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 men’s sexual health. You can find out more about women’s sexual health here.
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Men, diabetes and sexual health

( from Andrology Australia http://www.andrologyaustralia.org/docs/Factsheet_Diabetes_08.pdf)

Men with diabetes are at greater risk of sexual and reproductive health problems including:

  • Erectile problems
  • Testosterone (or androgen) deficiency
  • Lack of libido (sexual desire)
  • Retrograde ejaculation (semen flows back into the bladder)
  • Balanitis (inflammation of the head of the penis)

Diabetes and Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction is when a man is unable to get or keep an erection that allows sexual activity with penetration. Erectile problems are not a disease, but a symptom of some other problem, either physical, psychological or a mixture of both.

How common is erectile dysfunction in men with diabetes?

Estimates suggest that up to four in every five men with diabetes will experience erectile problems and they are twice as likely to have erectile problems as men without
diabetes. Age also increases the risk of getting both diabetes and erectile dysfunction. Often erectile problems develop after a man has had diabetes for several years.

How can diabetes cause erectile dysfunction?

Diabetes can cause erectile problems by:
··Reducing blood flow to the penis or by affecting the function of blood vessels in the penis, making it more difficult for a man to get and/or keep an erection. This is more common in men with high blood pressure and high cholesterol, conditions both linked with diabetes.
··Damaging the nerves in the penis, which are essential for erections to happen.
··Lower levels of testosterone (the male sex hormone).
Some men with diabetes can have erectile problems as a result of psychological issues, including performance anxiety, and not as a direct result of the diabetes, which is a common problem for men in general.

Can erectile dysfunction be prevented in men with diabetes?

Erectile problems are more likely to happen when blood glucose levels are poorly controlled. Keeping blood glucose and blood lipids (cholesterol and triglyceride) in the
normal range is important to prevent nerve and blood vessel damage to the penis. Not smoking and limiting alcohol intake may also help make erectile problems less likely.

How is erectile dysfunction treated in men with diabetes?

It is important to manage the diabetes and any other associated conditions, such as high blood pressure, first. When diabetes is properly controlled, most doctors start treatment for erectile problems with oral medications (PDE5 inhibitors) such as Viagra®, Cialis® or Levitra®. The tablets work in about half of men with diabetes.  New research has shown that for men with diabetes and erectile problems, taking a low dose of these medications everyday has better results. If oral medications do not work well, other treatments can be given and include vacuum devices, penile injections and surgery.

One of the biggest factors with erectile dysfunction is the fear of seeking help or talking about the problem. Many men and indeed their partners, suffer in silence. This creates problems for the relationship and for the man in terms of self esteem and wellbeing. It is important to talk about it. When you do you will find there are things that can be tried to make a difference.

In many cases being able to let go of some of the stress and anxiety that builds up around erectile dysfunction makes a difference alone. There are also ways of having a loving relationship despite this problem. Counselling can help you to work out ways of dealing with the problem and working on having  happy and fulfilling partnership.

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Diabetes and testosterone deficiency

What is testosterone deficiency?

Testosterone (or androgen) deficiency is when the body is unable to produce enough testosterone for the body to function normally.Testosterone is the most important androgen
(or male sex hormone) in men and plays a key role in reproductive and sexual function. Testosterone is also important for the good health of many non reproductive tissues in the
body. It plays an important role in the growth of bones and muscles, and affects mood, sex drive and certain aspects of mental ability.

What are the features of testosterone deficiency?

The signs of testosterone deficiency are different depending on the age when testosterone levels fall below the normal range. Many of the symptoms and signs are not specific and may happen with other medical illnesses. In adult men, the symptoms of testosterone deficiency include mood changes, poor concentration, low energy, decreased libido, and reduced body hair growth.

How can diabetes cause testosterone deficiency?

Production of testosterone is affected by type 2 diabetes. Testosterone production is triggered by luteinizing hormone (LH) in the brain. High blood glucose levels in men with diabetes can reduce the amount of LH released, which may then lower testosterone levels. Obesity, which is often linked with type 2 diabetes, may itself result in low testosterone levels.

Can testosterone deficiency be prevented in men with diabetes?

Modifying lifestyle to control blood glucose levels by maintaining a healthy weight and regular exercise may improve testosterone levels.

How common is testosterone deficiency in men with diabetes?

Testosterone deficiency is common in men with diabetes and about one in three men with type 2 diabetes have low serum testosterone levels. Men with type 2 diabetes are more likely to have low testosterone levels if they are also obese.

How is testosterone deficiency treated in men with diabetes?

Men with diabetes and testosterone deficiency should get treatment for the diabetes and other illnesses first as hormone levels may return to normal and testosterone therapy may never be needed. They should be advised to lose weight if they are overweight or obese. However, for men with diabetes and low testosterone levels caused by genetic disorders or other conditions, testosterone therapy can be given to return testosterone levels in the blood to normal. The available forms of treatment are testosterone injections, implants, oral capsules, skin patches, creams and gels.

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Diabetes and lack of libido

What is lack of libido?

Lack of libido is the term used to describe a lack of interest in sexual activity. Libido (sexual desire) is a complex condition produced by a combination of biological, personal and relationship factors.

How can diabetes cause lack of libido?

Low testosterone levels can cause lack of libido, therefore some men with diabetes and low testosterone levels may have a lower libido. Psychological problems are also a common cause of lack of libido. In men with diabetes and erectile problems, the psychological impact of sexual dysfunction may also lower their interest in sexual activity. Depression is another major cause.

How is lack of libido treated in men with diabetes?

Managing and controlling diabetes should be the first treatment option for men with diabetes and low libido to help improve feelings of sexual desire. Men who have lack of libido due to testosterone deficiency diagnosed by a doctor may need testosterone replacement. In addition, it is important that a doctor checks for any other possible underlying physical or psychological causes. Often, lack of libido in men with diabetes can hide a desire for more non-sexual intimacy and sharing. Individual or couple counselling can be helpful in identifying and addressing any issues to improve sexual desire.

Diabetes and retrograde ejaculation

What is retrograde ejaculation?

During ejaculation, semen is propelled forward through the urethra (the tube that runs from the bladder to the end of the penis) and out through the tip of the penis. Retrograde ejaculation happens when semen passes backwards through the bladder neck and into the bladder. As a result, little or no semen is discharged from the penis during ejaculation, and the first urination after sex looks cloudy as the semen mixes with the urine. It is not a harmful condition and does not need treatment, unless trying to father a child. In this situation, speaking to a fertility specialist should be considered.

How can diabetes cause retrograde ejaculation?

Retrograde ejaculation in men with diabetes may be caused by nerve damage to the muscle (external sphincter muscle) that opens and closes the bladder neck. High levels of blood glucose can damage the nerve and muscles of the sphincter, and the sphincter muscle may not close completely to stop semen from going back into the bladder.

How is retrograde ejaculation treated?

Controlling blood glucose levels and making lifestyle changes may improve retrograde ejaculation when it is a result of diabetes. Most men who have retrograde ejaculation do not need treatment. However, if men are trying to conceive, couples may need to seek assisted reproductive technologies.

Diabetes and balanitis

What is balanitis?

Balanitis is a very common inflammation of the glans penis (head of the penis) that can affect males at any age.

What are the signs of balanitis?

Some of the signs of balanitis are:

  • Inability to pull back the foreskin
  • Itchiness
  • Rash
  • Redness or swelling
  • Discharge from the penis

How can diabetes cause balanitis?

In men with diabetes, some urine may become trapped under the foreskin after urinating. The combination of a moist area and glucose in the urine can lead to bacteria growing and then infection (balanitis).

How is balanitis treated in men with diabetes?

If a man has diabetes and balanitis, antibiotics or antifungal medication may help clear up the infection. Washing the penis and under the foreskin with soap and warm water may
also help. It is also important to speak to your doctor about controlling blood glucose levels.

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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:

Overactive bladder.
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.

Urine retention.
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.

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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
  • smoke
  • 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.