Both type 1 and type 2 diabetes can lead to a range of complications, such as foot problems, kidney disease, and cardiovascular problems. Less talked about is the impact of diabetes on sexual health.
What are type 1 and type 2 diabetes?
Diabetes is a chronic condition which causes blood glucose levels (blood sugar) to become too high. There are two main types of diabetes: type 1, in which the body’s immune system attacks cells in the pancreas that make the hormone insulin, and type 2, in which the body either does not make enough insulin or cannot respond effectively to insulin.
Type 2 is much more common than type 1, accounting for 9 out of 10 diabetes cases. Type 1 diabetes often arises in childhood, whereas type 2 commonly appears in adulthood.
Because both conditions cause high blood sugar, both can cause a similar range of complications. Among these are kidney disease, peripheral nerve problems (for example, in the feet), and cardiovascular disease. Most symptoms of sexual dysfunction arising from diabetes occur dorectly due to chronic high blood glucose levels.
What types of sexual dysfunction can occur in diabetes?
A common sexual health issue seen in people with type 1 or type 2 diabetes is a decrease in libido or loss of a sex drive (also referred to as ‘hyposexual sexual desire disorder’)1. Other than diabetes, this disorder can be caused by a range of factors such as:
- side effects of medications for high blood pressure or depression,
- taking statins,
- tiredness and chronic tiredness,
- hormonal changes (e.g. testosterone or oestrogen deficiency),
- stress and anxiety,
- relationship issues.
Dysfunctions specific to people assigned female at birth (AFAB)
Many people AFAB with diabetes experience vaginal dryness as a result of high blood sugar levels and impaired blood flow, which may contribute to pain or discomfort during sex, low libido, potential difficulties reaching orgasm and a generally reduced sexual response. People AFAB may also experience vaginismus, the inability to relax muscles in the vagina to allow intercourse.
Thrush (candidiasis) is very common in diabetes, especially in people AFAB. Thrush is a fungal infection which anyone can get, but high blood sugar makes the urine a perfect breeding ground for the fungus. Urinary tract infections (UTIs) are also more common in people AFAB with diabetes for the same reason, especially cystitis which is an infection of the bladder4.
Dysfunctions specific to people assigned male at birth (AMAB)
High blood sugar levels may also lead to a range of problems for people AMAB with diabetes, possibly leading to erectile dysfunction and a variety of problems with ejaculation. Poor blood glucose control can impair blood flow to the genitals or cause nerve damage (diabetic neuropathy), which potentially causes erectile dysfunction and absent or retrograde ejaculation (which is what happens when semen travels to the bladder instead of through the penis during ejaculation).
Diabetic neuropathy can cause numbness, pain, or lack of feeling in the genitals. Other reasons for erectile dysfunction, that are also related to diabetes, include stress, obesity, high blood pressure, and high cholesterol. Any or all of these side effects can make sex painful or unenjoyable, which can further impact libido.
Treatments for sexual health problems
Some sexual problems caused by diabetes, such as vaginal dryness, may be avoided by maintaining blood glucose levels in the desired range. Maintaining overall physical and mental health can also go a long way in solving many diabetes-related sexual problems.
Sexual arousal, vaginal lubrication, and erection all have a lot to do with blood flow. Live a lifestyle that promotes good heart health and proper blood circulation, including regular exercise. Exercise can also have the added benefits of improving your energy level, mood, and body image.
Vaginal dryness is extremely common and management does not have to only fall onto people AFAB with diabetes. It can be remedied using a range of commercially available lubricants which can be obtained from pharmacies, which will reduce the pain and discomfort of sex and possibly help to restore libido.
Vaginismus can be treated with kegels (pelvic floor exercises), vaginal dilators, and cognitive behavioural therapy (CBT), helping relax the vaginal muscles.
People with hormone deficiencies may benefit from hormone injections, pills or creams. In premenopausal people AFAB, there are two medications that are approved by the FDA to treat low libido: flibanserin (Addyi®) and bremelanotide (Vyleesi®).
Bremelanotide has undergone clinical trials in the UK, but neither are currently licensed for commercial use in the UK. Hormone replacement may help, but the NHS notes that the most common cause of poor libido and reduced sexual desire is relationship problems, which may be effectively dealt with by counselling or couples’ therapy.
Erectile dysfunction might be treated with lifestyle changes including weight loss, a healthy diet, exercise and stress reduction. A recent study also suggests that amino acid supplements of l-arginine and l-citrulline may also help to improve erectile function5. These amino acids help increase the body’s production of nitric oxide, which dilates blood vessels and can increase blood flow to the penis. Low levels of nitric oxide are often found in people AMAB with diabetes.
A popular drug treatment for erectile dysfunction is a class of drugs called phosphodiesterase 5 (PDE5) inhibitors, for example sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca), avanafil (Stendra) and vardenafil (Levitra, Staxyn). They act by increasing blood flow to the tissues of the penis, although they do require sexual stimulation to be effective, which might be impacted by other factors such as low desire.
There is also some evidence that PDE 5 inhibitors which encourage capillary dilation, such as sildenafil, work more effectively in combination with the diabetes drug metformin in insulin-resistant AMAB, but this is disputed by others who found an increase in erectile dysfunction with metformin and actual interference by sildenafil in the actions of metformin and other diabetes drugs. In contrast, sulphonylurea drugs have been found to reduce erectile dysfunction, although they probably achieve this by reducing blood sugar6,7,8.
How does diabetes affect a person assigned female at birth sexually?
Diabetes can lead to a loss of libido and/or vaginal dryness due to high blood sugar.
How does diabetes affect a person assigned male at birth sexually?
Diabetes can result in a loss of libido, erectile dysfunction, absent and occasionally retrograde ejaculation.
Does type 1 diabetes affect erectile function?
Diabetes can cause erectile dysfunction, due to either restricted blood flow to the penis or nerve damage. In addition, some drugs commonly prescribed in diabetes, e.g. blood pressure medication, can cause the problem.
Can erectile dysfunction caused by diabetes be reversed?
Erectile dysfunction can be treated with drugs which reverse the effects of diabetes temporarily and prevent it from getting worse. In certain case when a nerve damage occurs, the dysfunction may be irreversible or irreversible without surgery.
Can you take Viagra if you have diabetes?
In fact, it is frequently recommended/prescribed for sexual dysfunction in diabetes.
What is one of the first signs of sexual dysfunction in people assigned male at birth with diabetes?
One of the earliest signs of sexual dysfunction due to diabetes in people AMAB is erectile dysfunction.
Can diabetics get an erection?
Yes, many diabetics can get normal erections without help. Others (35-75%) may require medication such as Viagra.
Can diabetes be transmitted from one person to another sexually?
No. Diabetes develops as a result of autoimmune or metabolic problems and cannot be passed on like an infectious disease.
Is treatment for erectile dysfunction available on the NHS?
Yes, several different treatment options are open to GP’s and sexual health specialists, including Viagra, vacuum therapy and surgery. In addition, Viagra is now available over the counter at pharmacies.
Does excitement raise blood sugar?
Yes. Like many emotions, excitement raises blood sugar. But remember, sex is as much a form of exercise as running and this will lower blood sugar.
- Clayton A. The pathophysiology of hypoactive sexual desire disorder in women. International Journal of Gynecology & Obstetrics. 2010;110(1):7-11.
- What is a hypo? [Internet]. Diabetes UK. 2021 [cited 12 December 2021]. Available from: https://www.diabetes.org.uk/guide-to-diabetes/complications/hypos
- Sex and diabetes [Internet]. Diabetes UK. 2021 [cited 12 December 2021]. Available from: https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/sex-and-diabetes
- Diabetes and sexual problems – in women [Internet]. Diabetes UK. 2021 [cited 12 December 2021]. Available from: https://www.diabetes.org.uk/guide-to-diabetes/complications/sexual-problems-women
- Barassi A, Corsi Romanelli M, Pezzilli R, Damele C, Vaccalluzzo L, Goi G et al. Levels of l-arginine and l-citrulline in patients with erectile dysfunction of different etiology. Andrology. 2017;5(2):256-261.
- Metformin + Viagra More Effective Treatment for Erectile Function [Internet]. Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. 2021 [cited 12 December 2021]. Available from: https://www.diabetesincontrol.com/metformin-viagra-more-effective-treatment-for-erectile-function/
- Al-Kuraishy H. Erectile Dysfunction and Low Sex Drive in Men with Type 2 DM: The Potential Role of Diabetic Pharmacotherapy. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2016;.
- Peuler J, Phelps L. Sildenafil does not enhance but rather attenuates vasorelaxant effects of antidiabetic agents. Journal of Smooth Muscle Research. 2015;51(0):22-36.