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Sex and Diabetes

What you should know about sex when you have diabetes.

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When you think about enjoying life and all its pleasures, great sex may be one of the first things to pop into your mind. The good news is that there’s no reason you can’t have a full and satisfying sex life if you have diabetes. But you need to understand how your disease can affect different aspects of your sexuality and sexual function.

First, bear in mind that sexual intimacy can be physically vigorous, burning calories. That means that, like exercise, it may put you at risk of hypoglycemia – inconvenient when making love, to say the least. To keep blood sugar stable, it’s wise to take glucose readings before and after sex to get an idea of how your body responds. Try having a sugary drink or a small snack beforehand or, with your doctor’s approval, adjusting your insulin if you know that sexual intimacy is in the offing.

For Women Only
Sexuality is complex in women even without interference from chronic disease, so it’s no surprise that they generally experience more sexual side effects related to diabetes than men. But the problems are not insurmountable. Among them:

  • – Blood-sugar fluxes. Though it’s not a universal experience, many women notice their blood sugar rises a few days before their monthly period begins. Researchers suspect (though not all agree) that fluxes in female sex hormones, such as estrogen and progesterone, temporarily make cells more resistant to insulin. If you suspect this is a problem for you:
  • – For several months, keep a log of when your period begins, then compare it to your daily blood-sugar records. If you find a distinct correlation between your glucose levels and your menstrual cycle, talk to your doctor about adjusting your insulin or doses of medication.
  • – Consider an alternative cause. Some doctors think the real reason blood sugar rises before your period is that the cravings and irritability of premenstrual syndrome make you eat more-or more erratically-thereby causing unusual peaks and valleys in blood-sugar levels. Try eating at regular intervals to keep blood sugar stable, and avoid alcohol and caffeine, which can affect mood.
  • – If you take oral contraceptives, ask your doctor which pill is best for you. Monophasic oral contraceptives (such as Alesse, Loestrin, and Ortho-Cept), which contain fixed amounts of estrogen and progestin, appear to keep blood-sugar levels more stable than triphasic (such as Triphasil and OrthoTricyclen) and progesterone-only contraceptives (such as Micronor and injected Depo-Provera).
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Vaginal dryness. Women with diabetes sometimes find they lack natural lubrication during sexual arousal, though this problem isn’t limited to people with high blood sugar. To deal with it, try using water-based lubricants, available at any pharmacy. If the problem continues, check with your doctor; you may have low estrogen levels that can be boosted with topical estrogen cream or hormone replacement therapy (HRT). Weigh the HRT option carefully, however. Although it may solve the lubrication problem, it may also raise the risk of other health problems.

Infections. Excess sugar in the blood encourages the growth of fungal organisms and bacteria, making women with diabetes more prone to yeast infections and vaginitis. If you experience vaginal discharge or itching, see your doctor for an antifungal cream or antibiotics.

Sex can sometimes seem more straightforward for men, but the male sexual response is also a complex melding of mind and body that involves numerous systems that can be affected by diabetes.

The major difficulty men may face is erectile dysfunction (also called impotence), the inability to achieve or maintain an erection-a problem that often occurs with age and is hardly limited to men with diabetes. In many cases, the cause is purely physical. When you have diabetes, poor circulation can prevent blood from properly engorging chambers in the penis, and nerve damage can interfere with signals involved with sexual response. (Fortunately, the nerves that enable orgasm are seldom impaired.) But depression and anxiety can cause erectile dysfunction as well, and sexual difficulties may involve a combination of factors. Here are some steps you can take:

1. Narrow it down.
Talk to your doctor about possible causes so you know how to treat the problem. It may be a simple matter of adjusting one of your medications. Many drugs, including some for high blood pressure, can interfere with sexual function. If that’s not the issue, pay attention to patterns: If erectile dysfunction seems to happen on and off, strikes suddenly, or occurs in some circumstances but not others, the problem may have a psychological component. If you gradually and consistently lose function over time, there’s more likely a physical cause.

2. Ask about Viagra.
The drug sildenafil citrate (Viagra) induces erections lasting at least an hour in about 80 percent of patients who take it. If side effects like headache, low blood pressure, and diarrhea bother you, other medications are available, though they tend to be less effective. If you have heart trouble, you may not be able to take Viagra.

3. Go to extremes.
If oral drugs don’t work, try alprostadil (Caverject). Like Viagra, it relaxes smooth-muscle tissue in the penis to boost blood flow, but it’s injected with a needle. Other injectable drugs (papaverine, phentolamine) are available as well. Non-drug approaches include vacuum devices (which use a hand-pumped tube that fits over the penis to draw blood into the organ) and surgically implanted rods that can be bent or inflated by a man (or his partner) when he wants an erection.