Diabetes and Sexuality in Older Adults

How are diabetes and sexuality related?

Diabetes may affect the sexual function of both men and women. People with diabetes tend to have problems with sexual function earlier in life than people who don’t have the disease.

How much diabetes affects sexual function may depend on how severe the disease is. It may also depend on how old you are when the disease begins. Men diagnosed after age 40 may have more mental and emotional adjustments to make than those who learned to live with diabetes at a younger age.

How does diabetes affect sexual function?

Diabetes can affect all aspects of your health, including your mental health. In general, if you have diabetes, you are more likely to have periods of time when you are not interested in having sex. This is especially likely when the diabetes is not in good control.

Diabetes in men can lead to hardening and narrowing of the blood vessels that bring blood to the erectile tissue of the penis. This spongy tissue swells and stiffens the penis during an erection. Decreased blood flow to the penis may make it harder to have or keep an erection. Many men who have diabetes have a problem with erectile dysfunction, also called impotence or ED. In fact, ED, along with the need to urinate and drink often, may be an early sign of diabetes. Men can have ED with either type 1 or type 2 diabetes.

Changes may more be subtle in women with diabetes. Diabetes can lead to narrowing of the blood vessels in the vaginal wall. Decreased blood flow may cause the vagina to be drier than normal. It also may increase the risk of repeat yeast infections. All of these changes can cause pain during sex.

In older women, the combination of diabetes and menopause may cause:

• a 50% decrease in vaginal blood supply due to low estrogen levels
• vaginal secretions that are less acidic and less protective, which lowers the resistance to bacteria in the vagina and increases the risk of yeast infection
• higher levels of sugar (glucose) in vaginal secretions that may increase the chances of getting yeast infections
• pain and bleeding with sex because of vaginal dryness and the thinning of the vaginal lining

Women may notice that they are not as easily aroused. They may be less sensitive to touching and stroking, which may make them less interested in sex. It may become harder for a woman to have an orgasm.

How is sexual dysfunction treated?

Treatment for a menopausal, diabetic woman may include estrogen hormone pills or vaginal cream. The hormones can help keep blood flowing in vaginal tissues. Estrogen also can help keep the acid level in the vagina high enough to protect against vaginal infections. Hormone therapy does pose some risks. Discuss the risks and benefits with your healthcare provider.

If a diabetic woman is having pain with sex, other treatments may include:

• an exam to check for and treat vaginal infection
• use of water-based lubricants such as KY jelly (petroleum jelly should not be used)

Treatment for older, diabetic men may include:

• an exam by a specialist called a urologist to look for other possible causes of sexual problems
• having sex only when well rested (early morning hours may be better because testosterone levels are higher then)
• taking a medicine such as Viagra, Levitra, or Cialis, as prescribed by the healthcare provider, to make it easier to have and keep an erection
• other treatments for ED
• taking the hormone testosterone

Diet and medicine to control blood sugar levels are very important to control diabetes and prevent more problems. The more closely your diabetes is controlled and treated, the less severe the problems, including those that affect sexual function.