Matthew Wosnitzer, MD, is a board-certified urologic surgeon and physician scientist. He specializes in male infertility.
On top of all the other health concerns related to diabetes, there is also an increased risk of sexual dysfunction in people of any sex or gender living with this all-too-common disease.
Although the cause of sexual dysfunction is not entirely clear, research suggests that it may be due to a combination of factors, including complications of the disease itself paired with health or lifestyle factors that contribute to both diabetes and sexual problems like erectile dysfunction or loss of libido.
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This article explores the causes and risks of sexual dysfunction in people with diabetes and the treatments that may help improve your sex life. It also offers tips on discussing these concerns with a healthcare provider so that you can take the steps needed to enhance your sexual health.
For this article, “male” refers to people with penises, and “female” refers to people with vaginas, irrespective of what gender or genders they identify with or whether they identify with any gender at all.
By definition, sexual dysfunction is a problem that interferes with any part of normal sexual activity, including sexual desire, arousal, physical pleasure, and orgasm. It is a largely subjective issue that can vary by a person’s age and personal preference. “Sexual dysfunction” usually is defined as a “person’s inability to participate in a sexual relationship as they would wish.”
The rate of sexual dysfunction in people with diabetes is statistically higher than in the general population. In males, this mainly involves erectile dysfunction and ejaculation problems, while in females, sexual desire, arousal, and the ability to orgasm are often affected.
Erectile dysfunction (ED) is the inability to achieve or sustain an erection suitable for sex. An erection is a complex function involving emotions, hormones, nerves, muscles, and blood vessels that work together to engorge a penis with blood to make it stiff enough for sex. A failure in any of these processes can lead to ED.
In males with diabetes, the risk of ED is 3 times greater than in those without it. Moreover, the symptoms tend to be more severe and occur 10 to 15 years earlier than in the general population, no matter if you have type 1 diabetes (the type you get through genetics early in life) or type 2 diabetes (the type you mainly get through lifestyle habits later in life).
Studies suggest that as many as 3 of every 4 sexually active males with diabetes will experience some degree of erectile dysfunction.
The reasons for this are far from clear. Some studies have shown a relationship between ED and poor blood glucose (sugar) control, while others have not. Those that show a relationship suggest that uncontrolled diabetes may damage the nerves and blood vessels needed to achieve an erection.
Other risk factors statistically linked to ED in people with diabetes include:
Other risk factors specifically linked to type 2 diabetes are also linked to increased risk of ED, including:
Ejaculation is the sudden discharge of semen from the body during an orgasm. In the same way that diabetes can increase the risk of erectile dysfunction, it can also increase the risk of male ejaculation problems, such as:
As with ED, the cause of ejaculation problems in people with diabetes is poorly understood.
Some scientists believe that hyperglycemia (high blood sugar) can damage the nerves and muscles involved in ejaculation, either by altering the body’s response to physical stimulation (making it oversensitive or under sensitive) or affecting contractions (spasms) of ejaculatory muscles.
Studies suggest that up to 40% of males with diabetes experience some form of ejaculation dysfunction. Even so, study results remain conflicting and more research is needed.
The causes of sexual dysfunction in females with diabetes are even less understood than in males. The problems can affect females of any age but are most common after menopause.
Whether you have diabetes or not, female sexual dysfunction is influenced by many things, including psychological and health-related factors. But, when diabetes is involved, the risk can increase exponentially, irrespective of whether you have type 1 or type 2 diabetes.
According to a 2013 study in Practical Diabetes, the types and frequency of sexual problems experienced by females with diabetes include:
Studies suggest that females with type 1 diabetes are more than twice as likely to experience sexual dysfunction than those without it. Females with type 2 diabetes are almost 2.5 times more likely to be affected than those without.
Unlike males with diabetes, the causes of sexual dysfunction in females appear to be mainly psychological, although there are also physical concerns.
Diabetes, especially type 2 diabetes, is associated with a high body mass index (BMI). In females especially, high BMIs translate to higher rates of depression and anxiety and, in turn, higher rates of sexual dysfunction. Moreover, the medications used to treat depression and anxiety (including antidepressants, mood stabilizers, and anxiolytics) can make things worse.
On top of this, uncontrolled hyperglycemia can reduce moisture levels in vaginal tissues, leading to vaginal dryness, pain, and an increased risk of infection.
Regardless of sex or gender, maintaining control of your blood sugar can help improve—and even normalize—many facets of your health, including your sexual health. This involves monitoring your blood sugar, adhering to your medications, and embracing healthy lifestyle choices like regular exercise, weight loss, and a diabetes-friendly diet.
There are also several treatments a healthcare provider may recommend for the specific types of sexual dysfunction you are experiencing.
The treatment of erectile dysfunction in people with diabetes is largely the same as in those without and may include:
Vacuum pumps, penile implants, and other therapies may be explored if ED is severely impacting your sexual health and well-being. Counseling can help address the psychological causes of ED.
Ejaculation dysfunction typically requires diagnosis and treatment by a specialist known as a urologist who is trained in disorders of the urinary tract and male reproductive system.
The treatment of ejaculation dysfunction varies by the cause:
The treatment of sexual dysfunction in females with diabetes is more or less the same as in those without.
Depending on the symptoms and causes, the treatment may involve:
It can be awkward and even embarrassing to discuss sexual problems with a healthcare provider. If you're feeling this way, the first thing to remind yourself is that you are not alone.
According to a 2021 study in Diabetic Medicine, 1 in every 3 people with diabetes experiences sexual dysfunction in some form. Moreover, having diabetes increases stress, which contributes to the loss of sexual function. As such, diabetes may be both a cause and effect of sexual dysfunction.
If you’re uncomfortable discussing sexual problems with your primary healthcare provider, ask for a referral to a specialist called an endocrinologist, who treats hormonal disorders, including diabetes. Endocrinologists have an in-depth understanding of the complications of diabetes and are experienced in dealing with sexual problems associated with the disease.
The first rule to overcoming awkwardness is to come prepared for your appointment. It often helps to make a list of your concerns so that you don't forget anything, namely:
By focusing on the medical concerns and answering questions as honestly as possible, you can provide the specialist with the information they need to start the investigation.
People living with diabetes are at far greater risk of sexual dysfunction than people without. In males, erectile dysfunction and ejaculation problems are common concerns. In females, a loss of sexual interest, arousal problems, vaginal dryness or pain, and an inability to orgasm are linked to psychological and physical concerns.
While treatments can help overcome these symptoms (including medications, counseling, and sex therapy), an emphasis would also be placed on better managing your blood sugar and embracing lifestyle choices that improve your general health and your emotional and sexual health as well.
Sexual health is directly linked to general health and well-being, so don't minimize any sexual problems you have or dismiss them as "one of those things" you have to live with.
Leaving these concerns unspoken can damage relationships or isolate you if you are outside of a relationship. This can increase the risk of depression, which, in turn, affects sleep, concentration, and appetite while causing physical symptoms like headaches, muscle aches, and digestion problems.
Sexual health is a facet of your general health. Therefore, it is in your best interest to regard it with the same importance as any other medical concern you face.
It can, although the exact cause is unknown. According to a 2014 study in Diabetes, Metabolic Syndrome and Obesity, males with diabetes have a threefold greater risk of erectile dysfunction (ED) than males without diabetes.
Yes, but it may take more than just erectile dysfunction (ED) drugs like Viagra. Many of the same factors that lead to diabetes—like obesity, high blood pressure, cholesterol, and smoking—also contribute to ED. So, the treatment plan would ideally involve lifestyle changes to better manage diabetes.
There are no hard-and-fast rules as to what is the best solution if you have diabetes and sexual dysfunction. In the end, it may involve medications, counseling, and changes in lifestyle.
This is especially true regarding female sexual dysfunction in which psychological causes (including anxiety and depression) may coincide with or predominate over physical ones.
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Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.
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