Can my diabetes affect my sex life? If so, how and what can I do about it?

Diabetes can have a profound effect upon a person’s sexual  drive,  functioning,  and  satisfaction. This  is especially  apparent in men, although  there is some evidence that  some  women  with  diabetes can also experience adverse effects on  their sexual responses. The reason for the significant effects on male sexual function arises from the complexity of the penile erec- tion  mechanism.  This  requires  satisfactory nerve, blood  vessel, and hormone function to be achieved and sustained. Diabetic nerve damage can be of two main types. One form is damage to the system that serves conscious movement and sen- sation and  the other  is damage to the  system that serves unconscious or  automatic  responses, such as bowel contraction  and  the  heart  beat. The  erectile mechanism is served by the latter, while the sensation of pleasure in sexual performance is served by the for- mer. Since the nerves to the genital area are relatively lengthy, they are prone to the damage described in Normal erectile function also depends on a  healthy blood supply to the penis, as erection entails  engorgement of the organ with blood. If the blood supply is compromised, the quality of the erec- tion will be poor. As discussed in Question 35, vascu- lar damage is commonly associated with diabetes and frequently affects the health of the vessels supplying the genitals. Finally, normal levels of the  male  hor- mone testosterone are necessary not only for sexual interest (libido), but also for perception of pleasura- ble  sensations from sexual arousal. Low testosterone levels, already  common  in  middle-aged  and  older men, are even more  common in men with diabetes. Indeed, there is suggestive  evidence that low testos- terone levels may contribute to worsening of diabetes, thus  creating a vicious cycle that  further  depresses hormone levels. In light of the three strikes  of dia- betic nerve damage, vascular damage, and diminished levels of male hormone, it is not surprising that poor sexual performance and diminished satisfaction are a frequent finding in men with diabetes. Indeed, more than half of all men with  type 2 diabetes of five or more years’ duration will complain  of  one or more symptoms of sexual dysfunction. Sometimes  this is worsened by medications commonly used by people with diabetes, such as certain blood pressure-lowering drugs.