Men, sex and diabetes
View(s):Many men who experience problematic erections suffer in silence because they postpone approaching their doctor. Although discussing your sex life may seem awkward to begin with, it is important to recognise that many doctors are familiar with issues regarding this topic, and there are doctors specially trained in managing sexual problems.
By Dr. Lasantha Malavige
Men and women with diabetes can have a normal sex life. Unfortunately, it is known that in some men and women, this condition can interfere with a range of sexual functions. This is more relevant to Sri Lankans as we are at a higher risk of developing diabetes and getting it at a younger age. Among the male sexual issues related to diabetes, erectile dysfunction is by far the most common and most troublesome sexual problem.
Erectile dysfunction (also known as impotence), is the consistent inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. ED is three to four times more common in diabetic men, compared with non-diabetic men. ED due to diabetes occurs a decade or so earlier than in men without diabetes.
Other male sexual problems in diabetes
Men with diabetes, particularly in the early stages of erectile difficulties, can experience ejaculation occurring too early. This condition, which may be distressing to either one or both partners, is known as premature ejaculation.
On the other hand problems of ejaculation may involve a persistent delay in or absence of orgasm and ejaculation, following normal sexual excitement. The volume of semen that a man releases might also be reduced.
Low sex drive is a common problem in diabetes. The level of normal sexual desire varies widely between individuals and also from time to time in a given individual. However, a man with low/absent sexual desire typically does not initiate sexual activity and may only engage in it reluctantly when it is initiated by his partner. This problem is often associated with erectile difficulties, and could either be its cause or its result.
Some painful conditions of the penis are known to be more common amongst men with diabetes:
The foreskin and the head of the penis can become red and painful. This problem may become recurrent, and is often due to a fungal infection. It is called balanitis.
The penis can sometimes loose flexibility. It may then be forced to bend or arc during an erection, while causing pain. This is a condition of uncertain cause, referred to as Peyronie’s disease.
The foreskin becomes very tight sometimes, making it difficult to pull it back over the head of the penis (glans). This condition, known as phimosis, can causes pain.
What are the reasons for sexual problems in a man with diabetes?
Diabetes is a complex disease process, with profound effects on all systems of the human body. The manner in which it leads to sexual problems too, is a culmination of several different factors rather than one single direct process.
Damage to blood vessels and nerves
The process of diabetes related vessel damage begins even before a person develops full blown diabetes. Fat deposits and blood clots frequently block the large pelvic blood vessels of diabetic men, thereby reducing the blood supply to the penis. Additionally small vessels within the penis are diseased and further limit flow of blood into the erectile tissue. These factors make it difficult for a man to achieve an erection.
Diabetes also attacks the nerves of the body. Pleasurable sensations that usually occur in response to stimulation of the penis are impaired. Nerve damage also interferes with transmission of signals from the brain to the penis, which leads to a weakened erection.
Other conditions related to diabetes which contribute to erectile dysfunction
High blood pressure (hypertension), unhealthy cholesterol levels and excess body weight (overweight/ obese) are conditions which are closely linked to diabetes. These conditions contribute to disease of blood vessels throughout the body and act as risk factors for erectile dysfunction, similar to the way in which they act as risk factors for heart attacks and strokes.
Some medication used to treat high blood pressure is also linked to erectile dysfunction. This may also be true of some cholesterol lowering drugs.
Low testosterone levels
Studies have shown that a substantial portion of men with diabetes who suffer from erectile dysfunction have testosterone levels below the normal range. Although the reasons for this are not fully understood, low testosterone associated with diabetes may contribute adversely towards a man’s sexual desire (libido) and the quality of his erection.
Psychological and relationship issues
Diabetes and its complications are associated with depression, which may predispose to erectile dysfunction. Erectile dysfunction may then worsen existing depressive symptoms, thereby leading to a vicious cycle.
Furthermore, reduction in erectile function can generate anxiety and make the situation worse.Other general factors such as stress, misinformation, unrealistic expectations and poor communication with one’s partner also contribute towards many forms of sexual dysfunction.
Other non related medical disorders and drugs/ substance abuse
There are numerous other conditions and drugs/ substances that may potentially lead to erectile dysfunction. Although not specific to diabetes, some of these maybe applicable to you:
Smoking, excessive alcohol intake and illicit drug use
Certain medications such as anti depressants, anti psychotics, some stomach ulcer medication, hormones and hormone modifying agents
Neurological conditions such as spinal cord injury and multiple sclerosis
Pelvic trauma, tumours or surgery (e.g. prostate surgery)
How can these problems be sorted out? What can I do to help myself?
Modify your lifestyle
Regular exercise, balanced diet, stopping smoking and avoiding excessive alcohol are important. Evidence shows that men who are able to make these changes could significantly retard the progression of their problems. Some men may even see an improvement. It is worthwhile noting that many of the specific treatment available for diabetes related sexual problems have the potential to fail, if not accompanied by suitable lifestyle changes.
Crush the stigma; communicate effectively with your partner
Many men find it extremely difficult to work up the confidence to talk to their partner about sexual difficulties. This is especially so in the Sri Lankan setting. You probably feel embarrassed, frustrated, nervous and depressed. Your partner too, despite wanting to talk about it may not do so because she worries about hurting your feelings. She may also believe that she is to blame for the situation, and feel that you no longer find her attractive. This lack of communication can make your relationship worse.
A man is most likely to find his partner understanding and supportive when approached. An open conversation can motivate both to explore options to improve the situation together and leave both partners feeling hopeful and relieved.
It is also important for your partner to appreciate that older men and diabetic men require more physical stimulation to achieve an erection.
Don’ t suffer in silence; Seek doctor’s help
Many men who experience problematic erections suffer in silence because they postpone approaching their doctor. Although discussing your sex life may seem awkward to begin with, it is important to recognise that many doctors are familiar with issues regarding this topic, and there are doctors specially trained in managing sexual problems.
There are many forms of treatment available for erectile dysfunction which include different kinds of oral medication, injections and vacuum devices. Self-medication can be harmful as some treatment may be unsuitable for you. Therefore, a detailed discussion with your doctor is required before you embark on treatment. Ultimately, the goal of therapy is not just a rigid erection but a satisfactory sexual relationship and good health.
(The writer is a specialist in Sexual Medicine)
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