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Sexual Dysfunction in Diabetes

Updated: September 16, 2013

Sexual dysfunction in men and women is more common than previously thought. This, at least in part, is due to the taboo that prevents open, objective discussion, even by physicians. Yet, sexual activity or the lack there of has caused lost fortunes, the downfall of kingdoms, governors, prosecutors, and is implied in the loss of Eden.


It is a difficult subject to study scientifically. Most available studies are observational, therefore subject to biases of the subjects, the investigators and the surrounding culture.  Nevertheless it is well documented that sexual dysfunction is more common in men and women with diabetes. In a survey of 541 diabetic males between the ages of 20 and 59 years 35% had erectile dysfunction (Diabetologia 1980 Apr;18(4):279-83).  A survey of women published in 2008 indicated 43.1% had some sort of problem related to sexual function (Obstet Gynecol. 2008 Nov;112(5):970-8.)


The complications of diabetes involve blood vessels for the most part. The development of and maintenance of the male erection requires an increase in blood flow to the penis.  The vaginal fluid occurring during female sexual arousal and activity as well as clitoral enlargement and breast nipple erection are all dependant on proper function of blood vessels. The inner lining of blood vessels, large and small, is called the endothelium. It is one of several controllers of blood flow and is therefore a mediator of sexual responses. There are few studies showing a direct effect of blood glucose (sugar) control and sexual function.  However one study evaluated the association of glycemic (blood sugar) control with erectile dysfunction in men with type 2 diabetes (The Journal of Urology, Volume 163, Issue 3, Pages 788-791). The study demonstrated that mean erectile function score decreased as hemoglobin A1c increased.  There is evidence that endothelial function is made worse by elevated blood glucose, cholesterol, hypertension and atherosclerosis.  Even wide variations in blood glucose have been demonstrated to cause endothelial dysfunction.  Measuring flow-mediated blood vessel dilation as in indicator of endothelial function, one study showed changing glucose between 180 and 270 mg/dl resulted in “…both endothelial dysfunction and oxidative stress in both normal and type 2 diabetic patients. Oscillating glucose between 90 and 270 mg/dl (5 and 15 mmol/l) every 6 h for 24 h resulted in further significant increases in endothelial dysfunction …” (Diabetes 57: 1349–1354, 2008).


What to Do? People with diabetes and sexual dysfunction should consult their physician first and openly discuss the situation. If blood glucose is not in control, try to get control. We feel so strongly about this that, as policy at the Diabetes Control Center, we will not prescribe Viagra®, Levitra® or Cialis® if A1c is 7.5% or greater.  Numerous therapies are available, including the three products noted above.   Before treatment, we think it best to attempt to establish a cause of the problem.


Sexual problems in men include:
A failure to get or maintain an erection (ED)
A lack of interest in sex (diminished libido)
Premature ejaculation
Delayed or subdued ejaculation


Causes of sexual dysfunction in men include limited blood flow to the penis and psychological causes (performance anxiety, depression).  Blood flow problems include, smoking, alcoholism, drug abuse, hypertension, some medications and uncontrolled blood glucose. Less frequent causes include hormonal insufficiencies e.g. testosterone, thyroid and other hormones.
An excellent, detailed review of this subject can be found at this link:
www.uptodate.com/patients. Search sexual problems in men.

 

Sexual problems in women include:
A lack of interest in sex (diminished libido).
Pelvic pain and other gynecologic problems.
Irritable bowel syndrome.
Vaginal dryness.
Hormonal disorders.

Elevated blood glucose, hypertension, elevated blood lipids and any other factors that decrease blood flow to the pelvis will decrease the sexual response. Hormonal deficiencies e.g. estrogen, thyroid and others have been demonstrated to cause sexual dysfunction in women. Several medications, including antihistamines and antidepressants have also been implicated.

An excellent, detailed review of this subject can be found at this link:
www.uptodate.com/patients. Search sexual problems in women.

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