Diabetes and Sex
Legal LawWhere to start?
The most common question I encounter as a family doctor is the problem of erectile dysfunction related to diabetes. With all the TV commercials about “ED,” more patients are speaking out.
Is Viagra the answer? For some, yes. But for many patients the problem is more complex.
For the most part, we’re talking about type II diabetes, the variety that occurs primarily in overweight men and women. In addition to the hormonal imbalance that leads to diabetes, a decrease in serum testosterone is common, resulting in decreased libido (sexual desire). Men especially suffer from this problem, although women are not immune. Diabetes can affect the circulatory and nervous systems, making it difficult for both men and women to become physically aroused.
Associated chronic diseases further complicate the problem. Many diabetics take medications for high blood pressure, medications that sometimes cause impotence or loss of desire. Depression is common and can lead to sexual dysfunction in both diabetics and non-diabetics. Unfortunately, some antidepressants also cause sexual disorders. Heart disease itself usually doesn’t cause impotence, but worrying about it can.
If you are diabetic and experiencing sexual difficulty, discuss the problem with your doctor. Although clinicians are encouraged to initiate discussions of sexual functioning, this vital issue is often overlooked.
Before visiting your doctor, organize your thoughts. How long has the problem existed? Is it mainly a physical problem or an emotional one? Can you tell the difference? Is it related to problems with your spouse or did it come up when you started taking a certain medication? Was the onset gradual, over months or years, or more rapid? Do you suffer from loss of interest, loss of ability, or both? Is there any discomfort? Is the problem always present or does it come and go? What solution are you looking for? Is the problem a threat to your marriage?
Your doctor will want to review your history carefully, including a complete list of your medications, and then perform a physical exam to rule out other physical problems such as prostatitis or vaginitis. You may want to do blood tests to determine hormone levels or other endocrine disorders.
The good news is that there is an answer for everyone. If low hormone levels are the cause, hormone replacement therapy may be the answer. If the cause is decreased circulation, there are methods to improve blood flow (Viagra is one of them, even for some women). For men, if all else fails, there are implantable devices. If the problem is a deteriorating relationship, counseling is often helpful.
But not everyone wants to improve sexual function. Many individuals and couples choose to focus on other areas of intimacy, such as companionship. Sometimes all a person needs to stop worrying and relax is to understand that they are not the only one with a problem.
Copyright 2010 Cynthia J. Koelker, MD