Will my diabetes cause sex problems?

That depends to a certain extent on whether you are a woman or a man. Previously it had been thought that diabetes had little or no effect on either a woman's sexual performance or satisfaction. Even now, based on what diabetic women report to their doctors, it would seem that they reach a sexual climax just as often as nondiabetic women.

Still there are rumblings from some diabetes therapists especially female diabetes therapists that sex problems associated with diabetes are as common among women as among men. It's just that the male sex problems have been given more attention. This is not necessarily due to sexism. It may be due to the fact that sexual response is easier to measure with men than with women.

The majority of women's sexual problems appear to be related to poor diabetes control. A woman understandably loses interest in sex when she is excessively tired and rundown from being out of control. High blood sugar and the resulting sugar in the urine increase susceptibility to vaginal infections that cause swelling, itching, burning, and pain, which are hardly conducive to enthusiasm for sexual intercourse. These infections can be treated with salves, but the only real cure is keeping your diabetes in control.

If a long term diabetic woman develops neuropathy (damaged nerve cells) again often as a result of poor control it may involve the nerve fibers that stimulate the genitalia so that arousal may not occur, making intercourse painful because lubricating fluids are not released. Arthur Krosnick, M.D., writing in the September-October, 1980 Diabetes Forecast, recommends the use of water soluble lubricants, such as K-Y Lubricating Jelly for this condition. He also states that "Estrogen deficiency responds to vaginal creams. These creams are available by prescription and do not affect diabetes control."

Although emotional factors associated with diabetes anxiety, fear, anger can have some effect on a woman's sex life, blood sugar control appears to be far more significant. As for men, there has been a lot of talk about diabetes causing impotence. There has been so much talk, in fact, that the resulting fear has been known to cause it. A psychologist we heard speak told about one of his patients who wasn't aware of the existence of diabetic impotence and was getting along just fine. When he did hear the discouraging word, it was instant impotence for him. (We hope we're not doing harm by making you aware of the problem.)

The impotence legends and actualities have been brought about by several factors. Sometimes when a man is an undiagnosed, out of control diabetic, he can develop a temporary impotence, which goes away when he gets in control.

Sometimes when diabetes is first diagnosed, a man is shot with so many negative emotions such as anxiety, depression, anger, guilt, and fear of rejection that he becomes impotent for psychological reasons.

Not surprisingly this "performance anxiety" often results in impotence. Indeed, the British Medical Journal reported that impotence was most likely caused by psychological factors in two thirds of the men studied and by physical factors in only one third.

The well known broadcaster and syndicated columnist, Dr. Gabe Mirkin, has discovered an easy and inexpensive (especially if you use one cent stamps) test to determine if impotence is psychological or physical.

He explains that "There are two stages of sleep: rapid eye movement (REM) and nonrapid eye movement sleep. In nonrapid eye movement sleep, males achieve an erection. This can occur several times throughout the night and the male wakes up the next morning without even knowing about it."
If you are achieving erections in the night, then your impotence is psychological. To check this out, Dr. Mirkin recommends taking a roll of postage stamps, tearing off the appropriate number of stamps (he suggests four), and securing them tightly to the penis before going to bed. If the stamps are torn apart in the morning, then you know you're having erections.

To make sure that anxiety resulting in fitful sleep doesn't confuse the issue, it might be an idea to try this test more than once before deciding that your impotence is physical rather than psychological.
Since this is obviously a test that June can't check out personally, we'd appreciate it if you could let us know if this test works.

What can you do about impotence that is mainly psychological? 

We hope it will help some just to have the reassurance that it is mainly psychological and that when you start handling the negative emotions that engulfed you with your diagnosis of diabetes the sex problem will gradually disappear. We know, however, that such emotions and their effects can't always be swept away with logic and Dutch uncle conversations with yourself. You can't immediately eliminate your problem just because you've been told what's causing it. It takes time and consideration (consideration of yourself by yourself as well as consideration from your partner). If it takes too much time and only you can decide how much is too much you shouldn't hesitate to get some psychological help. If your doctor isn't able to recommend a psychological counselor or sex therapist, you can contact any large university in your area. Most of these have human sexuality programs and can give you the names of qualified sex therapists who are available for private consultation.

What about physical impotence in diabetic men? 

Then it's usually a gradual, long term process caused by nerve damage. This can often be prevented by good diabetes control. When it does develop, however, counseling with a qualified sex therapist is again in order. He or she can advise you on alternative ways of giving and experiencing sexual pleasure as well as help you decide if penile prosthesis would be a good solution to your problem.
There are two kinds of prosthesis currently available: the semirigid rod and the inflatable. Many men have had success with penile prosthesis, but it is not something you should rush into without careful consideration and without thoroughly discussing the idea with your sexual partner.

You can become impotent while under the influence of certain drugs. Among these are alcohol, tranquilizers, marijuana, estrogens, and drugs for hypertension. In many older men impotence may be caused by hypertension drugs with diabetes getting the blame. When possible these suspect drugs should be avoided or their use should be discontinued.

Does diabetes cause male sterility? 

No. Studies have shown that it does not affect your sperm count.

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