Men aren't the only ones who experience sexual problems as a result of diabetes.
Reviewed by Louise Chang, MD
When most people hear the words "diabetes and sexual dysfunction," they automatically think it's the man's problem. But women with diabetes can also experience sexual problems related to their blood sugar levels.
For diabetes educator Ann Albright, PhD, RD, that's not only a medical fact, it's a fact of life.
"It's not diabetes per se that harms your intimate life. It's the complications of uncontrolled blood sugar levels that cause problems for both men and women -- the only difference is that many women simply aren't as aware of this complication as men are," she tells WebMD. Albright also is the president of health education for the American Diabetes Association.
Albright says women are getting better at coming forward with intimacy issues, but when it comes to diabetes, most are still reluctant to talk to their doctor.
Endocrinologist Loren Wissner Greene agrees. "Women aren't talking to their doctors about it, doctors aren't talking to women about it, and so for many it remains a silent problem that goes undiagnosed and untreated." Greene is a clinical associate professor at NYU Langone Medical Center in New York City.
When Glucose and Intimacy Collide
Although women with diabetes may be slow to admit there is a problem between the sheets, the medical community has been even slower to study the issue. It wasn't until 1971 that a groundbreaking study was published on this subject in the journal Diabetes.
In the study, 35% of women with diabetes reported being unable to have an orgasm during intercourse, compared to just 6% of the women who didn't have diabetes.
Albright says one reason women with diabetes may have trouble achieving orgasm is that high blood sugars can affect vaginal lubrication.
"The lubrication issues not only can impact sensation, they also can make sex very uncomfortable, even painful," she says.
In a 1986 study now considered a cornerstone of research on the topic, nearly half the women in the study had a sexual problem. Of these, 32% of women reported experiencing problems with lubrication. Eighty-nine percent said the problems started after their diabetes diagnosis.
Albright says there are many health benefits of good blood sugar control, but many women don't realize that better lubrication, and, ultimately, a better sex life may be among them.
Blood Sugar and Sexual Desire
Lubrication can be a huge intimate issue, but it's not the only one women with diabetes may have. Endocrinologist Spyros Mezitis, MD, says there are also important links between glucose levels and genital stimulation -- a factor that affects not only how pleasurable sex feels, but also a woman's desire for it.
"It all comes down to microcirculation," says Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. "When blood glucose is uncontrolled, it impacts the tiny blood vessels that feed our nerves and allow a woman to experience the full spectrum of intimate sensation."
When microcirculation is impaired in men, erectile dysfunction occurs -- so the impact is obvious to both partners, he tells WebMD. In women, the effect isn't as apparent. It's all about arousal and sensation in the genital area, which frequently no one but the woman herself must acknowledge.
Greene says the longer sugar levels remain uncontrolled, the more likely it is for circulation problems to interfere with intimacy.
"Over time, increased glucose in the blood begins to destroy myelin -- a protein that covers nerves," Greene says. When this happens, it leads to neuropathy -- a type of nerve damage.
The most frequent type is peripheral neuropathy. It commonly results in foot problems such as numbness and tingling. Another type of neuropathy -- autonomic neuropathy -- affects nerves in areas such as the stomach and urinary tract and may also impact the nerves in the pelvis -- nerves that are directly connected to sexual stimulation.
"Again, it's damage to the tiny blood vessels supplying the nerves that are at the root of the problem," she says.
"Some people believe only those with type 1 diabetes, which develops at an early age, are at risk for these kinds of problems, but in reality many people with type 2 diabetes have it for many years before they are diagnosed, and when they are diagnosed, most of the time some damage has already occurred," Greene says.
Women, Sex, and Diabetes: The Role of Infections
In addition to problems related to blood supply and nerve function, doctors say women with diabetes are also prone to two types of medical problems that also can interfere with intimacy: Yeast infections and urinary tract infections.
"The vagina is a moist, warm place that favors the overgrowth of yeast anyway -- add excess sugar into the mix and you have the ideal breeding ground for yeast, one reason women with uncontrolled blood sugars frequently develop chronic yeast infections," Mezitis says.
What many may not recognize is the impact these infections have on delicate vaginal tissue -- and the role they can play in making sex very uncomfortable, even after the infection has cleared.
"It can leave the vaginal tissue raw and irritated, particularly if the infections are chronic and keep coming back -- the irritation continues, and combined with a lack of lubrication, this can make sex extremely uncomfortable, even painful," Greene says.
Urinary tract infections can have the same effect, Mezitis says. "The burning and pain can make sex very uncomfortable -- and when there is chronic infection, there is chronic discomfort that can cause a woman to avoid sex for long periods of time," he says.
And avoiding sex may only make the problem worse.
"The longer a woman goes without having sex, the more difficult and sometimes painful it can be for her to begin again," Greene says.
Women, Sex, and Diabetes: A Complex Issue
Experts have suggested that one reason there is so little research on women, sex, and diabetes is that for women, achieving sexual satisfaction is a complex and multi-faceted issue. That means finding a single "smoking gun" becomes a daunting, and some say, impossible, task.
Albright believes the complexity of a woman's sexuality is one of the main reasons the impact of diabetes can be so devastating.
"Sometimes sexual problems can be clearly glucose related, but sometimes it's also the demand that diabetes itself takes on a woman's life and how coping with the disease can ultimately impact sexual functioning," she says.
"The demands of the diabetes itself can affect you emotionally and if you're a woman the stress of those demands is simply more likely to play out in the bedroom."
Greene adds that for many women with diabetes, depression is also a factor. "In and of itself," she says, "depression can impact your intimate life, but so can many of the medications prescribed to women who do develop depression as a result of their diabetes."
Women, Sex, and Diabetes: Getting Help
Although there may be no single answer for every woman whose sex life is affected by her blood sugar, there are two tactics experts say works for every woman:
- Bring your problem out into the open. Telling the doctor about problems in
the bedroom may not only help your sex life, it could clue in the doctor that
your blood sugar isn't under control. "It's important to bring that aspect of
your life into the examining room," Mezitis says. "It can help you work with
your doctor to fine-tune both your medication regimen and the suggested
lifestyle changes so you do get the best possible control of your blood sugar."
- Keep your doctor in the loop. Don't be shy about asking your doctor about specific treatments for sex-related problems, Mezitis says.
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"If it's a lubrication issue, for example, or even a sensation issue, there are localized hormone treatments that might be a huge help," he says.
Likewise, if you're suffering with chronic yeast infections that you're treating with over-the-counter preparations, Greene says to share that with your doctor.
"This is important because chronic yeast infections can be a sign that your blood sugar is not being well controlled during certain times of the month," Greene says. He says studies have shown many women need more insulin when they're premenstrual.
"Telling your doctor about chronic infections, or any lingering vaginal soreness that interferes with your sex life may actually lead to better control of your sugar levels," Green says, "while at the same time helping to reduce intimate problems."
The bottom line: If you're experiencing problems between the sheets, don't pull the covers over your eyes and hide.
"Talk to your doctor, either your endocrinologist or your gynecologist," Albright says, "very often there are treatments or lifestyle changes that can make a difference."
Ann Albright, PhD, president of health education, American Diabetes Association.
Loren Wissner Greene, MD, endocrinologist, professor, NYU-Langone Medical Center, New York City.
Spyros Mezitis, MD, endocrinologist, diabetes expert, Lenox Hill Hospital, New York City.
Enzlin, P. Diabetes Spectrum, October 2003; vol 16: pp 256-259.
Kolodny, R. Diabetes, 1971; vol 20: pp 557-559.
Newman, A. Journal of Behavioral Medicine, 1986; vol 9: pp 261-270.
Reviewed on July 31, 2008 © 2008 WebMD, LLC. All rights reserved.