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Women, Sex and Diabetes
While impotence may not receive sufficient attention in relation to men and diabetes, we rarely hear about problems relating to women with diabetes and sexual problems, yet it is a very real problem for women who suffer from it. Many women have difficulty talking to their partner about sexual difficulties and do not seek help due to shame embarrassment or fear.
As with men, there are many factors that can cause sexual problems in women, that can be psychological or physical. Stress, tiredness, anxiety, relationship problems can affect energy levels and sexual desire. Some medical conditions are linked to sexual dysfunction in women, such as diabetes, cardiovascular disease, MS and some prescription drugs.
Do women with diabetes have problems that are different from women without diabetes? There are very few sources of information about this, yet sex is part of human nature and belongs to a healthy lifestyle so it is to nobody's advantage to avoid discussing these issues. Research published in 2002 [ref 1] interviewed 120 women with Type 1 diabetes and compared them with a control group of women without diabetes. The results showed that women with diabetes reported significantly more problems with sexual dysfunction than women without diabetes, 27% compared to 15%. There was no association between sexual dysfunction and age, weight, duration of diabetes or blood glucose control. However, there was a close link between sexual dysfunction and depression in both women with diabetes and those without it. The study highlights that sexual dysfunction is common on women with diabetes and that this affects the quality of life.
Common problems
Autonomic Neuropathy [nerve damage]
As we know this is a common complication of diabetes and it can lead to poor bladder control and poor vaginal lubrication. This can result in discomfort and inconvenience that may affect a woman's labido.
Poor bladder control occurs when the nerves to the bladder are damaged and this may lead to an inability to empty the bladder completely. Women are advised to urinate before intercourse and within 30 minutes after. The American Diabetes Association advises people suffering from inconsistent urine release to follow a planned bladder emptying programme whereby they try to urinate every hour until the bladder feels full.
Poor vaginal lubrication can occur if neuropathy affects the nerve fibres that stimulate the genitalia so that arousal may not occur so making intercourse painful [dyspareunia] because the lubrication fluids are not produced. This situation can be helped by the use of a lubrication jelly from the pharmacy [eg KY Jelly] or for women that find that lubricating jelly diminishes their labido, a mild skin cream may be more helpful.
Note: Poor vaginal lubrication can also be cause by low hormone levels which can affect women with and without diabetes. This needs to be diagnosed by a doctor and if necessary treated with hormone replacement therapy.
Low sex drive
A lack of interest in sex can affect both men and women. It may be a factor throughout life but if a temporary phase, it can be caused by psychological factors such as depression, tiredness or hormonal problems or linked to certain medicines. The medicines that can affect a low sex drive are tranquillisers, the Pill, antidepressants and pills for high blood pressure - some of which are commonly used by people with diabetes. It is advisable to discuss this with your doctor to consider changing medications.
Poor sleep may lower women’s libido – a study has found that low libido during menopause may be linked to disturbed sleep. This is the first time that sleep disturbances have been independently associated with diminished sexual desire. Of the 341 women in the study, 64% reported a low libido and 43% said they had trouble sleeping. [American Journal of Obstetrics and Gynecology, June 2007]
Painful sex in women
Pain during sex [dyspareunia]can be superficial or deep pain. Superficial pain is often caused by infections such as thrush, common in women with diabetes or by vagismus, a condition that causes the lower vaginal muscles to go into spasm. Deeper pain can be caused by a lack of lubrication or stimulation or by conditions such as pelvic inflammatory disease or endometriosis.
Hypoglcaemia and sexual intercourse
For men it is well recognised that intercourse uses up large amounts of energy - the old joke about it being the same as running a 4 minute mile! So it is necessary to be aware that this could cause a hypo.
But women should also be aware of hypos during and after sex and there are those that recommend that Some women put out an adrenalin response while they are having intercourse and this produces a loss of control, sweating and erratic heartbeat. These symptoms are similar to those of a hypo and so it is important that the two are not confused. Checking blood glucose levels before and after sex is recommended. While this may sound a little contrived and perhaps takes away some of the spontaneity, it does serve to emphasise that women with diabetes do have added difficulties compared to women without diabetes.
Ref 1 Diabetes Care 2002;25:672-676