Let’s Talk About Sexual Dysfunction and Type 1

While many people with Type 1 are comfortable talking about their A1C, few are as open to discussing how diabetes affects their sex lives. People with diabetes should be talking to their endocrinologists regularly about their sexual health, but the subject rarely comes up, says Dr. Jennifer Goldman-Levine, a professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences.

”it’s an uncomfortable topic for patients, particularly men,” she says.

That’s unfortunate, because the sooner diabetes-related sexual dysfunction is diagnosed, the more likely it is that it can be treated. Erectile dysfunction (ED) or other sexual dysfunction in people with Type 1 diabetes is most likely caused by nerve damage and poor blood flow, and there’s an optimal window for treating the problem. For example, a group of researchers recently found that for each year Type 1 diabetes-related ED is left untreated, the chances for reversing it go down, according to Dr. Hunter Wessells, a urologist with the University of Washington, Seattle. In the 2013 study led by Dr. Wessells, researchers found that the chances of recovering sexual function dropped 47% if men with diabetes waited 5 years or more to seek treatment after the first ED incident, according to a MedScape Multispecialty report.

While many choose to suffer in silence when things aren’t going well in the bedroom, T1 sexual problems are a lot more common than you might think. Researchers overseeing a 10-year study of 652 women with T1 found that 35% experienced some form of sexual dysfunction, including loss of libido, dryness, lack of arousal, and pain during sex. Various studies have found between 20% to 85% of men with diabetes experience mild to severe ED. At a 2013 presentation to the European Association for the Study of Diabetes, Dr. Wessells declared that men with diabetes are 3 times more likely to experience ED when compared to the regular population, and some 50% will experience impotence in their lifetimes. Other problems for men can include retrograde ejaculation (when sperm leaks into the bladder during orgasm) and premature ejaculation. Both men and women can experience an inability to orgasm because of T1-related sexual dysfunction.

While temporary sexual dysfunction can result from an ill-timed low, it’s actually hyperglycemia that does the long-term damage. High BG can cause high blood pressure, which can reduce blood flow vital for good sex. It also can wear down nerves over time in sexual organs, just like in less sensitive extremities, says Dr. Goldman-Levine.

“Nobody considers that neuropathy happens over the entire body,” she says. “Everyone just seems to concentrate on feet.”

If sexual dysfunction is caught in time, it can be treated. The most effective way to treat it is by preventing more nerve damage by keeping BG in check. Once BG is brought under control, the strategies for treating sexual dysfunction are largely the same for people with T1 as for the general population. Studies have proven that sildenafil citrate-based drugs (like Viagra) are safe for men with diabetes; the only trick is that such drugs might require a higher dosage than what’s needed for the average population to work, depending on the nerve damage. Other treatments for men with more severe ED include a vacuum pump, penile injections, and surgery.

Treatment options for women can include Kegel exercises to strengthen muscles and vaginal lubricants. As is often the case with sexual health, T1 female sexual dysfunction is less understood and has fewer treatment options than T1 male sexual dysfunction.

“We do a better job of preventing and trying to prevent sexual problems in men than in women,” says Dr. Goldman-Levine.

The good news is that people with diabetes are finding ways to have sex despite health-related obstacles. According to a 2010 University of Chicago study, middle-aged and older people with diabetes are having as much sex as their peers, even if that sex sometimes comes with complications. Researchers for that study surveyed nearly 2,000 people and found that some 70% of partnered men with diabetes and 62% of partnered women with diabetes, ages 57 to 85, engaged in sexual activity 2 to 3 times a month, a rate which mirrors the sexual activity of older Americans without diabetes.

shutterstock_35112517_couple_pillow_fighting_300pxThe key to a long and satisfying sexual life is to talk to your medical care provider about the subject, says Dr. Goldman-Levine. It’s also vital for doctors to ask questions about sexual health during regular checkups. A smidge of embarrassment with a doctor now can save a lot of frustration down the road. The best treatment strategy is to prevent problems from happening or getting worse.

“The earlier you make sure you have good glycemic control, the more likely you are to prevent sexual dysfunction,” Dr. Goldman-Levine says. “The further out you are and the more damage is done, the less likely it is that treatments are going to work.”

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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