Diabetes and Sex

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Is sex affected by diabetes?

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. Viagra (Sildenafil), which has been found to be effective for male erectile dysfunction, has now been shown in some preliminary studies to be of help also among females, lending further support to the medical contention that perhaps diabetes also impairs female (clitoral) erectile function.

Is this condition the same as impotence?

No, this was a scientific "error," a harsh diagnosis overkill in the past. Erectile dysfunction has since then been considered a distinct and remediable medical entity and has replaced the term impotence, in this particular context. Impotence is now relegated to its proper "domain" where the male (himself) is unable to cause pregnancy. This clearer definition is more medically accurate and has given more hope and psychological relief to the millions afflicted by erectile dysfunction, which today has great treatment success rate.

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% 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. Erectile dysfunction is not inevitable with aging, even into the 70s and 80s. With proper medical counseling and aids like Viagra, etc., most males and females can enjoy sex at any age.

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-tanquilizers, 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."

Does diabetes cause gangrene of the male organ?

This is a myth that has been used to scare men to seek medical treatment for diabetes in the olden times. While there was wisdom in the intent, the medical truth is that the small arterioles in the penis have not been found to be affected by arteriosclerosis (hardening of the arteries) compared to arteries of the heart, brain, kidneys, abdomen and legs. If there is any report in the medical literature about diabetes causing gangrene of the penis, it must be so rare physicians have not encountered it. On the other hand, trauma and other conditions, like priapism (abnormally prolonged, painful and persistent erection), have been well-known to cause gangrene, when intractable and not amenable to treatment.

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, Viagra is the current drug of choice. Erection is achieved about one hour to one hour and a half following ingestion of the pill, which comes in 25 mg, 50 mg and 100 mg. Persons on nitroglycerine (medications for coronary heart disease) are strictly warned against taking Viagra, the combination of which could cause intractable shock and death. Viagra, if taken properly under a physician's supervision, is a safe and very effective wonder drug. 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 Viagra, 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. The wet cavity allows the male organ to slide in and out more easily, increasing both partners sense of ecstasy. The lubrication also increases the sensitivity of the vaginal lip and clitoris to touch, increasing the responsiveness and pleasure to digital caress. With proper vaginal lubrication, proper "ambiance," and well-controlled blood sugar (and other medical conditions, if any), diabetic women can enjoy pleasurable sex at any age.

What are the other causes of loss of vagina lubrication?

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 feel 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. The best (more romantic) strategy is for the male partner to apply the lubricant to his fingers, which he uses to caress his partner's clitoris and vaginal orifice in a natural and tender manner. Squeezing the lubricant directly to the female organ is simply unimaginative and gross, and could turn off some women. If needed during the act, more lubricant may be applied. This simple and inexpensive strategy has tremendously (to the surprise of many partners) improved the pleasure of sex, the sexual relations of husbands and wives, and lovers in general, and has enhanced many a marriage and personal relationship to a significant extent.

Which sex lubricants are available?

Sex lubricants are over-the-counter drugstore items which do not need a prescription. They are either water-based, oil-based and pertoleum-based. Water-based has glycerine in it, tasteless, does not stain the bed sheet, may be used even inside the vagina, does not damage condoms, and hence the most popular one. Oil-based are butter, corn oil, peanut oil, cooking oil, all of which could be used but they stain the bed, and could damage condoms. Petroleum-based are petroleum jelly, mineral oil, petrolatum, vaseline products and baby oil. These petroleum-based lubricants should not be used INSIDE the vagina, since they are irritating and can cause infection. Example of water-based lubricant is K-Y Jelly. A little dab of water may be applied over the K-Y Jelly to liquify it more, if needed, especially if the act is extended. This will effectively make the lubrication last. The jelly may be applied as often as needed. Some lubricants claim to have spermicidal ingredient in them, but these are not guaranteed to prevent pregnancy. It is very important that trauma to either sex organs is avoided during the act, since this will cause harm, some permanent, and preclude future sexual pleasure. Lovemaking should be romantic, selfless, considerate and tender in order to achieve, not only the physical pleasure (and pregnancy, if this is goal) but the psychological and spiritual climax in both partners.

©2003Raoul R. Diez, M.A.O.D.