5 ways diabetes can impact your sex life

When someone has diabetes, their body can’t maintain healthy levels of glucose in the blood. Glucose is a form of sugar that is the main source of energy for our bodies. A hormone called insulin is essential for glucose uptake into the body. In people with diabetes, not enough insulin is made by the body, or insulin doesn't work properly.

If diabetes goes undetected or isn’t controlled, it can cause serious short-term and long-term health complications, increasing the chance of sexual and reproductive health problems including:

• Erectile dysfunction
• Low testosterone
• Low sex drive
• Retrograde ejaculation
• Balanitis

1. Erectile dysfunction and diabetes

Erectile dysfunction is when you have difficulty getting or maintaining an erection hard enough for sex. The causes of erectile dysfunction can be physical, psychological, or a mixture of both.

How common is erectile dysfunction in men with diabetes?

You’re more than twice as likely than normal to have erectile dysfunction if you have diabetes.

Erectile dysfunction is also more common than normal in men who are overweight, have cardiovascular disease, high blood pressure or high cholesterol, and these are all common conditions in people with diabetes.

How can I prevent erectile dysfunction with diabetes?

Nerve damage and reduced blood flow to the penis are usually the reasons for erectile dysfunction in men with diabetes. Keeping blood levels of sugar and fats (cholesterol and triglycerides) normal is important to prevent nerve and blood vessel damage.

A healthy diet, regular exercise and avoiding excessive drinking, smoking, and drug use may not only improve your erectile dysfunction but will also benefit your overall health and wellbeing. If there’s a psychological cause of your erectile dysfunction, speaking to a psychologist or sexual health therapist may help.

How is erectile dysfunction treated with diabetes?

Chat to your doctor about treating erectile dysfunction. Your first step will be ensuring your diabetes and any other related conditions (such as high blood pressure) are properly controlled. Medical treatment for erectile dysfunction is usually a type of drug known as a phosphodiesterase type-5 (PDE5) inhibitor, like sildenafil or tadalafil.

If oral medicines don’t work, there are other treatments that you can explore, including penis injections and surgery.

2. Diabetes and low testosterone

Testosterone is a hormone that is needed for normal reproductive and sexual function. If you have type 2 diabetes, you’re more likely than normal to have a low testosterone level. You’re even more likely to have testosterone problems if you’re diabetic and also overweight.

How does diabetes cause low testosterone?

High levels of blood sugar in men with diabetes can impact the amount of luteinizing hormone the brain releases. This hormone is needed for the testicles to make testosterone.

Low energy levels, mood swings, irritability, poor concentration, reduced muscle strength and low sex drive are symptoms of low testosterone, but they are also symptoms of other illnesses.

Can low testosterone be prevented in men with diabetes?

Keeping a healthy weight and doing regular exercise to control blood sugar levels can keep your testosterone levels normal.

How is low testosterone treated in men with diabetes?

If you’ve got diabetes and low testosterone, you should get treatment for diabetes and any other related conditions first, as this might return your testosterone levels to normal.

If you’re overweight, weight loss might help.

Your doctor might recommend testosterone therapy for men with diabetes and low testosterone caused by genetic disorders or other conditions.

3. Diabetes and low sex drive

Sexual desire is different for everyone and fluctuates naturally throughout your life. There are normal dips during times of stress and a decline as you age — just a couple of the many reasons you might not feel up for it as much. If you lose interest in sex for no apparent reason, and it’s a concern for you and/or your partner, you might be dealing with low sex drive.

How does diabetes cause low sex drive?

Diabetes can cause low testosterone levels, which leads to a lower sex drive. On top of this, other problems sometimes caused by diabetes, such as difficulty getting an erection, can impact your interest in sex.

How is low libido treated in men with diabetes?

The best way to figure out how to manage low sex drive is to speak to a doctor because the best treatment varies from person to person.

If your doctor thinks your libido is being affected by other health conditions, treating those will be the first step. Counselling, either individually or with your partner, might be suggested if psychological or relationship factors might be causing your low sex drive.

Testosterone treatment can be effective for treating low libido in men whose testosterone levels are low, but there is no evidence that testosterone treatment can increase libido in men whose testosterone levels are normal.

4. Diabetes and retrograde ejaculation

If you have diabetes, the high levels of sugar in your blood can damage the nerves and muscles that open and close the neck of the bladder (external sphincter muscle). This muscle usually stops semen from entering the bladder when you orgasm so if it isn’t working properly, semen flows back into the bladder instead of being ejaculated.

To diagnose retrograde ejaculation, your doctor will ask you some questions, perform an examination, and request a urine sample that’s collected after orgasm. This sample, including any semen present, will be sent to a specialised laboratory for testing.

How is retrograde ejaculation treated in men with diabetes?

If retrograde ejaculation is caused by diabetes, controlling blood sugar levels and making lifestyle changes can help. Retrograde ejaculation is usually treated successfully with medication.

If you have retrograde ejaculation and you’re trying to conceive, you might need the help of assisted reproductive technologies such as in vitro fertilisation (IVF).

5. Diabetes and balanitis

If you have balanitis, you might have itchiness, a rash, redness, swelling, or discharge from your penis, and you might not be able to pull back your foreskin over the head of your penis.

How does diabetes cause balanitis?

Sometimes, after urinating, urine gets trapped under the foreskin. If you have diabetes, the sugar in your urine can encourage bacteria to grow under the foreskin, leading to infection.

One of the types of medicines used to treat diabetes could also increase the risk of balanitis.

What treatments are there?

Practising good hygiene and controlling your blood sugar levels can help. Your doctor might prescribe antibiotics or antifungal medication to help clear up the infection.

What can I do about diabetes and sexual health problems?

If you're experiencing any of these issues, book an appointment with a GP. Discussing sexual health with a doctor isn't always comfortable but it's important, especially if you have diabetes. Support is available and there are several ways to manage diabetes and its impacts on your sex life. You can talk with your doctor about lifestyle changes or other ways to control your blood sugar levels. Your doctor might refer you to another medical specialist or sexual therapist if it’s suitable for you.