Because both patients and doctors often avoid the topic, we still do not know as much as we should about how diabetes affects people's sex lives. This is especially true when it comes to women's sexual problems.
Women with and women without diabetes have some sexual problems in common. These include poor vaginal lubrication, a decrease in sexual desire, pain during sex, and trouble having an orgasm. Doctors aren't sure how much diabetes affects women's sexual ability.
Women with type1 (insulin-dependent) diabetes who have not gone through menopause do not seem to have higher rates of sexual problems than other women. However, they may have some trouble with vaginal lubrication or suffer more frequent yeast infections, if their diabetes is poorly controlled.
Women with type 2 (non-insulin-dependent) diabetes may be more likely to have sexual problems than women of the same age without diabetes. Changes in blood vessels and nerve damage caused by diabetes may play a role in these problems.
Basic questions remain. We do not know if women with type 1 diabetes are more likely to face certain problems, while those with type 2 are more likely to face others.
The Problem Is. . .
If you are having a sexual problem, discuss it with your doctor. The doctor, in turn, will ask you questions, review your medical history, and try to assess your symptoms.
Is the problem physical? Or does it stem from feelings? Sexual problems -- for both men and women -- may be rooted in psychological issues. For many, the first hurdle is talking about sexual worries. Some doctors may hesitate to ask about sex. Some may even be afraid that their questions might seem like a sexual advance.
But sexual concerns should be brought out. Ask questions and answer those your doctor asks. This is your first step in understanding, caring for, and solving the problems you face.
Your doctor may ask if you've had:
A loss of interest in sex.
Vaginal dryness or tightness during sex.
Pain or discomfort during or after sex.
Your doctor may also ask if you have had trouble having an orgasm. In women with diabetes, this problem may relate to physical discomfort during sex. Diabetes rarely damages the nerves that control orgasm.
Because women with poorly controlled diabetes are more likely to have frequent yeast infections, your doctor may ask whether you've had problems with vaginal infections. Your doctor may also ask you about urinary tract infections.
If you find it hard to talk about these matters with your doctor, get help from other members of your health-care team. A nurse, gynaecologist (doctor trained to treat problems of women's sexual health), or mental health professional may be helpful.
These professionals can provide answers and help you talk with your doctor. If you need to, think about finding a new doctor with whom you feel more at ease discussing sexual problems.
Your doctor will factor in your medical history and the overall state of your health to diagnose the problem and advise a plan of action for you.
Treating Sexual Problems
Your doctor may suggest that your sexual problem stems from some psychological issues. Sexual function is complex. It involves many physical and emotional responses. Issues that can impair your sexual function include:
Not being able to talk about sexual concerns with your partner.
Worries about being unattractive.
Conflicts with your partner over money, children, work, or other life stresses.
A history of sexual abuse.
Depression.
If a psychological issue is at the root of your sexual problem, your doctor may refer you to a mental health professional trained in this area. This might be a psychiatrist, psychologist, or licensed social worker. If your sexual problem seems to stem from a physical cause, your doctor may suggest that you see a gynaecologist.
There are several different physical reasons for sexual difficulties.
Poor vaginal lubrication.
This can cause vaginal irritation and pain during sex. Low hormone levels can cause this problem. But you need to see your doctor to find out if this is causing your problem.
Most often, oestrogen (hormone) therapy helps improve lubrication. You can take oestrogen pills or you can wear a patch, get shots, or apply vaginal cream. Do not try to diagnose the problem yourself or use over-the-counter drugs that contain oestrogen. Your doctor should treat this problem.
If you've gone through menopause and have risk factors that prevent the use of oestrogen, a vaginal lubricant may help.
Pain during sex.
Learning to relax the muscles that surround the vagina (Kegel exercises) can help. You can practice by stopping the flow of urine when you urinate. Then let the muscles relax and feel the contrast.
If sex is still difficult or painful, try tensing and relaxing these muscles before or during sex. You can also try different positions. These include sitting or kneeling over your partner or lying on your side and facing your partner.
Sexual Problems Related To Diabetes Complications
Some diabetes complications can impair sexual function. Your diabetes-care team may be able to help or refer you to other health professionals who could help.
Women with severe nerve damage may lose some skin sensation around the genital area. This can lessen sexual pleasure. Sometimes gentle touch or a hand-held vibrator on or around the clitoris can help a woman with this problem reach orgasm more easily.
Some women with diabetes have a problem called neurogenic bladder, which means poor bladder control. It will help if you empty your bladder before and after sex. This also helps prevent infections.
Better blood glucose control may help prevent or lessen the problems of loss of sensation and neurogenic bladder. These are types of neuropathy, a common result of too-high blood glucose levels.
Women with end-stage kidney disease may also have some trouble with sexual desire.
If you have limited mobility or have lost a limb due to diabetes, talking to a physical therapist about ways to be comfortable during sex can help.
Birth Control And Safe Sex
Birth control and safe sex are two important sexual health issues. The goal of birth control is to prevent pregnancy. The goal of safe sex is to prevent sexually transmitted diseases.
Birth control choices are up to you and your partner. Talk to your doctor about choices that are good for you. Options include the pill, diaphragm or cervical cap plus spermicidal jelly, and sponge or condom plus spermicidal foam.
The pill may raise your blood glucose levels. Using the pill for more than a year or two may also increase your risk for diabetes complications. For example, if you get high blood pressure while you are on the pill, you increase the chance that eye or kidney disease will get worse.
Diseases that can be spread by sex are a serious concern. Diseases such as gonorrhoea ("clap") and chlamydia require early treatment to avoid problems such as sterility.
As yet there is no cure for AIDS. Safe sex to prevent AIDS means using a proper condom correctly. If you have questions, talk to your doctor.
Going Through The Change
Menopause is the stage of a woman's life when her monthly menstrual cycles stop. As with other issues of women's sexual health, this topic is rarely openly discussed. Now that women between the ages of 40 and 60 form the fastest growing part of our population, that's changing.
Menopause occurs when your body stops making the hormones that set the stage for pregnancy. Along with this come other physical and emotional changes common to aging women. These include skin wrinkling, breast tissue sagging, and for some, a decrease in sexual desire.
For women with diabetes, it's important to know that menopause affects your blood glucose levels. The hormones estrogen and progesterone keep your menstrual cycle going. They also affect your blood glucose levels. They blunt the effect of insulin and encourage the liver to make glucose.
Menopause changes this. Your oestrogen and progesterone levels drop to near zero. Without these hormones, the action of your insulin goes up. Your blood glucose may stay at levels lower than you were used to. Women with diabetes have added reasons to pay attention to the changes menopause brings.
When Will It Happen?
There is no set age for the onset of menopause. The average woman has her last period around age 51. Some women have periods throughout their 50s and into their 60s. Others -- about 10 percent of all women -- stop having their periods before age 40. This is called "premature" menopause. Other women no longer get periods because they've had their ovaries removed.
Menopause is a slow process. It may take from 5 to 10 years. Some months you may not release eggs (ovulate), and some months you may. As your ovaries begin to slow down, your periods become irregular. This is called pre-menopause.
When you do not ovulate, your body does not make progesterone. Oestrogen levels begin to drop, although your body still makes some oestrogen. As you begin to miss periods, you may have some of the symptoms of menopause, such as hot flashes.
After you've gone a full year without a period, menopause is complete.
Menopause And Insulin
If you take insulin for diabetes, menopause may affect how much insulin you need. As your body makes less oestrogen and progesterone, you should need less insulin. When menopause is complete, you will most likely need about 20 percent less insulin.
If you have type II diabetes, you may need lower doses of diabetes pills. On the other hand, you may find that menopause does not change your dose of insulin or diabetes pills. Weight gain and lack of exercise raise insulin needs. These often balance the dropping hormone levels.
To combat middle-age bulge, eat less and stay active. Your diabetes care team should help make changes in your meal plan and exercise program as you get older.
Without Oestrogen
When your body stops making oestrogen, your insulin needs aren't the only changes. The changes caused by menopause are a special concern for women with diabetes. Discuss these issues with your doctor.
Doctors most often advise hormone replacement therapy (HRT) for women with diabetes. Here are some of the reasons why:
Heart attack and stroke risk.
If you have diabetes, you are a greater risk for heart attack and stroke. After menopause, your risk increases. After menopause, a woman without diabetes has the same heart attack and stroke risks as a man.
Because you have diabetes, your risk of heart attack and stroke skyrockets after menopause to twice that for a man without diabetes.
One reason your risk of heart attack and stroke increases with menopause is blood fat levels. Lack of estrogen causes your total cholesterol level to rise. It also causes your high-density lipoprotein (HDL or "good") cholesterol level to drop.
If you have poorly controlled diabetes, chances are you have high blood fat levels. Menopause will make this worse. Oestrogen therapy can help. So can keeping your blood glucose and cholesterol levels under control with diet and exercise.
Bone loss.
When your oestrogen level becomes low, your bones start to lose some of their mineral content. This can turn into osteoporosis -- bones that are brittle and easily broken. Oestrogen therapy helps.
Talk to your doctor about other ways to keep your bones strong. Eating calcium-rich foods and getting weight-bearing exercise, such as walking, can help. For those who have osteoporosis, several drugs are available in addition to hormone replacement.
Vaginitis.
Yeast and bacteria cause vaginitis. They thrive in sweet, warm, moist places. If your blood glucose levels are high you are likely to have more yeast infections, even before menopause. After menopause, without oestrogen to nourish and support your vaginal lining, yeast and bacteria have an even easier time.
Several steps help to prevent vaginitis:
Stay in good blood glucose control.
Bathe often to keep faecal bacteria from getting into the vagina.
Consider taking oestrogen.
Some doctors believe that eating a cup of low-fat yoghurt a day may also help. Look for yoghurt that has "active cultures." These kinds of bacteria help battle yeast and prevent vaginitis.
Hormone Therapy
Hormone therapy most often begins after your first hot flash and lasts for the rest of your life. The most common treatment plan is to take oestrogen every day and progesterone pills the last 10 to 14 days of the cycle. Progesterone protects you against cancer of the uterine lining.
Another method is to take oestrogen and low-dose progesterone every day. These doses are usually not enough to make your periods start again, although they do in some women. But if you take them, your insulin or diabetes pill doses will go back up to your before-menopause levels.
Hormone therapy may help with the problems cited above: blood fat levels, osteoporosis, vaginitis, and cardiovascular disease. But, this treatment is not for everyone. If you have a history of breast or endometrial cancer, blood clotting problems, severe eye disease, or kidney disease, you should not receive hormone therapy.
Other factors that may make hormone therapy a poor choice include a family history of breast cancer and a personal history of uterine fibroid or breast fibrocystic disease. Talk to your doctor about these.
After menopause, all women should have yearly mammograms to check for breast cancer, and yearly Pap smears to check for cervical cancer.
Because you have diabetes, you should also have a glycated haemoglobin test (a blood test that checks long-term blood glucose control) four times a year and have your blood fat and cholesterol levels checked four times a year, or more often if they are not normal. Sometimes, progesterone can worsen blood cholesterol levels.
You should also have yearly eye exams and kidney function tests.
Menopause is a normal, natural process. Like other issues of sexual health, it is a subject you need to be able to discuss freely with your doctor about your concerns.
As a woman with diabetes, you need to take an active role during and after menopause. You have more at stake than other women going through this phase. Look for a health-care team with the skill and knowledge to help you with this stage of your life.
Good diabetes control, weight-bearing exercise (check with your doctor before starting), and a healthy diet will all help to keep you feeling your best.
Women with and women without diabetes have some sexual problems in common. These include poor vaginal lubrication, a decrease in sexual desire, pain during sex, and trouble having an orgasm. Doctors aren't sure how much diabetes affects women's sexual ability.
Women with type1 (insulin-dependent) diabetes who have not gone through menopause do not seem to have higher rates of sexual problems than other women. However, they may have some trouble with vaginal lubrication or suffer more frequent yeast infections, if their diabetes is poorly controlled.
Women with type 2 (non-insulin-dependent) diabetes may be more likely to have sexual problems than women of the same age without diabetes. Changes in blood vessels and nerve damage caused by diabetes may play a role in these problems.
Basic questions remain. We do not know if women with type 1 diabetes are more likely to face certain problems, while those with type 2 are more likely to face others.
The Problem Is. . .
If you are having a sexual problem, discuss it with your doctor. The doctor, in turn, will ask you questions, review your medical history, and try to assess your symptoms.
Is the problem physical? Or does it stem from feelings? Sexual problems -- for both men and women -- may be rooted in psychological issues. For many, the first hurdle is talking about sexual worries. Some doctors may hesitate to ask about sex. Some may even be afraid that their questions might seem like a sexual advance.
But sexual concerns should be brought out. Ask questions and answer those your doctor asks. This is your first step in understanding, caring for, and solving the problems you face.
Your doctor may ask if you've had:
Your doctor may also ask if you have had trouble having an orgasm. In women with diabetes, this problem may relate to physical discomfort during sex. Diabetes rarely damages the nerves that control orgasm.
Because women with poorly controlled diabetes are more likely to have frequent yeast infections, your doctor may ask whether you've had problems with vaginal infections. Your doctor may also ask you about urinary tract infections.
If you find it hard to talk about these matters with your doctor, get help from other members of your health-care team. A nurse, gynaecologist (doctor trained to treat problems of women's sexual health), or mental health professional may be helpful.
These professionals can provide answers and help you talk with your doctor. If you need to, think about finding a new doctor with whom you feel more at ease discussing sexual problems.
Your doctor will factor in your medical history and the overall state of your health to diagnose the problem and advise a plan of action for you.
Treating Sexual Problems
Your doctor may suggest that your sexual problem stems from some psychological issues. Sexual function is complex. It involves many physical and emotional responses. Issues that can impair your sexual function include:
If a psychological issue is at the root of your sexual problem, your doctor may refer you to a mental health professional trained in this area. This might be a psychiatrist, psychologist, or licensed social worker. If your sexual problem seems to stem from a physical cause, your doctor may suggest that you see a gynaecologist.
There are several different physical reasons for sexual difficulties.
This can cause vaginal irritation and pain during sex. Low hormone levels can cause this problem. But you need to see your doctor to find out if this is causing your problem.
Most often, oestrogen (hormone) therapy helps improve lubrication. You can take oestrogen pills or you can wear a patch, get shots, or apply vaginal cream. Do not try to diagnose the problem yourself or use over-the-counter drugs that contain oestrogen. Your doctor should treat this problem.
If you've gone through menopause and have risk factors that prevent the use of oestrogen, a vaginal lubricant may help.
Learning to relax the muscles that surround the vagina (Kegel exercises) can help. You can practice by stopping the flow of urine when you urinate. Then let the muscles relax and feel the contrast.
If sex is still difficult or painful, try tensing and relaxing these muscles before or during sex. You can also try different positions. These include sitting or kneeling over your partner or lying on your side and facing your partner.
Sexual Problems Related To Diabetes Complications
Some diabetes complications can impair sexual function. Your diabetes-care team may be able to help or refer you to other health professionals who could help.
Women with severe nerve damage may lose some skin sensation around the genital area. This can lessen sexual pleasure. Sometimes gentle touch or a hand-held vibrator on or around the clitoris can help a woman with this problem reach orgasm more easily.
Some women with diabetes have a problem called neurogenic bladder, which means poor bladder control. It will help if you empty your bladder before and after sex. This also helps prevent infections.
Better blood glucose control may help prevent or lessen the problems of loss of sensation and neurogenic bladder. These are types of neuropathy, a common result of too-high blood glucose levels.
Women with end-stage kidney disease may also have some trouble with sexual desire.
If you have limited mobility or have lost a limb due to diabetes, talking to a physical therapist about ways to be comfortable during sex can help.
Birth Control And Safe Sex
Birth control and safe sex are two important sexual health issues. The goal of birth control is to prevent pregnancy. The goal of safe sex is to prevent sexually transmitted diseases.
Birth control choices are up to you and your partner. Talk to your doctor about choices that are good for you. Options include the pill, diaphragm or cervical cap plus spermicidal jelly, and sponge or condom plus spermicidal foam.
The pill may raise your blood glucose levels. Using the pill for more than a year or two may also increase your risk for diabetes complications. For example, if you get high blood pressure while you are on the pill, you increase the chance that eye or kidney disease will get worse.
Diseases that can be spread by sex are a serious concern. Diseases such as gonorrhoea ("clap") and chlamydia require early treatment to avoid problems such as sterility.
As yet there is no cure for AIDS. Safe sex to prevent AIDS means using a proper condom correctly. If you have questions, talk to your doctor.
Going Through The Change
Menopause is the stage of a woman's life when her monthly menstrual cycles stop. As with other issues of women's sexual health, this topic is rarely openly discussed. Now that women between the ages of 40 and 60 form the fastest growing part of our population, that's changing.
Menopause occurs when your body stops making the hormones that set the stage for pregnancy. Along with this come other physical and emotional changes common to aging women. These include skin wrinkling, breast tissue sagging, and for some, a decrease in sexual desire.
For women with diabetes, it's important to know that menopause affects your blood glucose levels. The hormones estrogen and progesterone keep your menstrual cycle going. They also affect your blood glucose levels. They blunt the effect of insulin and encourage the liver to make glucose.
Menopause changes this. Your oestrogen and progesterone levels drop to near zero. Without these hormones, the action of your insulin goes up. Your blood glucose may stay at levels lower than you were used to. Women with diabetes have added reasons to pay attention to the changes menopause brings.
When Will It Happen?
There is no set age for the onset of menopause. The average woman has her last period around age 51. Some women have periods throughout their 50s and into their 60s. Others -- about 10 percent of all women -- stop having their periods before age 40. This is called "premature" menopause. Other women no longer get periods because they've had their ovaries removed.
Menopause is a slow process. It may take from 5 to 10 years. Some months you may not release eggs (ovulate), and some months you may. As your ovaries begin to slow down, your periods become irregular. This is called pre-menopause.
When you do not ovulate, your body does not make progesterone. Oestrogen levels begin to drop, although your body still makes some oestrogen. As you begin to miss periods, you may have some of the symptoms of menopause, such as hot flashes.
After you've gone a full year without a period, menopause is complete.
Menopause And Insulin
If you take insulin for diabetes, menopause may affect how much insulin you need. As your body makes less oestrogen and progesterone, you should need less insulin. When menopause is complete, you will most likely need about 20 percent less insulin.
If you have type II diabetes, you may need lower doses of diabetes pills. On the other hand, you may find that menopause does not change your dose of insulin or diabetes pills. Weight gain and lack of exercise raise insulin needs. These often balance the dropping hormone levels.
To combat middle-age bulge, eat less and stay active. Your diabetes care team should help make changes in your meal plan and exercise program as you get older.
Without Oestrogen
When your body stops making oestrogen, your insulin needs aren't the only changes. The changes caused by menopause are a special concern for women with diabetes. Discuss these issues with your doctor.
Doctors most often advise hormone replacement therapy (HRT) for women with diabetes. Here are some of the reasons why:
If you have diabetes, you are a greater risk for heart attack and stroke. After menopause, your risk increases. After menopause, a woman without diabetes has the same heart attack and stroke risks as a man.
Because you have diabetes, your risk of heart attack and stroke skyrockets after menopause to twice that for a man without diabetes.
One reason your risk of heart attack and stroke increases with menopause is blood fat levels. Lack of estrogen causes your total cholesterol level to rise. It also causes your high-density lipoprotein (HDL or "good") cholesterol level to drop.
If you have poorly controlled diabetes, chances are you have high blood fat levels. Menopause will make this worse. Oestrogen therapy can help. So can keeping your blood glucose and cholesterol levels under control with diet and exercise.
When your oestrogen level becomes low, your bones start to lose some of their mineral content. This can turn into osteoporosis -- bones that are brittle and easily broken. Oestrogen therapy helps.
Talk to your doctor about other ways to keep your bones strong. Eating calcium-rich foods and getting weight-bearing exercise, such as walking, can help. For those who have osteoporosis, several drugs are available in addition to hormone replacement.
Yeast and bacteria cause vaginitis. They thrive in sweet, warm, moist places. If your blood glucose levels are high you are likely to have more yeast infections, even before menopause. After menopause, without oestrogen to nourish and support your vaginal lining, yeast and bacteria have an even easier time.
Several steps help to prevent vaginitis:
Some doctors believe that eating a cup of low-fat yoghurt a day may also help. Look for yoghurt that has "active cultures." These kinds of bacteria help battle yeast and prevent vaginitis.
Hormone Therapy
Hormone therapy most often begins after your first hot flash and lasts for the rest of your life. The most common treatment plan is to take oestrogen every day and progesterone pills the last 10 to 14 days of the cycle. Progesterone protects you against cancer of the uterine lining.
Another method is to take oestrogen and low-dose progesterone every day. These doses are usually not enough to make your periods start again, although they do in some women. But if you take them, your insulin or diabetes pill doses will go back up to your before-menopause levels.
Hormone therapy may help with the problems cited above: blood fat levels, osteoporosis, vaginitis, and cardiovascular disease. But, this treatment is not for everyone. If you have a history of breast or endometrial cancer, blood clotting problems, severe eye disease, or kidney disease, you should not receive hormone therapy.
Other factors that may make hormone therapy a poor choice include a family history of breast cancer and a personal history of uterine fibroid or breast fibrocystic disease. Talk to your doctor about these.
After menopause, all women should have yearly mammograms to check for breast cancer, and yearly Pap smears to check for cervical cancer.
Because you have diabetes, you should also have a glycated haemoglobin test (a blood test that checks long-term blood glucose control) four times a year and have your blood fat and cholesterol levels checked four times a year, or more often if they are not normal. Sometimes, progesterone can worsen blood cholesterol levels.
You should also have yearly eye exams and kidney function tests.
Menopause is a normal, natural process. Like other issues of sexual health, it is a subject you need to be able to discuss freely with your doctor about your concerns.
As a woman with diabetes, you need to take an active role during and after menopause. You have more at stake than other women going through this phase. Look for a health-care team with the skill and knowledge to help you with this stage of your life.
Good diabetes control, weight-bearing exercise (check with your doctor before starting), and a healthy diet will all help to keep you feeling your best.
