Sexual and Urologic Problems of Diabetes: Diabetes and Sexual Problems

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Sexual and Urologic Problems of Diabetes: Diabetes and Sexual Problems
National Diabetes Information Clearing House

Diabetes and Sexual Problems
When you want to lift your arm or take a step, your brain sends nerve signals to the appropriate muscles. Internal organs like the heart and bladder are also controlled by nerve signals, but you do not have the same kind of conscious control over them as you do over your arms and legs. The nerves that control your internal organs are called autonomic nerves, and they signal your body to digest food and circulate blood without your having to think about it. Your body's response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax. Damage to these autonomic nerves is what can hinder normal function.

Sexual Problems in Men With Diabetes
Erectile Dysfunction
Estimates of the prevalence of erectile dysfunction in men with diabetes range from 20 to 85 percent. Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection, the inability to sustain an erection, or the occasional inability to have or sustain an erection. A recent study of a clinic population revealed that 5 percent of the men with erectile dysfunction also had undiagnosed diabetes.

Men who have diabetes are three times more likely to have erectile dysfunction as men who do not have diabetes. Among men with erectile dysfunction, those with diabetes are likely to have experienced the problem as much as 10 to 15 years earlier than men without diabetes.

In addition to diabetes, other major causes of erectile dysfunction include high blood pressure, kidney disease, alcoholism, and blood vessel disease. Erectile dysfunction may also occur because of the side effects of medications, psychological factors, smoking, and hormonal deficiencies.

If you experience erectile dysfunction, talking to your doctor about it is the first step in getting help. Your doctor may ask you about your medical history, the type and frequency of your sexual problems, your medications, your smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes. Your blood glucose control and hormone levels will be checked. The doctor may also ask you whether you are depressed or have recently experienced upsetting changes in your life. In addition, you may be asked to do a test at home that checks for erections that occur while you sleep.

Treatments for erectile dysfunction caused by nerve damage, also called neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed in the urethra, and shots directly into the penis, to surgery. All these methods have strengths and drawbacks. Psychotherapy to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries is another option.

* Sairam K, Kulinskaya E, Boustead GB, Hanbury DC, McNicholas TA. Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction. BJU International. 2001;88(1):68–71.

Retrograde Ejaculation
Retrograde ejaculation is a condition in which part or all of a man's semen goes into the bladder instead of out the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. The semen mixes with urine in the bladder and leaves the body during urination, without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. His urine may appear cloudy; analysis of a urine sample after ejaculation will reveal the presence of semen.

Poor blood glucose control and the resulting nerve damage are associated with retrograde ejaculation. Other causes include prostate surgery or some blood pressure medicines.

Retrograde ejaculation caused by diabetes or surgery may be improved with a medication that improves the muscle tone of the bladder neck. A urologist experienced in infertility treatments may assist with techniques to promote fertility, such as collecting sperm from the urine and then using the sperm for artificial insemination.

More Information on Erectile Dysfunction
For additional information, see the fact sheet Erectile Dysfunction, available from the National Kidney and Urologic Diseases Information Clearinghouse at 1–800–891–5390. This fact sheet is also available online.

Sexual Problems in Women With Diabetes
Decreased Vaginal Lubrication
Nerve damage to cells that line the vagina can result in dryness, which in turn may lead to discomfort during sexual intercourse. Discomfort is likely to decrease sexual response or desire.

Decreased or Absent Sexual Response
Diabetes or other diseases, blood pressure medications, certain prescription and over-the-counter drugs, alcohol abuse, smoking, and psychological factors such as anxiety or depression can all cause sexual problems in women. Gynecologic infections or conditions relating to pregnancy or menopause can also contribute to decreased or absent sexual response.

As many as 35 percent of women with diabetes may experience decreased or absent sexual response. Decreased desire for sex, inability to become or remain aroused, lack of sensation, or inability to reach orgasm can result.

Symptoms include

decreased or total lack of interest in sexual relations

decreased or no sensation in the genital area

constant or occasional inability to reach orgasm

dryness in the vaginal area, leading to pain or discomfort during sexual relations
If you experience sexual problems or notice a change in your sexual response, talking to your doctor about it is the first step in getting help. Your doctor will ask you about your medical history, any gynecologic conditions or infections, the type and frequency of your sexual problems, your medications, your smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may also help pinpoint causes. Your blood glucose control will be discussed. The doctor may ask whether you might be pregnant or have reached menopause and whether you are depressed or have recently experienced upsetting changes in your life.

Prescription or over-the-counter vaginal lubricant creams may be useful for women experiencing dryness.

Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations. Psychological counseling, as well as Kegel exercises to strengthen the muscles that hold urine in the bladder, may be helpful. Studies of drug treatments are under way.