Sex experts have divided sexual dysfunction disorders into four categories: desire disorder, arousal disorder, orgasm disorder, and pain disorder. One type of disorder can and often does coexist with another. None of these types of disorders is unique to people with diabetes, but diabetes can contribute to some of them. Sexual problems can occur at any stage in a person’s life and can occur suddenly or gradually over time.
The physical health issues that are commonly associated with diabetes can contribute to sexual problems, so when any form of sexual dysfunction develops in a person with diabetes, it should be considered as a possible cause. However, diabetes should not automatically be assumed to be the problem; other potentially relevant health issues, many of which are not diabetes-specific, such as anxiety, depression, or low self esteem to mention a few.
Most diabetic complications are related to high blood glucose, and sexual problems are no exception. In the short term, high blood glucose can negatively affect energy level as well as mood, which in turn, influence the person’s sexual functioning and relationship. The body’s cells require glucose for energy and high blood glucose levels usually indicate that glucose is not being moved efficiently into the body’s cells to provide energy. The higher blood glucose levels are, the more tired a person will typically feel.
In addition, when blood glucose levels are high, the diabetic patient may feel irritable. Other symptoms of high blood glucose such as frequent urination, thirst, and having blurry vision can be annoying and preoccupying. Persistent high blood glucose levels can increase the likelihood of infections in the urinary tract, vagina, and penis, which can obviously affect intimate relationships.
Over the long term, blood glucose levels that remain high and uncontrolled contribute to neuropathy (nerve damage) and blood vessel damage leading to impaired blood circulation. Both of these can affect the body’s response to sexual stimulation, leading to erectile dysfunction in more than one in three men with diabetes as well as lubrication problems related to sexual function in up to 60% of women with diabetes.
Women share with their health providers their frustration dealing with disturbed sexual performance and desire. They generally have less interest in sex because of depression or changes in blood glucose levels that can leave them feeling tired or irritable. Intercourse might also be painful because of vaginal dryness.
Men are more disturbed by experiencing erectile dysfunction (ED) a common problem amongst men who have diabetes (50% of male diabetics suffer from it)- with under-reporting a common problem due to embarrassment. Men who have diabetes tend to develop ED between 10 and 15 years earlier than men who do not have the disease.
What causes erectile dysfunction amongst diabetics?
Causes of ED are complex, and are based around changes that occur in the body over time affecting nerve, muscle and blood vessel functions.
In order to obtain an erection, men need to have healthy blood vessels, nerves, male sex hormones and a desire to have sex. In diabetes, the blood vessels narrow and eventually block, depriving blood supply to nerves (which then malfunction then degenerate) and muscles (which fatigue more easily).
Many common medications taken by diabetic patients (including antidepressants and blood pressure drugs) can also result in ED.
Other factors causing sexual dysfunction in diabetic patients
Many other factors may cause sexual dysfunction amongst pre–diabetic and diabetic patients.
• being overweight
• Sedentary life style
Psychological factors have an enormous influence. Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of sexual dysfunction cases.
Tackling the problem
Prevention is better than cure! Maintaining a healthy lifestyle, regular exercise, weight loss to achieve a body mass index less than 25, not smoking, drinking alcohol in moderation, and of course maintaining good blood sugar and lipid (fat) control are extremely important targets. Seeking help for the management of anxiety and depression, and where necessary relationship counselling can also be helpful.
Conventional medications to treat diabetes and high lipid levels have been demonstrated to reduce the rate of diabetic complications. Additionally, new approaches using natural, herbal combinations like Ascarx® have been shown to dramatically reduce glucose and lipid levels, in a safe and well-tolerated way. In our clinical observations of several hundred pre-diabetics and type 2 diabetics, cases have demonstrated frequent improvement of vascular phenomena such as impotence. In a study of AscaRx® out of 56 male type 2 diabetic patients five men resumed sexual activity; three had been using Sildenafil concurrently. Additionally, some patients in this study were observed to have significant improvements in vascular ischemic phenomena associated with diabetes, including limb claudication, renal dysfunction due to renovascular disease and most strikingly, reversal of proliferative retinopathy in two cases. The mechanism behind these interesting findings undoubtedly involves better blood sugar and fat control, but like the mechanisms behind ED, the story certainly does not end there!