Sex and Diabetes

Read about the author Samantha Evans

According to Diabetes UK, there are currently 4.8 million people living with #diabetes in the UK, 90% of whom have Type 2, 8% who have Type 1 and 2% who have other forms of the condition. These are the people who have been diagnosed, it is estimated that there are 850,000 people who are yet to be diagnosed (April 2023)

Being overweight is the single greatest risk for developing Type 2, however your age, family history and ethnicity can also increase your risk and people of African-Caribbean, Black African or South Asian descent are 2-4 times more likely to develop Type 2 diabetes. The reason for this is not clearly understood, which is why it is important that people educate themselves about their increased risk, find out their family history and are regularly screened by their GP.

Type 2 can be reversed or controlled through a healthy, balanced diet, losing weight and taking medication.

Type 1 diabetes affects around 8% of people who have diabetes, typically occurring in childhood or before the age of 40 and is not caused by obesity. Insulin producing cells in the body are destroyed or damaged, leaving the body unable to produce the hormone to control sugar levels. It is controlled by daily insulin injections or using an insulin pump.

Diabetes not only affects your general health, but can impact upon your sexual health and pleasure too. Although sex problems are more common in people who have diabetes, there are many ways in which you can still enjoy a healthy, fulfilling sex life.

People who have diabetes often suffer from different sexual problems, including erectile dysfunction and vaginal dryness and lack of clitoral and vaginal sensation, but they can all suffer from low libido. Diabetes causes damage to nerves and small blood vessels, which affects the body’s response to sexual stimuli. Damage to these nerves hinders nerve signals to the genitals and can decrease blood flow to the tissues of the sexual organs, impacting upon normal sexual function.

Who is more at risk of developing sexual problems?

Diabetic neuropathy and related sexual problems appear to be more prevalent in people who:

• have poor blood glucose control
• have high levels of blood cholesterol
• have high blood pressure
• are overweight
• are older than 40
• smoke
• are physically inactive

Causes of low libido

• depression
• extreme fatigue
• lack of energy
• side effects of medication, such as those taken for high blood pressure and depression
• hormonal changes
• mental health problems such as stress, anxiety and relationship issues

Diabetic neuropathy

This can cause numbness, pain or decrease in sensation in the genital area leading to inability to orgasm or less intense orgasms, painful sex and less pleasurable sex as a result of diminished sexual stimulation. People may find they struggle to hold sex toys so choosing one that is easy to hold, control or simply place between your legs or a partner can control and hold for you is a good idea.

Relationship issues

Sexual function problems can lead to relationship issues as a result of a lack of communication between couples. Often couples give up on their sex life to avoid discussing the problems rather than opening up the conversation to talk about how they each feel and explore ways in which their sexual problems can be overcome.

The role a person takes on as the primary caregiver can alter the way in which they see their partner sexually. Getting caught up in the roles of “caregiver” and “patient” can detract from the physical and emotional aspect of the relationship, with romance and the sexual relationship being left behind or completely overlooked.

The most widely reported problem faced by people with a penis who have diabetes is erectile dysfunction (ED), the inability to maintain or get an erection sufficient to have sexual intercourse. The prevalence of ED in people with diabetes varies widely, ranging from 20%-75%. People who have diabetes are 2-3 times more likely to experience ED than men who do not have the disease. Among people who have ED, those with diabetes develop the problem 10-15 years earlier than those who do not have diabetes. ED is often seen as a warning sign of a diagnosis of diabetes, especially for people with a penis under 45 years.

The side effects of medication for other medical conditions can cause ED. Symptoms that co-exist with diabetes which can contribute to ED include:

• obesity
• high blood pressure
• emotional and psychological problems such as depression, self-esteem and anxiety
• lack of exercise

Retrograde ejaculation

Retrograde ejaculation is another sexual problem that may occur.. This occurs when some or all the semen is ejaculated back into the bladder instead of via the penis and is caused by abnormal glucose levels damaging the sphincter muscle, controlling the opening and closing of the sphincter at the base of the bladder. The man experiences an orgasm but often with little or no ejaculate, known as a “dry orgasm”. It does not pose a threat to health, but may cause problems when trying to conceive a baby.

Balanitis

Balanitis is the inflammation of the end of the penis and foreskin (the glans) caused by infection, such as thrush, bacterial infections, sexually transmitted diseases, skin irritations and certain skin conditions. This often occurs in people with diabetes due to sugary urine, causing thrush, which sits at the end of the penis. This is why it is important to use sexual lubricants free from irritating ingredients including glycerin, glycols or sorbitol, all of which can cause or exacerbate thrush. Be aware that many condom brands are lubricated with lubricants that contain glycerin which can cause irritation, so switch to condoms lubricated with silicone lube or non lubricated condoms and use your our skin safe lube.

Vaginal dryness and thrush

The most commonly reported sexual health problem in people who have a vulva and vagina is vaginal dryness, caused by hormonal changes to the walls of the vagina and reduced blood flow to the genital area. Those who have difficulty controlling their blood sugar may find themselves particularly prone to yeast infections due to the higher levels of glucose, which creates a sugary environment for thrush to thrive. It is important to use an irritant free sex lubricant as many commercial lubricants and vaginal moisturisers available over the counter or on prescription contain glycerin which can cause thrush.

It is important that healthcare professionals educate themselves about suitable sexual lubricants and vaginal moisturisers, as some still recommend poor products such as KY and well known OTC brands that contain glycerin, glycols and sorbitol in addition to parabens, dyes, perfume and alcohol in addition to products on prescription that contain these ingredients

As people get older, vaginal dryness and vaginal atrophy, both symptoms of the menopause can impact upon vagina health and sexual pleasure too. Using local eostrogen can make a huge difference to your vagina, vulva and bladder health.

Nerve damage to the bladder can lead to urinary incontinence and frequent urinary tract infections, which can make sex uncomfortable and painful as well as embarrassing. Using a waterproof sex blanket or sheet can help.

Diabetic neuropathy

Diabetic neuropathy can affect the nerves in the genital area, causing desensitisation in the clitoris and penis and making sexual arousal more difficult to achieve.

How to enjoy sex when you have diabetes

Many of the problems mentioned above can be frustrating, annoying, painful, embarrassing and cause anxiety. They can impact upon relationships during a time when the person with diabetes needs support. Many people give up on their sex life, but there are many simple ways in which you can ease the pain, discomfort and embarrassment these problems cause, manage your symptoms and enjoy great sex..

Combating low energy and fatigue

This is a problem that affects both sexes, so why not try having sex at a different time of day if you find yourself flagging when evening arrives. Set the alarm 15 minutes earlier in the morning and enjoy the benefits of early morning sex to kick-start your day. Plan a secret lunchtime rendezvous for some quickie sex or enjoy a long leisurely afternoon in bed, exploring your partner. Experiment with what works for you. Feeling fatigued can impact upon your libido, so make time to rest, ensure you get plenty of sleep and recognise the limitations of your body.

Be liberal with lubrication

The benefits of using lubrication during sex cannot be underestimated. Hormonal changes, pregnancy, stress and the menopause can all affect the amount of vaginal lubrication we produce. A good water-based lubricant can make sexual intercourse feel more comfortable, increase pleasure and last longer whatever your gender. Use as much as you want to ensure that sex feels great. Avoid lubricants containing glycerin, glycols and parabens which may cause irritation or thrush. Many people find they experience thrush when they have diabetes so it is important to irritant free lubricants/vaginal moisturisers

YES organic lubricant is completely free from glycerin, glycols and parabens and only contains plant-based materials. SUTIL Luxe is a silky smooth water-based lubricant that moisturises, nourishes and soothes our most intimate areas, as well as lubricating for sexual pleasure. Feeling like a silicone lubricant without the silicone, this fabulous water-based lubricant gently cushions and glides, blending seamlessly with your own natural lubrication during sex. Free from any irritating ingredients, including glycerin, glycols and sorbitol it is a great lubricant to use whatever your gender.

Don’t attempt to DIY your lubricant either, as many people assume that household items can double up as lubricant. The main offenders are Vaseline and cooking or coconut oil, but this can do more harm than good and research shows that using cooking oils and petroleum-based products can increase your incidences of thrush by 22%.

Increase your libido

Hormone replacement therapy can help, so speak to your GP to see if this is a possibility for you. Introducing changes to your diet can help boost testosterone and improve your libido. Fatigue can affect your libido, so it is important to ensure you get sufficient rest and give your body time to relax.

Ensure that you stay healthy

Ensuring that your overall health is good will lead to a healthy sex life. Maintaining normal blood glucose levels is important because sex uses energy. Hypoglycaemia can occur during sex as with any exercise, so ensure that you check your blood glucose level before having sex and take medication or a sugary snack if needed. Having a glass of lucozade,fruit squash or dextrose tablets on the bedside table is a good idea. Sex can make you feel sweaty, and your heart beat faster just like hypoglycaemia, so recognising the difference is important so you can stop and take a drink or eat a snack.

Maintaining a healthy weight is essential to keep your heart in shape. Good blood flow around the body will benefit sexual arousal, erections and vaginal lubrication. Taking exercise will help you to lose weight as well as being able to sustain sex activity for a longer period of time. It can also help boost self-esteem and body confidence too. Taking regular exercise can also help reduce depression by releasing feel good endorphins which can boost your mood and lowers blood pressure, reducing the risk of heart attack, stroke and renal disease.

Overcoming lack of sensation

Neuropathy can reduce clitoral responsiveness to touch, affecting the ability to become aroused and have orgasms. Using lubricants and vibrators can increase sensitivity to touch. Most vibrators will help, but using products that have strong vibrations such as the Rocks-Off Oriel or Doxy Massager will produce clitoral stimulation in almost anyone with a clitoris. Used as an all over body massager, you can experience sexual sensations in your breasts and other erogenous zones.

Sonic wave and air pulse sex toys offer different sexual sensations as they are not vibrators. These include Satisfyer Pro 2 a clitoral stimulator that uses sound wave technology. The Pro 2 engulfs the clitoris and creates gentle pressure waves that gently suck and tease the clitoris with a choice of eleven amazing intensities.The Satisfyer Pro Plus Vibration combines Air Pulse Wave technology with vibrations to offer a unique sexual sensation. Lelo SONA 2 is a sonic wave stimulator powered by SenSonic technology, gently caressing and teasing the clitoral tissue. As this sensation is totally different to vibration, it is ideal for those who struggle to orgasm or experience decreased sensation. They are all easy to use because you do not have to move them, just locate the right spot on your clitoris and hold them in place to work their magic.

Using a couples’ toy such as a constriction ring or a small clitoral vibrator such as Je Joue Mimi Soft or Satisfyer Candy Cane can increase sexual stimulation during sexual intercourse. Using pelvic floor exercisers such as LELO Luna Beads can improve the strength of your pelvic floor, making orgasms more intense and helping to combat urinary incontinence. Pelvic health physio are the experts in helping you to enjoy good pelvic health so ask your GP to refer you, you can self refer to some clinics, or you can find one in private practice.

Overcoming Erectile Dysfunction

If you think that your medication may be causing ED, talk to your GP to see if you can try an alternative drug with fewer side effects. Introducing changes to your lifestyle, such as losing weight, taking moderate exercise, reducing alcohol consumption and giving up smoking can improve ED. If these measures do not help, your GP can prescribe medication to improve symptoms of ED.

Some people are unable to take medication for ED, so using a vacuum constriction device such as the Bathmate Hydromax can enable a person to get an erection. Creating a vacuum around the penis by inflating a hand held pump or using the Bathmate Hydromax in the bath or shower with water causes the blood to be drawn into the penis.The Bathmate Hydromax is gentler on the tissues of the penis because it creates an overall vacuum, something many hand – held devices don’t do.

A constriction ring can then be slipped over the penis to help maintain the erection during sexual intercourse. Using both medication and a penis constriction device have been found to greatly improve erections. Constriction rings should not be worn for more than 30 minutes.

The clever design of the Atom Plus enables it to be used from flaccid and allows the wearer to orgasm even without an erection, making it ideal for those with erectile dysfunction.

Some male sex toys are suitable for helping to overcome erectile dysfunction and offer great sexual stimulation not possible during manual/mutual masturbation.

The Pulse Solo Essential is a uniquely designed male sex toy that uses a piston-type mechanism that causes its PulsePlate to move up and down. This technique is known as Penile Vibratory Stimulation.The design of the Pulse enables the user to enjoy an orgasm without the need for an erect penis, making it suitable for those with ED and also allows for hands-free stimulation, ideal for those with physical disabilities.

The Pulse III Duo is a couples’ vibrator that encourages sexual intimacy between men suffering from ED and their female partner. Like the Solo, the Pulse III Duo uses oscillating plates to stimulate the flaccid or erect penis, but the Duo also has a vibrating underplate to stimulate the clitoris. This is great for couples who can no longer enjoy penetrative sex but are looking to maintain their sex life.

Treating Balanitis

Balantitis can be easily treated with antifungal creams and medication to clear the infection, as well as ensuring that penis hygiene is meticulous. Wiping the head of the penis after urination and ensuring that you wash beneath the foreskin daily will help prevent this condition occurring. A circumcision may be necessary if the condition does not respond to conventional treatment. Using a sexual lubricant such as YES organic lubricant can reduce the prevalence of thrush developing.

Great sex without intercourse

Not everyone has penetrative sex, but if this is how you enjoy sex, there are many ways to keep enjoying it beyond penetration. Sex without intercourse can allow many couples to enjoy a more fulfilling sex life. With intercourse off the menu, couples can focus on the many other ways they can make love by using erotic touch with a great lubricant, experimenting with sex toys, reading erotic fiction or watching films, and exploring the use of light bondage. Being inventive about how you have sex and what you can try will help you to enjoy a satisfying sex life. Some sex toys such as the Hot Octopuss Pulse III Duo offer sexual stimulation to both partners when penetration isn’t possible.

The Fun Factory Manta is designed to be the perfect fit for partner sex as well as solo play, sliding between your bodies and turning your penis into a vibrator. It is easy to use as a penis masturbator, especially if you have limited manual dexterity.

Incorporating sex toys into your sex play offers a wide range of sexual stimulation that just is not possible during penetrative sex, so try masturbation with toys, use remote controlled sex toys use YES lubricants, experiment with anal play or oral sex, let your imagination go and have fun!

Talk to each other

Sexual problems often occur when communication breaks down in relationships. If this is the case, speak to your GP, who can refer you to a sex therapist a qualified professional who will listen to your issues and give advice and ideas about how to overcome these problems.

Being honest with each other can help open up channels of communication to express how you feel about your diabetes or your partner’s diabetes. You may find that you both have the same fears and worries and can support each other to ensure that your relationship gets back to normal. It may never return to the way it was before the diagnosis of diabetes, but making changes to your relationship can help you both to enjoy a satisfying and fulfilling sex life.

If you are in a new relationship or have a new sexual partner, communication is key to enjoying pleasurable sex. No one is going to worry that you may need to have a sugary drink or snack by the bed or wherever you are enjoying sex play, or that you want to use your good lube.

Having a diagnosis of diabetes does not mean you should give up on your sex life. Many people with diabetes do not experience any of the symptoms mentioned above, but if you think that you may have any of the symptoms, seek medical advice. There are many ways in which you can overcome sexual problems, manage your symptoms and enjoy a great sex life. Keep experimenting to find ways to enjoy sex that suit you and your partner, don’t give up because a healthy sex life is important.

Talking about sex needs to be a compulsory part of treatment and ongoing care, but often we hear people say it has never been discussed at any consultation. Their foot health is more likely to be raised rather than their sexual health! Both need to be discussed.

At Jo Divine we believe that sexual health and sexual pleasure go hand in hand and have created a health brochure with suitable products to help people with sexual issues. Our main Jo Divine catalogue contains suitable male sex toys too. Working with medical professionals we hope to encourage patients and HCPs alike to talk more freely about sexual problems, knowing they have a great website to signpost people to or be signposted to. A health issue doesn’t mean your sex life will have to stop!

Useful websites

Diabetes UK :www.diabetes.co.uk
College of Sexual and Relationship Therapists (COSRT) : www.cosrt.org.uk
Pelvic , Obstetric and Gynaecological Physiotherapy : https://thepogp.co.uk/