Diabetes patients usually are aware of the potential complications of their disease — heart disease, stroke, kidney failure, blindness, amputations. Yet even considering these life-threatening and disabling consequences, many patients rank sexual dysfunction high on their list of worries.

Diabetic men thought sexual dysfunction as the third most important of all complications — after kidney disease and blindness. Sexual difficulties have a negative effect on both physical and mental health as well as quality of life.

When blood flow throughout the body is compromised, as it is with cardiovascular disease, the sexual response is likely to be affected as well. Diabetic patients have a high risk of cardiovascular disease, and sexual dysfunction often is one of the earliest signs of diseased blood vessels, particularly in males.

But even persons with healthy blood vessels can experience sexual problems if there is any malfunction of the autonomic nerves that carry signals from the brain or of the local nerves that control sensations. And nerve damage is another common complication of diabetes.

Preventing and treating neuropathy requires good control of blood sugar. The role of blood sugar control in reducing diabetic complications has been well documented. Men who lower their blood sugar reading by one percent over a three-month period reduced risk for the complications that can cause erectile dysfunction.

The best way of controlling blood sugar is through diet, exercise, weight loss and proper use of insulin and or other medications.

Hypertension, another major risk factor for heart disease, should be treated aggressively with diet, exercise and medication. A reading 130/80, borderline high for a healthy person, is considered hypertension for a person with diabetes.

More than two-thirds of males with hypertension have some degree of erectile dysfunction. And to make matters worse, some blood pressure medications, such as beta blockers and thiazide diuretics, can either cause or contribute to sexual problems.

For men, a major advance came with approval of PDE5 inhibitors — first Viagra and later Cialis and Levitra.

Although some promising studies are under way, no satisfactory treatment of female sexual dysfunction is currently available. A woman’s sexual response is too complex to respond to simple changes in blood flow. Diabetic sexual dysfunction in women was more likely to be related to psychological effects such as depression, anxiety and poor adjustment to the disease rather than physical complications such as neuropathy.

Medications such as tranquilizers and antidepressants that might be used to treat psychological effects can contribute to sexual dysfunction. Age is less a factor in a woman’s diabetic sexual dysfunction although menopause can lead to problems such as reduced desire and vaginal dryness.

Sex is an important part of a healthy life. For diabetics, keeping this spark alive and healthy usually is a continuing challenge. The initial step toward a solution is to bring the topic out of the closet for frank discussion — first with your spouse and then with your doctor.



Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.