Sex With Diabetes: Women’s Awkward Bedroom Questions, Answered

From everydayhealth.com

Diabetes affects nerves and blood vessels throughout your body, but its impact on sexual health might come as a surprise. For some women with diabetes, the concern may not even come up during regular check-ups, but it’s important to speak up if your symptoms are getting in the way of your sex life.
“Just like if you had any other health issue, it’s totally justifiable to talk to your healthcare provider about [sexual health]," says Susan Davis, PhD, bachelor of medicine and bachelor of surgery, a professor of women’s health at the School of Public Health and Preventative Medicine at Monash University in Melbourne, Australia, and president-elect of the International Menopause Society.

According to a review published in April 2013 in The Journal of Sexual Medicine, female sexual dysfunction occurs more frequently in women with diabetes than in women without diabetes. “It’s really important to destigmatize the ability of women to talk to their doctors about what’s bothering them,” says Dr. Davis.

Before voicing your sexual concerns to your provider, here are some of the fundamental underlying reasons why diabetes may affect you down there.

Why Is It More Difficult to Become Aroused?

Arousal and achieving an orgasm are tied to both nerves and blood vessels in the vagina and genital area, says Davis. High blood glucose can damage nerves and cause peripheral neuropathy, which can affect everything from your fingers to your toes to your genital area. “Sensation to touch can be diminished, and that clearly is going to affect sexual response,” she adds.
In addition to neuropathy, women with diabetes are more likely to have blood vessel damage than those women without the disease. This damage can impact the amount of blood flowing to your vagina and genital area. Less blood flow could affect your arousal and orgasms, says Davis.
She compares this phenomenon to erectile dysfunction (ED) in men, which is more common in men with diabetes than men without diabetes, and points out that although this issue hasn't been as well studied in woman as ED has been in men, it's still a genuine concern for women. In a small study published in June 2015 in The Journal of Sexual Medicine, researchers found differences in the physiology of vaginas (including blood vessels) in women with type 2 diabetes.
Keeping blood glucose in your target range may help protect your nerves and blood vessels, as well as prevent complications of diabetes. If you’re having difficulty with arousal or orgasm, ask your provider about whether any medication you currently take could be a contributor, says Davis. In particular, blood pressure medication can affect blood flow, and antidepressants can dampen sexual desire, she adds. Although you shouldn’t stop taking these drugs on your own, consider bringing up these side effects with your provider.

Why Is Intercourse Sometimes Painful?

Women with high blood glucose are more prone to vaginal infections, which might make sex uncomfortable or have the unwanted side effect of discharge. Both of these could get in the way of sex, says Neil Goodman, MD, an endocrinologist in Miami and cofounder of the reproductive medicine committee for the American Association of Clinical Endocrinologists.
Yeast infections occur because these bacteria thrive under high blood glucose in the vagina and aren’t detected by the immune system. “Every woman can have yeast in her vagina,” says Dr. Goodman, “but because of all of the other problems with diabetes, the yeast can take over a bit and overgrow, leading to infection.” Yeast infections can be treated with anti-fungal medication, including pills and creams, says Goodman. Keeping your A1C on target can also help prevent these infections.
Davis says that during menopause — when estrogen is low — thinning and dryness of the vagina can increase the risk for yeast infections. This thinning and dryness, which is called vaginal atrophy, can make sex uncomfortable, too. Tell your doctor if you find intercourse uncomfortable or painful. Davis recommends asking about vaginal estrogen therapy, which can come in the form of a topical cream or an inserted ring and may reduce the risk of infections, ease urinary incontinence, and alleviate vaginal dryness.

Why Isn’t My Sexual Desire Stronger?

Goodman says women with diabetes can have irregular menstrual cycles, and those changing hormones can affect mood, energy, and fatigue. In turn, these feelings could affect sexual desire.
Lack of sexual desire is like a jigsaw puzzle, says Davis, and is impacted by your relationship with your partner, workplace stress, family stress, financial concerns, past history of sexual abuse, fatigue, and changes in weight and body image, which can affect how comfortable you feel being in the nude. Even simple things like privacy to be intimate in your home with children sleeping in the next bedroom can affect desire. “It’s not usually one thing that fixes everything,” she adds. “You’ve got to really take a long, hard look at your situation.”
Medication options for low sexual desire in women are limited. Although doctors sometimes prescribe testosterone off label, the Food and Drug Administration (FDA) has not approved this therapy for use in women. Davis notes that Addyi (flibanserin), which was approved by the FDA in 2015 to help treat low desire in premenopausal women, might not be appropriate for women with diabetes because one of the side effects is fainting — something that could be problematic for patients prone to hypoglycemic episodes. Plus, the efficacy is marginal, she adds.
Goodman says he’s seen his patients have the most success seeking a specialist in sexual counselling. He also says that tuning into sexual desire comes down to patience and communication between partners: “A lot of couples have trouble talking to each other about sex.” Tactics might include telling your partner how you like to be kissed or touched. Goodman says decreased sexual desire is not unique to women with diabetes, and that it can affect all women.
But he points out that women with diabetes may be dealing with more health issues than women without diabetes — and that this can affect desire.

How Do I Talk About Sex With My Healthcare Provider?

“Women should not be embarrassed or ashamed to speak to their doctor about this, if they feel that their ability to become aroused or achieve orgasm has changed,” says Davis.
Davis says that she’s had patients tell her that their doctors have been dismissive of their sexual concerns because of misconceptions about women not being sexually active in their sixties and beyond, particularly during and after menopause. If your provider rebuffs you or he doesn’t feel comfortable addressing the issue, don’t be discouraged. “You should identify someone on your [diabetes] management team who you can talk to,” says Davis.

https://www.everydayhealth.com/type-2-diabetes/living-with/sex-with-diabetes-womens-awkward-bedroom-questions-answered/