It's easy to pin a lagging libido on stress, depression, age, or lack of sleep. But if your sexual feelings have changed or if intercourse has become uncomfortable or nearly impossible, either as a result of chronically high blood glucose levels (an occasional high level will not cause long-term problems) or nerve problems, diabetes could be the cause.
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Experts estimate that 75 percent of men and 35 percent of women with diabetes experience some sexual problems due to diabetic neuropathy (nerve damage) to the nerves that stimulate normal sexual response.
The good news: Research has shown that people can lower their risk for diabetes-related sexual problems by taking steps to control their diabetes, including:
controlling blood glucose.
lowering blood pressure.
lowering triglyceride levels.
The Diabetes Control and Complications Trial (DCCT), a 10-year National Institutes of Health study of individuals with type 1 diabetes, found that improved diabetes control decreased the risk of developing neuropathy by 60 percent. This means the steps you can take to manage your diabetes are the same keys that open the doors to a healthy sexual relationship.
Women with diabetes may find it difficult to stimulate lubrication, experience orgasm, or even feel sexual desire due to nerve damage. These steps can reduce sexual complications and increase pleasure.
Get rid of dryness: For persistent vaginal dryness, purchase a water-base vaginal lubricant over the counter from any pharmacy. You might also work on relaxing the muscles around the vagina with Kegel exercises: contracting your pelvic muscles to control the flow of urine.
Lose weight: Being overweight can contribute to low self-esteem and loss of libido. A recent Duke University study found that shedding weight (17.5 percent of body weight) helped obese men and women feel better about sex than they had previously. To lose weight, get help from a registered dietitian or participate in a healthful weight-loss program.
Reduce stress: Stress can also inhibit sexual desire. Remove as many stressors from your life as possible. To better handle unavoidable stress, consider taking up a yoga or meditation class to reduce anxiety and provide calm.
Treat depression: Talk to your health-care provider about being screened for depression if you've been feeling low and have had little interest or pleasure in sex or other activities for more than a couple of weeks. Depression can also lead to difficulty with sex and/or loss of pleasure.
Like women, men can experience a drop in libido due to weight gain or depression, but the most common sexual complication for men with diabetes is erectile dysfunction (ED), the inability to achieve or maintain a satisfactory erection for sexual intercourse. Many men with diabetes develop ED because of a testosterone deficiency, which can be detected by a simple blood test.
There are many different causes of ED besides diabetes, including stress, high blood pressure, excess alcohol intake, and depression. So it's a good idea to consult your doctor to rule out or treat other causes.
ED treatments vary, and there are many products available, including:
prescription medications (such as Viagra, Cialis, or Levitra)
penile constriction rings.
penile sleeves, vacuum pumps, injections, suppositories, and surgical implants.
Before you invest in a solution, find out if it's proven to work, then see if your health insurance will cover it. Ask your doctor or pharmacist for recommendations.
Despite the sexual problems you may be experiencing, remember that it takes two to tango. Talk to your partner about your concerns. You may want to meet with a relationship counselor to learn how to communicate more effectively and resolve any issues that may be standing in the way of enjoying a healthy sexual relationship.
What About an Aphrodisiac?
There's a lot of hype about aphrodisiacs -- foods with properties that supposedly stimulate sexual desire. Many experts believe aphrodisiacs have a placebo effect -- they work because we believe in them. The very idea of aphrodisiacs may be stimulating enough.
"Just thinking about food can cause a person to salivate," says Alan R. Hirsch, M.D., FACP, founder and neurological director of the Smell & Taste Treatment and Research Foundation in Chicago. What happens with food and appetite can happen with thoughts and sexual arousal, he says. "Thinking or dreaming about sex can begin the arousal process," Hirsch says.
The bottom line: The most powerful sex organ is your brain. If you believe a food will get you in the mood, try it! Just keep in mind how the food may affect your health. For example, dark chocolate may boost serotonin, a hormone that improves mood, but it's high in calories and will raise blood glucose levels, so make a little go a long way.
While it's difficult to discuss sexual issues, it's important to share them with your doctor because they may indicate other health problems, such as depression or high blood pressure. Plus you may discover a good solution and get your sex life back on track.
At your next visit, make it a point to list problems with your sex life right off the bat, before your nerves get the best of you and while there's plenty of time to tackle treatment options. Not sure how to bring it up? Try rehearsing one of these openers:
"Doctor, I have something personal to discuss."
"I was wondering: Can my diabetes affect my performance in the bedroom?"
"I'm having some problems enjoying romance/intimacy."
For more help on understanding or improving your sex life, visit:
AASECT (aasect.org), the official Web site for the American Association of Sexuality Educators, Counselors, and Therapists.
Dear Janis (dearjanis.com), an interactive Web site with Janis Roszler.
His and Her Health (hisandherhealth.com), which provides good information on both male and female sexual concerns.
Urology Health (urologyhealth.org), the official Web site of the American Urological Association.
Janis Roszler, R.D., CDE, LDN, wrote The Secrets of Living and Loving with Diabetes (Surrey Books, 2004) and Sex and Diabetes (American Diabetes Association, 2007).