Heart to Heart Talk
Diabetes and sex
By Dr. Philip S. ChuaCebu Daily News
Does diabetes affect sexual function?
Yes. In men, diabetes mellitus can cause a varying degree of erectile dysfunction (inability to attain or sustain erection satisfactory for intercourse) as the diabetes progresses. Most of the time, however, the exaggerated and unfair condemnation of diabetes as causing severe erectile dysfunction leads to a psychological deterrent and a self-fulfilling prophecy in most men. Many well-adjusted and well-treated diabetics enjoy sex without problems. In women, loss of vaginal lubrication is a major sexual effect of diabetes. It is also theorized that there could be some erectile dysfunction of the clitoris (female anatomical counterpart of penis) among women with diabetes.
How common is erectile dysfunction?
It is very common. While impotence (accurately diagnosed) affects very few men, erectile dysfunction affects an estimated 10 to 20 million men aged 19 and older in the United States. The prevalence is 52 percent in men aged 40 to 70 and increases with age. However, today, men–and women–can enjoy sexual activity throughout life, with proper care and strategy.
What are the other complications of diabetes?
Diabetes has a lot of potential complications. Among them are the effects on the small arteries and big arteries in the body, causing blockages in the circulation, leading to damages (poor supply of blood, oxygen and nutrition) to the various organs of the body: the eyes (retinopathy that results in blindness), kidneys (nephropathy resulting in kidney failure), legs (resulting in leg an feet ulcers, gangrene and amputation), nerves (neuropathy that causes numbness and pains in the feet), and cellular immunity (weakens the immune system leading to infections). This is the reason why all diabetic patients must be under the care of a physician and why the blood sugar must be well-controlled at all times.
What are the causes of erectile dysfunction?
Erectile dysfunction is rare in diabetic men until their mid-30s. Erectile dysfunction is very common in the general male population, especially in these modern times. Contributing to cause this condition are psychologic factors (severe anxiety, fear of intimacy, fear of unwanted pregnancy, sexual guilt, depression), drugs (most medications for high blood pressure and coronary heart disease, psychotropic drugs, CNS depressants-tranquilizers, etc. do affect erection), arteriosclerosis/vascular (blocking arteries that supply blood to the male organ), and, rarely, biogenic (associated with low testosterone levels and reflecting disorders of the hyphothalamic-pituitary-gonadal axis).
Does alcohol affect erection?
Alcohol definitely affects erection, either in diabetics or non-diabetics. While the first shot of alcohol may cause a little euphoria and a sense of well-being in most persons, and therefore, perhaps helps in improving the sexual climate, the second and subsequent drinks will impair erection in most men, depending on their tolerance to alcohol. As Shakespeare wrote “Alcohol increases the desire but diminishes the performance.”
What is the treatment for these side-effects of diabetes on sex?
Making the correct diagnosis is very important, since the treatment depends on the cause. Once the diagnosis of erectile dysfunction is confirmed, erectile dysfunction drugs (Viagra, Cialis, Levitra, etc) are the current initial choice. Persons on nitroglycerine (medications for coronary heart disease) are strictly warned against taking these type of drugs, the combination of which could cause intractable shock and death. It is essential that the diabetes is well-controlled at all times for this to work. Quitting smoking, exercising at least 3 times a day, and a conducive environment, will help tremendously in improving sexual performance.
If Viagra does not help, what next?
Viagra helps alleviate erectile dysfunction in about 90% of diabetics and more in non-diabetics. Other assistance may come from sex therapy, other medications (penile erection suppository; yohimbine, which is still controversial; prostaglandin E1), vacuum constricting devices, male hormone testosterone, which is rarely needed, and which increases the chances of cancer of the prostate; and, surgery (aorto-iliac procedures for blocked arteries in the pelvis that partly supply the male organ, and implantation of penile shaft prosthesis, but this keeps penis rigid at all times and not too comfortable. With the advent of erectile dysfunction pills, most of these “other aids” have been relegated to the background and used only in dire cases that do not respond to the drug.
How about in diabetic women?
Among diabetic women, the major sexual side-effect is loss of the natural vaginal lubrication, which makes sexual encounters most uncomfortable and even painful. Master and Johnson, pioneering sex researchers in the 1960s, stressed the importance of vaginal lubrication during the initial sexual arousal in women and throughout the sex act. Other causes of loss in vaginal lubrication are: stress or psychological factors, undesired partner, drugs (Tricyclic Antidepressants, like Elavil, Anafranil, Tofranil, Sinequan, birthcontrol pills, antihistamines, cold formulas, etc), alcohol, cigarettes and marijuana. Other conditions include jet lag from travel across time zones, excessively prolonged foreplay or lovemaking, pregnancy and childbirth.
Is there a remedy for loss of vaginal lubrication?
There is an easy remedy to this problem. There is practically no excuse why women should not enjoy sex as men do. Loss of vaginal lubrication happens to majority of women past 40 years old, some even as young as in their 20s and 30s. The cause among menopausal women is hormonal, but stress, as stated above, could play a great role also, especially in the younger women. Diabetic women do not have to be ashamed of this, since this affects non-diabetics also, and at any age. Those who have this lubrication problem do not have to be disheartened and hopeless, either. The condition is easily solved. There are now a lot of commercially available (no prescription needed) sexual lubricants. This can be applied before sex by the partner. This simple and inexpensive strategy can tremendously improve and enhance the pleasure of sex.
*For more data, please visit philipSchua.com
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