By Eileen B. Wyner, NP
Bulfinch Medical Group

I’m going to go out on a limb and make an assumption (despite what my father always told me):  Everybody reading this has seen at least one advertisement on TV or in a magazine about erectile dysfunction and the medications available for treatment. In fact, sometimes I look at my bath tub and just chuckle. But that’s not true for everyone. These ads refer to a topic that is no laughing matter for people living with diabetes who have sexual dysfunction.

Sexual dysfunction affects both men and women so I want to break this down for you. Erectile dysfunction (ED), or impotence, is defined as the inability to achieve or maintain an erection that is suitable for sexual intercourse. Poorly controlled blood sugars can cause damage to the blood vessels and nerves in the genital area that can lead to ED.  Over 30 million men are affected by ED, with somewhere between 35%-75% of men with diabetes affected at some level across the lifespan. There are many potential reasons for ED, including but not limited to medication side effects, fatigue, stress, poorly controlled blood sugars, excessive alcohol intake, increased age, increased weight, and high blood pressure.

Another potential culprit in ED may be low testosterone levels. Testosterone is a hormone responsible for the development of male reproductive tissue.  This condition is twice as likely to occur in men with poorly controlled diabetes. Low testosterone may present with complaints of decreased libido, depression, fatigue and decreased energy, and a decrease in lean body mass. Testosterone levels can be checked by a blood test if your health care provider thinks this is indicated. A treatment plan can then be established if necessary.

One very important treatment for ED is attaining better control of your blood sugar. Oral medications are another available treatment option, but there are certain medical conditions where the use of these agents is contraindicated.  Men with heart disease or on certain cardiac or blood pressure (antihypertensive) medications may have very serious low blood pressure if they take any of these agents, so it is important to discuss your medications with your health care provider. Men that are able to use ED medications may have less serious side effects such as headache, facial flushing, back pain, and nasal congestion. These side effects are related to how these medications work.  They are vasodilators, which means they cause a systemic effect to all the body’s blood vessels so they open more fully. Some non-medication treatment options for ED include assistive devices such as vacuum pumps, local injections, and in some cases surgical intervention for penile implants.  Talk to your health care provider about what treatment options are best for you.

Women with diabetes may also have symptoms of sexual dysfunction. Women may experience symptoms such as decreased libido, vaginal dryness, and decreased orgasmic ability again due to damage to blood vessels and nerve endings in the genital area. Elevated blood sugars may cause vaginal yeast infections and urinary tract infections that compound vaginal dryness and make sexual intercourse uncomfortable.  The possible treatment  modalities in this case also include achieving better blood sugar control and discussing with your health care provider  if prescription or over the counter medications are indicated.  Once you and your health care provider discuss your issues with sexual dysfunction, they may refer you to another provider to assist in developing a treatment plan. Men may benefit from an evaluation with a urologist and women may require an evaluation with a gynecologist.

The key to dealing with a problem, any problem, is discussing it with your health care provider. Talking about sex isn’t easy. It may be hard for you and your partner to admit there is a problem, and it may be embarrassing to discuss with your provider (especially if they are a member of the opposite sex). I want you to think that a problem in the bedroom is a problem just like numbness in your toes or hypoglycemia with exercise. You need to let your provider know so you can get help.  I will share with you that as a provider it can also be hard to ask about sex. I have no trouble asking Are your toes numb? or Are you checking your blood sugar before driving? But I stop and think a second before I ask if there are any problems in your sex life. I want to make you feel comfortable enough with me to talk about this because sexual health is an important part of our general health— and I don’t want to miss any part of you when you come to see me. So what do you think? Ready to talk? I hope so.