as needed. Your doctor may also recommend regular hemoglobin A1C testing to reflect your average blood sugar level for the two- to three- month period before the test.
- Ask your doctor about adjusting your diabetes medications. If your average blood glucose level increases, you may need to increase the dosage of your diabetes medications or begin taking a new medication — especially if you gain weight or reduce your level of physical activity. Likewise, if your average blood glucose level decreases, you may need to reduce the dosage of your diabetes medications.
- Ask your doctor about cholesterol-lowering medication. If you have diabetes, you’re at increased risk of cardiovascular disease. The risk increases even more when you reach menopause. To reduce the risk, eat healthy foods and exercise regularly. Your doctor may recommend cholesterol-lowering medication as well.
- Seek help for menopausal symptoms. If you’re struggling with hot flashes, vaginal dryness, decreased sexual response or other menopausal symptoms, remember that treatment is available. For example, your doctor may recommend a vaginal lubricant to restore vaginal moisture or vaginal estrogen therapy to correct thinning and inflammation of the vaginal walls (vaginal atrophy). If weight gain is a problem, a registered dietitian can help you revise your meal plans. For some women, hormone therapy is an option.
Diabetes and menopause is a twin challenge. Work closely with your doctor to ease the transition.
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 lifestyle changes or other ways to control your blood glucose levels.
Your local doctor may also refer you to a specialist or sexual therapist if needed. 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.
Bladder Problems – in men and women
Many events or conditions can damage nerves that control bladder function, including diabetes and other diseases, injuries, and infections. More than half of men and women with diabetes have bladder dysfunction because of damage to nerves that control bladder function. Bladder dysfunction can have a profound effect on a person’s quality of life. Common bladder problems in men and women with diabetes include the following:
Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include
- urinary frequency—urination eight or more times a day or two or more times a night
- urinary urgency—the sudden, strong need to urinate immediately
- urge incontinence—leakage of urine that follows a sudden, strong urge to urinate
Poor control of sphincter muscles.
Sphincter muscles surround the urethra—the tube that carries urine from the bladder to the outside of the body—and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when a person is trying to release urine.
For some people, nerve damage keeps their bladder muscles from getting the message that it is time to urinate or makes the muscles too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. If urine remains in the body too long, an infection can develop in the kidneys or bladder. Urine retention may also lead to overflow incontinence—leakage of urine when the bladder is full and does not empty properly.
Diagnosis of bladder problems may involve checking both bladder function and the appearance of the bladder’s interior. Tests may include x rays, urodynamic testing to evaluate bladder function, and cystoscopy, a test that uses a device called a cystoscope to view the inside of the bladder.
Treatment of bladder problems due to nerve damage depends on the specific problem. If the main problem is urine retention, treatment may involve medication to promote better bladder emptying and a practice called timed voiding—urinating on a schedule—to promote more efficient urination. Sometimes people need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine.
Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications, strengthening muscles with Kegel exercises, or surgery can help. Treatment for the urinary urgency and frequency of overactive bladder may involve medications, timed voiding, Kegel exercises, and surgery in some cases.
Urinary Tract Infections
Infections can occur when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections. Symptoms of urinary tract infections can include
- a frequent urge to urinate
- pain or burning in the bladder or urethra during urination
- cloudy or reddish urine
- in women, pressure above the pubic bone
- in men, a feeling of fullness in the rectum
If the infection is in the kidneys, a person may have nausea, feel pain in the back or side, and have a fever. Frequent urination can be a sign of high blood glucose, so results from recent blood glucose monitoring should be evaluated.
The health care provider will ask for a urine sample, which will be analyzed for bacteria and pus. Additional tests may be done if the patient has frequent urinary tract infections. An ultrasound exam provides images from the echo patterns of sound waves bounced back from internal organs. An intravenous pyelogram uses a special dye to enhance x-ray images of the urinary tract. Cystoscopy might be performed.
Early diagnosis and treatment are important to prevent more serious infections. To clear up a urinary tract infection, the health care provider will probably prescribe antibiotic treatment based on the type of bacteria in the urine. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids will help prevent another infection.
Who is at risk for developing sexual and urologic problems of diabetes?
Risk factors are conditions that increase the chances of getting a particular disease. The more risk factors people have, the greater their chances of developing that disease or condition. Diabetic neuropathy and related sexual and urologic problems appear to be more common in people who
- have poor blood glucose control
- have high levels of blood cholesterol
- have high blood pressure
- are overweight
- are older than 40
- are physically inactive
Can diabetes-related sexual and urologic problems be prevented?
People with diabetes can lower their risk of sexual and urologic problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their health care provider recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease.
At the end of the day sexual and urological health are one part of a lifelong management plan for diabetes. As with all parts of this, a healthy and happy lifestyle is the best way to ensure your health, wellbeing and quality of life. Always seek help and support where needed, for any issue that is worrying you.