Diabetes and sex

By Madeleine Castellanos, M.D.

Diabetes is a progressive disease that can debilitate one's body organ by organ when left out of control. It's most famous for contributing to heart disease, stroke, peripheral vascular disease, blindness, renal failure. But long before any of these take place, diabetes can kill your sex life.

Diabetes itself is not responsible for the damage done to the body. Instead, it is the rise in blood sugar that comes from either insufficient insulin release (type 1) or a body's resistance to the effects of insulin (type 2). 

Type 2 begins as an adult and is almost always related to being obese or overweight for some time. Often, it can be reversed if a person returns to a normal weight. Many doctors are happy if they see their diabetic patients maintain their blood sugar under 150, or even 180 if they have had the disease for some time. I believe that these levels permit slow degeneration of the tissues and nerves of the body which can severely affect one's quality of life. Ideally, a level between 80 and 125 is best.

Good sexual functioning depends on good blood flow and the ability to not only perceive sensations, but to have the organs and tissues respond to these sensations. When a person's blood sugar is high, cells cannot function properly and nerve endings become damaged. This can cause numbness, or worse: uncomfortable tingling. Having uncontrolled levels of blood sugar also causes damage to the blood vessels in the form of decreased ability to relax and contract when needed as well as increased atherosclerosis decreasing blood flow.

Ways that nerve damage manifests for someone with diabetes could be a decreased sensation in their genitals. When this happens, it becomes more difficult to become aroused when touched or stroked. Impaired blood flow commonly causes erectile dysfunction in men and lack of lubrication or difficulty reaching orgasm in women. To make matters worse, patients with diabetes have a poorer response to medications for erectile dysfunction.

One of my goals is to inform people of how the choices they make today can affect their tomorrow. Maintaining very careful control of one's blood sugar can prevent this damage, but requires close attention to food choices, avoidance of sugar and simple carbohydrates, portion control and complete compliance with diabetic medications. The damage to one's sex life can sneak up on you, but is very disheartening when it happens. Prevention is key. Before the damage is done.

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