Diabetes and Men: Sexual Issues
Reviewed By Brunilda Nazario, MD
A funny thing happened to Jim Turner years ago when he was hiking with a girlfriend. It was evening and the two were lying on a blanket under a full moon. The conditions were perfect for romance. "And I just had zero interest in sex," says Turner, an actor and dLife television host, who has type 1 diabetes. "I was lying there staring at the moon. My girlfriend looked at me and said, ‘Why are you sweating so much?’"
These were the days before he regularly tested his blood sugar levels and Turner hadn’t realized his levels were so low. But even now, with testing, he says sexual spontaneity can take a hit when you have diabetes.
Diabetes is a leading cause of sexual issues in men. Some issues, like loss of spontaneity, can be chronic irritants. Some, such as erectile dysfunction (ED) — the inability to get or keep an erection — are easy to recognize. Others, such as decreased desire for sex or low testosterone, can creep up on you.
"Decreased libido moves slowly, like a glacier," says R. Keith Campbell, distinguished professor in diabetes care and pharmacotherapy at Washington State University, who has type 1 diabetes. "You may not even notice it until your partner says, ‘You haven’t tried to have sex with me for six weeks.’"
Whatever the problem, there are effective solutions for diabetes-related sexual issues in men. Read on to learn about them.
Diabetes and Men: What Causes Sexual Problems?
Men with poor blood sugar control are most likely to have sexual issues. Prolonged high blood sugar levels can damage nerves and blood vessels, including those in the penis. This disrupts blood flow and can cause erectile dysfunction. Sexual issues can also happen in men with good diabetes control, but they are usually milder and easier to treat.
About half of men who’ve had diabetes for more than 10 years have erectile dysfunction (ED), and men with diabetes tend to develop it 10 to 15 years before other men. If you have trouble achieving and maintaining an erection more than half the time, you may have ED.
Depression or emotional problems and some medications can also cause ED. "Fortunately, none of the medications used to treat diabetes cause sexual dysfunction in men or women," says Vivian Fonseca, MD, FRCP, chief of endocrinology at Tulane University School of Medicine in New Orleans and president-elect of medicine and science for the American Diabetes Association. "However, high blood pressure is common in people with diabetes, and some blood pressure medications — such as beta blockers, clonidine, and diuretics — are more likely to cause ED than others."
Erectile Dysfunction and Heart Disease
Men with erectile dysfunction and diabetes are also more likely to have heart disease, another diabetes-related risk, because the same problems that block blood flow in the penis block it in the heart. So any lifestyle practice that is bad for your heart — such as smoking, being sedentary, and being overweight — also hurts your ability to have or sustain an erection.
"For men with type 2 diabetes, erection problems are usually just the tip of the iceberg," says Ira Goldstein, MD, director of San Diego Sexual Medicine at Alvarado Hospital.
More than 13 million men experience low testosterone, and men with diabetes are twice as likely to be among them. "Especially with type 2 diabetes, men with abdominal fat usually have significantly lower testosterone levels than other men," Campbell says.
About 70% of men who have low testosterone say they also have symptoms of low testosterone, such as erectile dysfunction, and 63% say their sex drive is reduced. Low testosterone can also cause depression or fatigue. Yet it often goes undiagnosed, partly because the symptoms are similar to those of other conditions.
If you have symptoms of low testosterone, a simple blood test will confirm whether it is the cause. Low testosterone is easily treated by prescription skin patch, injection, topical solutions applied to the gums, or gel applied to the skin.
Diabetes and Sex: Treating Erectile Dysfunction
A variety of methods, which are sometimes combined with low testosterone treatments, can improve erections in men with diabetes:
- Oral medications. Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are FDA-approved for treating ED. All of them begin working within a half hour. How long these medications are effective in producing an erection with stimulation varies, from about four hours for Viagra and Levitra to 36 hours for Cialis. They can’t be used with some medications, and they can cause side effects — notably, erections that may last more than four hours. But for up to 60% of men with diabetes, they are effective in treating ED.
- Injections. If oral drugs don’t work, the injectable medication alprostadil (Caverject, Edex) may help. Like oral medications, it dilates blood vessels in the penis, encouraging blood flow. You inject this type of medication into the base of the penis. "It sounds painful, but men who use it love it," Campbell says. Erections come fast and may last a couple of hours. Penile injections can only be done three times a week and can cause scarring or prolonged erections. But they are effective in up to 90% of men with diabetes.
- Prostaglandin suppositories. Muse pellets are tiny suppositories, the size of a grain of rice, that are injected into the tip of the penis. They work like other medications, relaxing the muscles and dilating the blood vessels. Suppositories are easy to use and can be used twice a day. But they have downsides, including expense and testicular pain, burning, and dizziness in some cases. They can also cause burning in your partner. They are successful in about 35% of men.
- Devices. Vacuum pumps, constriction bands, and penile support sleeves are other options. Constriction bands keep the blood in the penis once it’s erect, so they can be especially useful if you can get an erection but have trouble keeping it. Vacuum pumps are inexpensive, can be purchased at a pharmacy without a prescription, and work to some degree on virtually all men. But they are more complicated to use than constriction bands. "They require a lot of lubrication, a lot of stimulation, and your partner’s participation," says Campbell. Penile sleeves or implants can be good choices for men who are physically unable to get an erection.
7 More Sexual Solutions
"You don’t want to over-think sex, but if you’re aware of different aspects of sex with diabetes, you can develop a process that works," Campbell says. These tips may help:
Don’t sweat spontaneity. It’s easy for thoughts of diabetes-related differences or inadequacy to dampen your sex drive, especially after you have children and the window for intimacy shrinks. "You start checking your blood sugar and making adjustments a couple of hours ahead," Turner says. "And then you start kicking yourself: Why can’t I be normal? And you lose your confidence."
Remember that other people are in the same boat, says Janis Roszler, RD, CDE, LD/N, a diabetes educator and coauthor of Sex and Diabetes. "Every couple with kids has things they have to arrange so they can be intimate," she says. "Everyone has stuff that gets in the way of intimacy."
Know your body at different blood glucose levels. "I encourage men to learn how sex is for them at different blood sugar levels," Campbell says. "Then they can determine their own best levels for having sex."
Some experts recommend checking blood sugar levels regularly before sex to guard against hypoglycemia. Others say it’s an individual choice that depends on factors such as whether you’re prone to hypoglycemia at night or after vigorous exercise. If you decide to do testing before sex, Campbell says, "Don’t make it part of the sexual process."
Get moving. The more you exercise, the less likely you are to have erectile dysfunction.
Treat depression. Emotional issues — such as stress, depression, anxiety, and conflict with your partner — can affect any couple’s sex life and relationship. If you’ve been feeling depressed for two weeks or more, talk to your doctor. Counseling or medication can help depression and other emotional issues.
Eat right: The Mediterranean diet. Some research shows that erectile dysfunction is less common in men with type 2 diabetes who follow a Mediterranean diet. Other research has shown that the Mediterranean diet reduces metabolic syndrome — the grouping of obesity, insulin resistance, blood pressure, and abnormal lipids that increases a person’s risk of heart disease, diabetes, and stroke. Ask your doctor if the diet, which focuses on fruits, vegetables, potatoes, beans, and whole grains, is right for you.
Don’t smoke. In addition to causing cancer, heart disease, and emphysema, smoking can also contribute to ED. In fact, men who smoke are about twice as likely to develop ED than those who don’t smoke. So if you smoke, it’s one more good reason to quit.
Limit alcohol. Excessive drinking can also affect ED. Alcohol restricts blood flow to the penis and can affect how much testosterone your body produces. Both these things can have an effect on your sex drive and erection