Sexual Healing for Women With Diabetes

Sex plays an important role in a healthy relationship with your partner. But if you have a chronic condition such as diabetes, your libido may be lagging. "Low libido is common in women with any kind of chronic disease, because if you are not healthy, sex is not likely to be the first thing on your mind," says Mario Skugor, MD, an endocrinologist at the Cleveland Clinic in Ohio.

However, diabetes can dampen your desire in more direct ways too. The disease can damage the body's blood vessels, thus impeding blood flow to organs including the vagina, explains William Petit, MD, medical director of the Joslin Diabetes Center affiliate at The Hospital of Central Connecticut. This can impair a woman's ability to become aroused and reduces vaginal lubrication, which can make for painful sexual intercourse.

In addition, "if your blood sugars are not well controlled, it may acutely affect nerve functioning," says Dr. Petit. This condition, called diabetic neuropathy, involves damage to the nerves and may contribute to problems with sexual dysfunction.

Indeed, as many as 35 percent of women with diabetes experience some type of sexual dysfunction, including low libido, difficulty getting aroused and difficulty achieving orgasm, according to the National Institutes of Health.

Your first step is to manage your blood glucose levels. When diabetes is well controlled, you are at a decreased risk for many complications, including sexual difficulties. Here's how to handle some of the conditions that you may be experiencing as a result of your diabetes, so you can get your groove back.

The condition: Decreased arousal

The low-libido lowdown: Over the long term, high blood sugar (hyperglycemia) can damage the blood vessels and reduce blood flow to various parts of the body, including the vagina and clitoris. Limited blood flow to these sexual organs can make getting aroused more difficult.

What you can do:: "Part of the solution is communicating with your partner," says Dr. Petit. The answer to arousal may lie in more foreplay (good news to most women!). Foreplay can help stimulate arousal and increase blood flow to those organs. "If your partner is in a rush, the solution may be simply slowing down."

The condition: Vaginal dryness

The low-libido lowdown: Nerve damage to cells that line the vagina can result in dryness, which in turn may lead to discomfort during sexual intercourse. Two-thirds of women with diabetes have vaginal dryness, says Dr. Skugor.

What you can do: Use an over-the-counter water-soluble lubricant or a prescription variety to help with vaginal dryness. If you are in menopause and are struggling with vaginal dryness (which is also a symptom of menopause), talk to your doctor about whether or not hormone therapy is a good option for you.

The condition: Bladder dysfunction

The low-libido lowdown: Diabetes can also damage the nerves that control bladder function, which can contribute to a host of problems, including overactive bladder, urinary urgency, urinary frequency, getting up at night to urinate and urinary incontinence (leakage). In addition, diabetes puts you at a higher risk for recurrent urinary tract infections (UTIs). If you are affected by any of these conditions, "sex is probably not high on the list," says Dr. Petit. Psychologically and physically, you just won't be in the mood.

What you can do: For UTIs, your doctor may prescribe an antibiotic. Drinking plenty of fluids may help prevent another infection. Keeping tight control of your blood glucose levels can help keep these complications at bay.

The condition: Depression

The low-libido lowdown: Individuals with diabetes, particularly those who have the type 2 variety and are morbidly obese, may fall prey to depression. "It could be that they cannot walk, they are limited in the things they can do, their body doesn't look good, people laugh at them or they are discriminated against," says Dr. Skugor.

When you're depressed, you don't want to have sex, he adds. In addition, even if you are not overweight, unmanaged diabetes can bring on sexual problems, and you in turn may become depressed or angry that you can no longer enjoy sex.

What you can do: Talk to your healthcare practitioner to determine whether counseling or medication could help you. And if you're concerned that antidepressants might further quell your desire, take heart: A medication called Wellbutrin (buproprion) generally does not increase sexual problems and in fact "increases orgasmic potential for women," says Dr. Skugor. Certain other newer antidepressants may also reduce the risk of sexual dysfunction in women and men.

The condition: Anxiety

The low-libido lowdown: If your blood sugar dips down low, you may experience anxiety. When you are jittery and not feeling like yourself, sex is not always on your mind, explains Dr. Skugor.

What you can do: Eating can help elevate blood sugar levels, thus helping to alleviate anxiety. A short-term solution for blood sugar levels that are slightly off: a small snack. If you have a tendency toward low blood sugar (hypoglycemia), work with your doctor to better balance them.

The condition: Fatigue

The low-libido lowdown: An individual with high blood sugar has to urinate frequently and consequently doesn't sleep well, says Dr. Skugor. What's more, this individual will be dehydrated and lightheaded and will experience a general feeling of malaise -- not a recipe for putting you in the mood.

What you can do: Of course, the best tack is controlling your blood sugar. But if you find that fatigue is a problem for you, shoot for getting intimate at the time of day when you have the most energy -- whether it's the early morning, late afternoon or evening.

Whatever you do, "don't say to yourself, 'I guess it's my diabetes; I have to live with these side effects,'" says Dr. Petit. "There are things you can do to fix problems related to sexual dysfunction." Find someone you feel comfortable talking to -- whether it's your gynecologist, your endocrinologist or another member of your healthcare team. This individual can help you determine whether medication, counseling and other measures are needed.

If you do start feeling in the mood again, use birth control as needed. A woman with diabetes who wants to have a baby should watch her blood sugar levels very closely. In fact, blood sugar levels need to be more tightly controlled than usual before you embark on getting pregnant. Read more on what you need to know about diabetes and pregnancy.

Note that diabetes can cause sexual difficulties for men as well. Get more details on sexual dysfunction and diabetes.

More: Get help from the Diabetes and Sexual Health message boards.

Resources: American Diabetes Association, "Diabetes and Women's Sexual Health"; National Diabetes Information Clearinghouse, "Sexual and Urologic Problems of Diabetes"; Cleveland Clinic, "Sexual Dysfunction and Disease"