Addressing the Sexual Problems of Diabetic Women

Diabetes need not hinder a happy, healthy sex life

by Shauna S. Roberts

Once, researchers basically ignored women's sexual problems. The only area deemed worthy of study involved difficulties bearing children.

Times are changing. As the Baby Boomers age, menopause and its problems are attracting more attention. And the increasing number of people with diabetes encourages more researchers to focus on diabetes-related problems, including sexual problems in women.

Sexual Problems Of Women With Diabetes

Experts divide women's sexual problems into four general categories:

• Lack of sex drive (libido), including a lack of sexual fantasies
• Problems becoming aroused (not enough vaginal lubrication, not feeling aroused, decreased sensation, tight vaginal muscles)
• Recurrent or persistent delay in or lack of orgasm
• Recurrent of persistent pain during sex or sexual stimulation

Experts label these situations "problems" only when they cause a woman distress. For example, a woman who has no partner may not consider lack of sex drive to be a problem.

Women with diabetes can experience all four problems. What scientists don't yet know is whether these problems are more common in women with diabetes than in other women. What little research has been done has produced conflicting results. For example, some studies have found women with diabetes have decreased libido compared with other women; others haven't. Estimates of the percentage of women with diabetes who have decreased sexual desire vary widely, ranging from 4 to 45 percent.

However, when it comes to arousal difficulties, research results have been fairly consistent: Women with diabetes appear to be twice as likely as other women to have decreased lubrication of problems becoming sexually stimulated.

Diabetic nerve disease is a major cause of impotence in men with diabetes. Men's and women's bodies are similar enough that researchers have expected nerve disease to underlie sexual problems in women with diabetes, too. But so far, research has found no link.

Two studies have looked at whether poor blood glucose (sugar) control or diabetes complications are associated with sexual problems in women with type 1 diabetes, as they are in men. Neither study found such an association. However, one of the studies found that the more complications a woman had, the more sexual problems she was likely to have.

One important way that diabetes affects women's sexuality is through its psychological effects. Diabetes doubles the risk of depression, a known cause of sexual problems in women. Diabetes changes a couple's relationship, sometimes for the worse. Having a chronic illness can damage self-esteem and alter a woman's perception of her desirability. Like a stone thrown into a pond, the psychological effects of diabetes ripple throughout many aspects of life, including sex.

High blood glucose levels also make it easier to get urinary infections and yeast infections, which can make sex uncomfortable.

In addition, women with diabetes can develop sexual problems for the same reasons as other women. One cause is menopause. The drop in hormones during menopause can reduce the sex drive. When estrogen levels drop, the lining of the vagina can become thin, which can make sex painful. Also, lubrication may decrease, possibly leading to pain during sex.

Other factors that increase the risk of sexual problems are:

• Having a disease involving the nerves, such as Parkinson's disease of a spinal cord injury
• Having a chronic illness
• Having had genital surgery
• Having liver or kidney failure
• Having disease of the blood vessels of the feet and legs
• Having been abused sexually
• Being under stress
• Having problems in a relationship
• Taking certain drugs (A wide variety of common drugs, including antihistamines, some kinds of high blood pressure pills, birth control pills, alcohol, and antidepressants, can cause sexual problems in women.)
• Worrying about getting pregnant

Treatments

One easy and cheap self-help remedy for vaginal dryness is using a water-based lubricant during sex. Several kinds of lubricant are available without a prescription at your pharmacy or grocery store. For many women with arousal problems, a lubricant may be all they need to have sex comfortably.

Other things you can try yourself are to stop smoking, drink alcohol moderately or not at all, and get your blood glucose levels under good control. Even though the studies mentioned earlier failed to find a link between poor control and women's sexuality, doctors believe it probably does have an effect. High glucose levels can damage blood vessels and nerves, both of which play crucial roles in sexual response.

If self-help measures aren't enough, it's time to see your health care provider. The solution may be as easy as treating an infection or switching to a different blood pressure medicine.

If your problems stem from menopause, hormone replacement therapy may help. Treatment with the female hormone estrogen can help atrophy of the vagina, pain during sex, and genital insensitivity. Although estrogens can be taken as pills or patches, estrogen cream or a vaginal ring used directly in the vagina work better. Women who still have their uterus should take progestin when they take estrogen to protect the lining of their uterus from cancer.

However, taking estrogens after menopause has been linked to a higher risk of heart attack, stroke, breast cancer, and gall bladder problems. Because of this, doctors now prescribe estrogens after menopause with great caution.

Young women make both male and female hormones. Production of male hormones drops off greatly in the premenopausal years. Some doctors treat lack of desire in women after menopause with testosterone and other male hormones. But this kind of hormone therapy does not have Food and Drug Administration (FDA) approval and may be risky. There have been reports of women with diabetes whose blood glucose levels rose while they were taking testosterone. In addition, doctors believe it can cause acne, liver disease, and facial hair growth.

Some drug companies that make impotence drugs for men are testing these drugs in women. These drugs include sildenafil (Viagra), tadalafil (Cialis), and alprostadil in gel form. All target arousal problems. None has yet been approved by the FDA for this use; in fact, it's not yet clear whether any of them even work in women. .

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Because the most common causes of sexual problems in women with diabetes are psychological, your health care provider may refer you to a mental health professional who has training in treating sexual problems. Your therapist can help you work through depression, deal with stress, come to terms with your self-image as a woman with diabetes, or deal with whatever else is disrupting your sex life.

If you have genital pain or if your doctor thinks your sexual problems may be due to menopause, he or she may refer you to a gynecologist for diagnosis and treatment.

Last, but certainly not least, talk to your partner about the problems you are having. Together, you may be able to work out a solution--for example, by trying different positions that are more comfortable, or by taking more time with the arousal stage.

Shauna S. Roberts, PhD, is a science and medical writer and editor in New Orleans, La.

Written in 2004. Last reviewed: 10/05

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