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Sexual Health: Love, Lust and Life

Winning the Uphill Battle: Sexual Dysfunction and Diabetes

By Naomi Mendelsohn

Just because someone has diabetes, doesn't mean we can blame sexual dysfunction on the disease.

Impotence is a little word that strikes fear into the hearts of men and women everywhere. Especially when you look at the statistics. An estimated 31 percent of American men and 43 percent of women suffer from some form of sexual dysfunction.

But this fear strikes deeper into the hearts of people with diabetes. Shockingly high percentages of men with diabetes, over 50 percent of men over 50, and approximately 35 percent of women with diabetes suffer from some form of sexual dysfunction related to their disease.

But fear not. There are many factors involved in diagnosing sexual dysfunction. And, often, all it takes is some education and good, tight glucose control to get you back in the saddle again.

The skinny: men

"As you look at men over 50 with diabetes, over half have erectile dysfunction," explains Kenneth Snow, M.D., director of the Sexual Function Clinic and Senior Staff Physician at the Joslin Diabetes Center. "This is much more than the general population."

Erectile dysfunction manifests itself in men with diabetes in several ways. The most common problem is the inability to attain and maintain an erection adequate for intercourse. The second largest problem for men is retrograde ejaculation, or when the semen is ejaculated back into the bladder instead of out through the penis.

"Although this might be psychologically disconcerting to men who experience it, medically, it's not a problem that needs to be dealt with," Dr. Snow assures.

The skinny: women

Unfortunately, there is a lack of information about women's sexual dysfunction in general. This translates into a lack of information about this same disorder in women with diabetes.

"There is next to nothing published about sexual dysfunction in diabetic women," explains Julie Sharpless, M.D, endocrinologist at the Joslin Diabetes Center. "Therefore one could only speculate about most questions."

What we do know, however, is that sexual dysfunction manifests itself differently in women than in men. Some symptoms include poor vaginal lubrication, a decrease in sexual desire, painful intercourse and inability to, or difficulty in, having an orgasm.

"Often times the problems center around the production of estrogen," explains Dr. Snow. "Premature menopause is more common in women with type 1 diabetes and women whose diabetes is not tightly controlled."

However, Dr. Snow also cites a lack of information as a leading problem in helping women with diabetes overcome their sexual dysfunction.

"We don't even have a good sense of how common the problems are in diabetic women, let alone the best therapy," says Dr. Snow.

Hope on the horizon

The good news for both men and women is that sexual dysfunction is easily treated if diabetes is found to be the problem. According to Dr. Snow, tight glucose control is key.

"Men who have poorly controlled blood sugars are more likely to develop sexual dysfunction and other complications."

The bad news, however, is that diabetes is not always the root of the problem.

"Just because someone has diabetes, doesn't mean we can blame sexual dysfunction on the disease," Dr. Snow cautions. "The first issue is to clarify what the problem is and then decide whether the cause is organic or psychological or both."

Dr. Snow cites a number of potential causes that can result in sexual dysfunction.

"If there's evidence that it's organic in nature, we have to define what the problem is. Is it related to blood sugar or complications with diabetes? Is there a psychological component?"

What can you do?

The first thing to do is talk to your doctor or diabetes team. This is crucial, especially in people with diabetes, because some medications for sexual dysfunction are incompatible with medications used to treat other diabetes complications.

"For example, some diabetics have heart disease, diagnosed or undiagnosed," explains Dr. Snow. "Some medications, like nitrates which are used to ease heart disease, are contra-indicated with Viagra. When men start having sex again, it will bring out the heart disease. This is a horrible way to find out."

A doctor or diabetes team can help you steer clear of any potentially dangerous drug combinations. They can also help determine the root of the sexual dysfunction and create an appropriate treatment plan which might include tighter glucose control, medication and therapy.

What the future holds

In the wake of Viagra's success, doctors and pharmaceutical companies are on the lookout for new therapies to cure sexual dysfunction. Dr. Snow points to advances in research as hope for all people, men and women, with and without diabetes, suffering with sexual dysfunction.

"We have a better understanding of the chemical signals that go on," explains Dr. Snow. "So, now we know where we can possibly attack the problem."

Naomi Mendelsohn is a content editor at savvyHEALTH.com.

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