Poorly controlled diabetes can affect a person’s interest in sex, called the libido, and their physical ability to carry out sexual activity. Sexual activity is one of the most vulnerable areas when a person with diabetes is depressed. In that area, depressed people with diabetes report more problems than those without it. Depression also takes its toll on energy levels, which makes it difﬁcult to work up much enthusiasm for sex.
The physical symptoms of diabetes, whether acute (such as vaginal infections) or long-term (such as trouble holding an erection for men) can also take a toll on sexual pleasure. High blood sugars generally make you feel dragged out, not a condition that enhances interest in sex! Fortunately, there are things you can do to improve your sexual experiences by paying attention to both the psychological and physical aspects.
There are other problems for women with diabetes. For one thing, the dryness in a woman’s mouth is often matched by vaginal dryness. In addition, when diabetes is out of control, a woman is very likely to develop vaginal infections (speciﬁcally moniliasis and candidiasis). The itching and discomfort caused by these infections naturally make sex less appealing. But these symptoms will all improve when she gets her sugar into control.
Poor blood sugar control over months to years may lower a woman’s estrogen levels, and this will cause inadequate vaginal lubrication. A woman can use topical ointments to improve lubrication or estrogen replacement in the form of pills, patches, or vaginal creams.
Some of the emotional and physical problems caused by diabetes can decrease libido in men, just as in women. Sexual problems for men are often more evident because of the ability or inability to have an erection.
A typical long-term complication of poorly controlled diabetes is a deterioration of potency—the failure to have or keep an erection. Having and maintaining an erection is a complex process involving psychological, hormonal, vascular, and nervous systems. To have an erection, all systems must be functioning well. Like most diabetes-related problems, interest in sex is affected by recent blood sugar control. Good control is generally associated with high levels of libido and well-being, sexual and otherwise.
Struggling with erections can be permanent or temporary. Temporary impotence can be caused by exhaustion, overconsumption of alcohol, ingestion of some prescription drugs, and worry, especially the worry that you might be impotent. If you are erection challenges, you must determine whether the cause is physical or psychological. Don’t shy away from the possibility that it is “all in your head.” The strongest, most brutal men get just as stressed, depressed, and anxious as anyone else.
You can start to ﬁnd the answer by asking yourself these questions:
—Did the erection problems begin suddenly?
—Is the erection problem on and off, sometimes or in some situations being complete and in other situations being no problem at all?
—Do you get an erection when you masturbate? (;-) ouch, personal!
—Do you have erections during the night, when you wake up, or when you are sleepy or bored?
If your answer to any of these questions is yes, then psychological factors are at least a part of your problem. This is good because counseling and recognizing the psychological roots may lead to a correction. If you essentially never have erections (at night, when bored or sleepy, fantasizing or masturbating or trying to!), then there is a physical problem.
More general psychological factors, such as anxiety or depression, may also lead to erection problems in men. Although the numbers vary widely, It is estimated that 10% to 67% of men experience erection problems that can be tied directly to their mental health.
Neuropathy is the most common physical cause of impotence. Autonomic neuropathy is usually associated with peripheral neuropathy and is a long-term complication of high blood sugar. Erection problems are partial at ﬁrst, causing difﬁculty in maintaining an erection. It may ﬂuctuate to some degree but is not related so much to the situation: you may be very interested and aroused, but “the ﬂesh just isn’t willing.” Over the years, it can progress to a complete inability to achieve an erection.
Vascular problems that interrupt blood ﬂow to the penis also contribute to impotence. They occur more often in older men with diabetes, especially those with heart disease or evidence of poor circulation to their feet. Hardening of the arteries (Atherosclerosis) blocks blood ﬂow to the penis and prevents it from becoming erect and ﬁrm. Smoking is a significant contributor to this problem. You should also be aware that many prescription medications can contribute to impotence, including blood pressure drugs such as beta blockers and diuretics, some antidepressants, ulcer medications, and medicines to prevent vomiting.
A decrease in the male hormone testosterone may also cause impotence, though this is a less common cause. Most men don’t have a problem with their hormones, but this is something that your Doctor can easily check with a blood test.
There are several successful approaches to treating erection or sexual problems. Even if you are embarrassed, try to bring up the subject in talking with those who can help. Most people think about their sex life but rarely talk about it, even with their partner. Some people ﬁnd it hard even to bring up the subject with a doctor or nurse. Sexual experiences are significant but very personal. If you are in a relationship, you should speak with your partner. He or she may have been feeling that it was all his fault. Talk with your Doctor too. You will probably have to bring up the topic yourself, especially if your physician is a man. A survey of physicians (both male and female) showed that 85% of the doctors regularly asked their male patients about sex, but only 33% regularly asked their female patients the same question.
If you are depressed, counseling, possibly combined with antidepressant medication, may help. You should also ask yourself whether your sexual dissatisfaction could be related to fears of pregnancy. Suppose you have addressed the emotional and physical components of sex together with your partner and Doctor, and things still aren’t going well, I will advise you to seek help from a mental health professional who is specially trained in dealing with sexual problems.
Several medications have been used, and new ones are coming out to treat erection problems. Common drugs used in Kenya are Sildenafil (Viagra), other names; Aronix, Liberize, Nipatra, Revatio, Grandipam, and tadalafil (cialis). Please speak to your doctor about the medication and contraindications. If your impotence is caused primarily by inadequate blood ﬂow, you could take an oral medication called yohimbine. This drug works for some people, but it can aggravate high blood pressure.
Don’t, and I repeat, DO NOT purchase any of the above drugs over the counter.