Daniel Sher expands on how diabetes can cause problems for your sex life and offers five ways to take back control.
If you or your loved one live with diabetes, you’ll know that this condition is about so much more than simply cutting back on sugar. Chronic conditions have the capacity to impact us on so many levels, including in the bedroom.
How does diabetes affect your sex life?
How does diabetes affect the body; and what does this mean for your sex life? Poorly managed diabetes can cause damage to the body’s nerves and blood vessels over the long term.
Nerves and blood vessels are pretty important for most of the things that we do, but they’re especially important during sex. This means that men who have poorly managed blood glucose are three times more likely to develop erectile dysfunction, in which they struggle to get or maintain an erection. In women, poorly managed diabetes can lead to reduced vaginal lubrication, pain during sex and difficulties in reaching orgasm.
What else? In the short term, if your blood glucose is too low or high, you’re going to run into trouble when it comes to your sexual functioning. For men: it’s going to be nearly impossible to maintain an erection. For women, you’re not going to be able to orgasm. Therefore, it’s absolutely vital that your partner knows beforehand that you might need to take a break if you run into these sorts of problems.
What about the psychological side of diabetes and sex? Our thoughts and feelings are really important when it comes to our sexual responses. We know that poorly managed diabetes can affect the brain in a way that leads to depression and anxiety. Both depression and anxiety are really bad for your sex life. For example, they can lead to low libido and erectile dysfunction.
In some people, these issues can lead to sexual performance anxiety, in which distressing thoughts lead to a spiralling tornado of fear that interrupts the communication between your brain and genitals. Obviously, this is not what we want to happen during sex.
Stress: The silent (erection) killer
As people with diabetes, we are under a whole lot more stress than most. From the daily monitoring and medication doses, to the stigma, increased financial burden and threat of long-term consequences, the stress associated with diabetes can really take its toll. If left unchecked, this can lead to diabetes distress, or diabetes burnout.
What does this have to do with your sex life? High levels of stress can cause your brain to go into fight-or-flight mode, dumping adrenaline and stress hormones into your bloodstream. While these brain-body changes are great for helping you fight against or flee from a predator, they are not particularly useful when you’re trying to have sex.
What can you do?
1. Manage stress effectively
Because of the negative impact that diabetes-related stress can have on your sex life, good stress management is vital. Different people have different strategies which work for them. However, some examples of evidence-based stress busters include mindfulness meditation, yoga, any form of physical activity, spending time with friends, support groups for people with diabetes, creating art, dancing and limiting your caffeine and alcohol intake.
2. Treat symptoms of depression and anxiety
When feelings of sadness, hopelessness and worry get so severe that they stop you from being able to live your life normally, this may suggest that it’s time for some professional input. Remember that depression and anxiety go hand-in-hand with sexual dysfunction and low sex-drive and they can also make it harder to manage your diabetes. Therefore, it’s vital to get the right sort of support for these conditions.
Speak with a clinical psychologist about how therapy can help. It may also be a good idea to speak with a psychiatrist to work out whether medication is needed.
Similarly, if you are worried that you may be experiencing diabetes burnout, it’s important to get some support from a therapist or counsellor specialised in diabetes care.
Have you ever tried to hide your diabetes from a new partner? If so, you’re not alone. If you’re not sure how empathic and understanding your partner is going to be, you may be inclined to try to hide your condition from them.
For many, a diagnosis of diabetes brings with it powerful feelings of shame and embarrassment. Some fear that their partner will be repelled by this information, or by the sight of their pump or CGM.
Ultimately, however, it’s vital that you are open with your partner about your condition. The timing at which you decide to disclose this is completely up to you. While some prefer to wait until several dates or sexual encounters have passed before opening up about their diabetes, others choose to be transparent from the get-go.
The downside to waiting is that this can introduce an element of tension and anxiety into your interactions, because you are trying to conceal something. From a safety perspective, it’s also important that your partner knows what to do if you experience low blood glucose and become confused or disorientated.
4. Manage your diabetes as well as you can
The more optimal your blood glucose management, the better your sexual functioning is likely to be. Why? Poorly managed blood glucose sets you up for physiological issues (including neuropathy) which can have a serious negative impact on your sexual health. Furthermore, poorly controlled glucose can also lead to anxiety, depression and other psychological difficulties, which can worsen sexual functioning.
Work closely with your doctor and treating team to get the support you deserve. In addition to managing your diabetes, you may find it helpful to reach out to a doctor who specialises in sexual health, a qualified sex therapist, or a clinical psychologist with a special interest in sexual health.
Staying physically active is a great way of improving your blood glucose control and psychological well-being. As mentioned above, exercise is also a highly effective stress-buster which can also reduce symptoms of anxiety and depression. Exercise also affects your body positively by decreasing insulin resistance and oxidative stress, thereby helping you to avoid sexual and medical complications later down the line.
As people with diabetes, we are told that we are not defined by our diagnosis. However, there’s also no escaping the fact that diabetes forms an important part of our lives, whether we love it or hate it. At the end of the day, if your partner is uncomfortable about or unaccepting toward your diabetes, this suggests that they need to be doing some serious introspection. This also should serve as something of a red-flag to you, prompting questions about the sort of relationship that you want and need.
MEET THE EXPERT
Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com
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