Sexual and Urologic Problems of Diabetes
Troublesome bladder symptoms and changes in sexual
function are common health problems as people age. Having diabetes can mean
early onset and
increased severity of these problems. Sexual and urologic complications of
diabetes are related to the nerve damage diabetes can cause. Men may have
difficulty with erections or ejaculation. Women may
have problems with sexual response and vaginal lubrication. Urinary tract
infections and bladder problems occur more often in people with diabetes. By
keeping your diabetes under control, you can lower your risk of sexual and urologic problems.
Diabetes and Sexual Problems
When you want to lift your
arm or take a step, your brain sends nerve signals to the appropriate muscles.
Internal organs like the heart and bladder are also controlled by nerve signals,
but you do not have the same kind of conscious control over them as you do over
your arms and legs. The nerves that control your internal organs are called
autonomic nerves, and they signal your body to digest food and circulate blood
without your having to think about it. Your body's response to sexual stimuli is
also involuntary,
governed by autonomic nerve signals that increase blood flow to the genitals and
cause smooth muscle tissue to relax. Damage to these autonomic nerves is what
can hinder normal function.
Sexual Problems in Men With Diabetes
Erectile Dysfunction
Estimates of the prevalence of erectile dysfunction in men with
diabetes range
from 20 to 85 percent. Erectile dysfunction is a consistent inability to have an
erection firm enough for sexual intercourse. The condition includes the total inability to
have an erection, the inability to sustain an erection, or the occasional
inability to have or sustain an erection. A recent study of a clinic population
revealed that 5 percent of the men with erectile dysfunction also had
undiagnosed diabetes.*
Men who have diabetes are three times more likely to have erectile
dysfunction as men who do not have diabetes. Among men with erectile
dysfunction, those with diabetes are likely to have experienced the problem as
much as 10 to 15 years earlier than men without diabetes.
In addition to diabetes, other major causes of erectile
dysfunction include high blood pressure, kidney disease, alcoholism, and blood
vessel disease.
Erectile dysfunction may also occur because of the side effects of medications,
psychological factors, smoking, and hormonal deficiencies.
If you experience erectile dysfunction, talking to your
doctor about it is the first step in getting help. Your doctor may ask you about
your medical history, the type and frequency of your sexual problems, your
medications, your smoking and drinking habits, and other health conditions. A
physical exam and laboratory tests may help pinpoint causes. Your blood glucose control and
hormone levels will be
checked. The doctor may also ask you whether you are depressed or have recently
experienced upsetting changes in your life. In addition, you may be asked to do
a test at home that checks for erections that occur while you sleep.
Treatments for erectile dysfunction caused by nerve damage, also called
neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed
in the urethra, and shots directly into the penis, to surgery. All these methods
have strengths and drawbacks. Psychotherapy to reduce anxiety or address
other issues may be necessary. Surgery to implant a device to aid in erection or to
repair arteries is another option.
* Sairam K, Kulinskaya E, Boustead GB, Hanbury DC,
McNicholas TA. Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction. BJU
International. 2001;88(1):68-71.
Retrograde Ejaculation
Retrograde ejaculation is a condition in which part or
all of a man's semen goes into the
bladder instead of out the penis during ejaculation. Retrograde ejaculation
occurs when internal muscles, called sphincters, do not function normally. A
sphincter automatically opens or closes a passage in the body. The semen mixes
with urine in the bladder and leaves the
body during urination, without harming the bladder. A man experiencing
retrograde ejaculation may notice that little semen is discharged during
ejaculation or may become aware of the condition if fertility problems
arise. His urine may appear cloudy; analysis of a urine sample after ejaculation will
reveal the presence of semen.
Poor blood glucose control and the resulting nerve damage
are associated with retrograde ejaculation. Other causes include prostate
surgery or some blood
pressure medicines.
Retrograde ejaculation caused by diabetes or surgery may
be improved with a medication that improves the muscle tone of the bladder neck. A urologist experienced
in infertility treatments may assist with techniques to promote
fertility, such as collecting sperm from the urine and then using the sperm for
artificial insemination.
For more, please read the
Erectile Dysfunction article.
Next: Sexual Problems in Women With Diabetes »
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