Sexual Dysfunction & Diabetes:Treatment of sexual dysfu...

Sexual Dysfunction & Diabetes:Treatment of sexual dysfunction

Sexual Dysfunction & Diabetes:Treatment of sexual dysfunction
Robert Cooper, M.D., FACE
yourtotalhealth.com

Left untreated, sexual dysfunction can affect a person’s quality of life. It can increase stress, trigger feelings of depression and even interfere with management of glucose (blood sugar) in people with diabetes.

Treatment of sexual dysfunction is directly related to its cause. Sometimes the solution for sexual problems is clear. For instance, if sexual difficulties stem from factors such as smoking or abuse of alcohol, normal sexual functioning may resume after an individual makes the appropriate lifestyle modifications (e.g., restricting consumption of alcohol, quitting tobacco).

Sexual dysfunction associated with high blood pressure, a major diabetic risk factor, can often be reversed by reducing blood pressure through exercise, diet and, if necessary, medications. Individuals who experience sexual difficulties because of psychological factors may benefit from mental health counseling or sex therapy.

Sexual dysfunction caused by long-term nerve damage (autonomic neuropathy), on the other hand, cannot generally be reversed, although researchers are studying ways to repair nerve injury caused by diabetic neuropathy. However, patients can help prevent further damage from neuropathy – and vascular disease - by controlling glucose. This can be achieved with insulin therapy, exercise and diet in individuals with type 1 diabetes and exercise, diet and (if necessary) medications in those with type 2 diabetes or other forms of diabetes, as recommended by the individual’s physician.

The Diabetes Control and Complications Trial (DCCT), the largest and most thorough diabetes study to date, concluded that maintaining near-normal glucose levels reduced diabetic patients’ risk of developing nerve damage by 60 percent.

Treatment options for men with diabetes who experience sexual dysfunction may include:

Medications to treat erectile dysfunction (the inability to have or maintain an erection). These oral medications, one of the most commonly prescribed groups of drugs, are known as PDE-5 inhibitors. Researchers have studied use of these medications by diabetic men and found them to be generally safe and effective.
PDE-5 inhibitors are not used if a patient takes nitrates (type of heart medication) or cannot safely engage in intercourse because of certain cardiac or other conditions. Also, the U.S. Food and Drug Administration (FDA) has cautioned that a small number of men taking these drugs have suddenly lost vision or hearing.

In addition, certain medications may be directly injected into the penis or inserted into the urethra.

Hormone therapy. A deficiency of testosterone (male hypogonadism) often contributes to sexual dysfunction in men with diabetes. Testosterone can be administered to patients via injection, topical gel or a patch. However, some research indicates that this treatment might increase the risk of prostate enlargement or cancer. Thus, patients undergoing hormone therapy are advised to have regular prostate examinations. Other possible risks of testosterone therapy may include sleep apnea, baldness, skin problems, breast enlargement and excessive production of red blood cells.

Antibiotics for bacterial prostate or urinary tract infections.

Kegel exercises to strengthen the muscles of the pelvic floor.

Vacuum devices. The physician may recommend a vacuum tube and pump mechanism, which relies on pressure to deliver blood into the penis. The patient will place a band around the penis to sustain an erection after the vacuum tube is removed.

Surgery. The patient may decide to improve functioning by having penile implant surgery, in which a prosthesis is inserted into the penis. Surgery may also be performed to unclog blood vessels and allow more blood to reach the penis.
Treatment options for women with sexual dysfunction may include:

Over-the-counter or prescription vaginal lubricants.

Kegel exercises.

Hormones. Hormone replacement therapy (HRT) -- estrogen or a combination of estrogen and progesterone -- may improve vaginal lubrication and have some other benefits. Systemic (throughout the body) HRT, such as pills or injections, is no longer routinely prescribed to menopausal women because of possible risks including blood clots and breast cancer. A vaginal estrogen cream may be recommended. In some cases women may be prescribed testosterone.

Use of a handheld vibrator on or around the clitoris to increase sexual pleasure and achieve orgasm more easily.

Oral stimulation by a partner, which may induce orgasm.

Use of a clitoral engorgement device. The FDA has approved a prescription device that stimulates blood flow to the genitals using a vacuum. This mechanism, which increases lubrication and the ability to reach orgasm, can be used before intercourse to achieve arousal or as a method of self-stimulation.

Antifungal medications for yeast infections medications for yeast infections.

Antibiotics for bacterial urinary tract infections.
In addition, women with poor bladder control (neurogenic bladder) should empty their bladder before and after sexual intercourse.

A physician may also prescribe treatments for conditions that contribute to sexual dysfunction -- for example, exercise and diet for obesity, sleep therapy and relaxation training for fatigue, bladder training and anticholinergic drugs for overactive bladder, alpha blockers or 5-alpha reductase inhibitors for prostate enlargement, and antidepressants, therapy and exercise for depression.

Recent research suggests that medications that treat erectile dysfunction might also improve sexual satisfaction and relieve symptoms such as pain during intercourse in diabetic and nondiabetic women. However, further study is needed to establish this finding, and the FDA has not approved use of this medication by women.