Why Bother About Sex?

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Diabetes brings many demands. Maya, a recently diagnosed woman, told me “I don’t have time or energy to think about sex right now.” But there are many reasons to have a good sex life with diabetes, and many ways to do it.

Why sex is good for you
I used to speak and write a lot about sex and chronic illness, but lately I’ve lost some interest in it. In the last two weeks, though, I have noticed some of what people miss out on when they don’t have sex.

• Self-concept/self-esteem. We definitely feel better about ourselves after a good sexual experience.

• Better mood, more happiness. Researchers from Dartmouth College and the University of Warwick studied 16,000 people. A WebMD article reports they found that “Increasing intercourse from once a month to once a week is equivalent to the amount of happiness generated by getting an additional $50,000 in income.”

I don’t think sex has to be intercourse. Most of the sex I have does not involve intercourse, but the closeness and pleasure still makes me happier.

• Improves relationships and provides emotional support. Contact is comforting and brings people closer together. Sexual contact strengthens pair bonds through release of the hormone oxytocin. My partner and I have a good relationship with or without sex, but it’s better with than without.

• Other benefits of oxytocin are improved sleep and lower blood pressure. Note that all loving contact releases oxytocin, but orgasm releases more. Sex also causes release of endorphins, which relieve pain.

How diabetes interferes with sex
That’s a good (and partial) list of benefits. If we like our life better, we’ll probably maintain better self-management to keep it going. Lowering blood pressure and improving sleep have direct health benefits.

But so what? Most of us would be having better sex if we could, but life and diabetes can make that hard to do. Diabetes can interfere with sex in at least six ways.

1. Problems with the mechanics of sex — erections in men, lubrication in women, pain with intercourse or difficulty with orgasm — are called “primary sexual dysfunction.” They are much more common in people with diabetes because of circulation and nerve problems in the genital area.

2. Other symptoms, such as fatigue, pain, or numbness, are called “secondary dysfunction” and make sex more difficult and less pleasurable.

3. Psychological effects of diabetes can include depression, anxiety, and feeling unattractive. All of these reduce interest in sex.

4. Medication effects — many commonly used medicines (mostly for blood pressure and depression) dampen sexual desire and function.

5. Loss of desire — due to low hormone levels (testosterone, estrogen), fatigue, or high or low glucose.

6. Low blood glucose — like any vigorous exercise, sex can cause blood sugar to drop. If it gets too low, both you and your partner may be afraid to have sex again. If this ever happens to you with sex, test before things get hot.

Ways to make sex better
There are too many treatments to list in one blog entry, and I’d like to hear what has worked for you. But here are some:

• For erection difficulties, a class of drugs known as PDE5 inhibitors work in about 50% of men with ED and diabetes. New drugs keep coming out. If they don’t work for you, other good approaches include vacuum pumps, constriction rings, or an implanted penile prosthesis. (Yes, these approaches work.)

• For dryness, over-the-counter lubricants should work fine. For pain with intercourse, estrogen rings or vaginal tablets often work well.

• Better glucose control — sex difficulties have a close correlation with A1C elevation. So better control helps. At the same time, many men report that a slightly higher glucose level at the time of sex helps them have a better time.

• Try different positions to avoid pain or discomfort with intercourse.

• Get enough rest — don’t make sex an afterthought at the end of a tiring day. And don’t go to bed straight from work, housework, childcare, or the computer. Take some romantic time and some calming-down time to get in the mood.

• Be creative — sex doesn’t have to always be about intercourse. Read up or explore what you can do with your hands, mouths, and other body parts. Our whole bodies can be sexy.

• Deal with relationship issues — sex makes relationships better, but a good relationship makes sex much better. Talk about or get help with what is bothering you. Paula Trief wrote a good article for us on improving relationships with diabetes.

• Investigate the effects of your medications — if you’re having sex problems and you’re on medicines for high blood pressure or depression, mention this to your doctor. Perhaps your treatment can be changed.

• Love yourself — if you are depressed, or if you feel unattractive or unlovable, it is not likely you will find a partner or have good sex. Get help with depression.

What do you think? If you want to know more about any of these topics, let me know in a comment. Please let us know about issues you may be having and what is working for you.

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