Diabetes can pose unique challenges to women. Some of these challenges are purely medical. For example, women with diabetes are more prone than women without diabetes to urinary tract and vaginal infections that create risk to overall health. Women with diabetes may experience a host of medical problems when faced with the prospect of becoming pregnant. If you are a woman, you may also notice that diabetes affects your menstrual cycle, which in turn can affect your diabetes and blood glucose control. And older women with diabetes may face special problems as they proceed through menopause.
Diabetes presents many emotional challenges of particular concern to women, particularly as it relates to sexuality. A woman’s sexuality is a complex mix of emotional and physical factors. Diabetes can affect a woman’s emotional and physical state of well-being and thus may have a significant impact on her sexual well-being. However, medical literature presents a confusing picture of what impact diabetes has, if any at all, on a woman’s sexual relations.
You may already be aware that women with diabetes face special challenges when it comes to sex. If you have diabetes, you are at greater risk of developing medical problems. When you are not feeling well physically, you are more likely to feel emotionally drained or overwhelmed, depressed or anxious. And when you are not feeling emotionally healthy, you are even less likely to feel sexually comfortable. Sexual function depends on both physical and emotional factors and diabetes can impact both.
For both women and men, problems with sex can have many causes. A sexual encounter involves four important events: desire, arousal, orgasm and satisfaction. Each stage of sex can be affected by both emotional and physical factors. You may have problems with one aspect of the sexual response, but not others. Your physical state of well-being can affect your emotional state and vice versa. For example, you may be feeling ill because of physical factors and have no desire for sex.
This can create conflict with your sexual partner. If you have difficulties in the relationship and are unable to talk about your feelings, this can create stress, make you feel less healthy in a physical sense, and have even less desire for sex. This can, in turn, trigger more difficulties in the relationship. It is often difficult to determine the original source of the problem or whether physical or emotional factors are to blame. Usually they are intricately intertwined.
Women with diabetes are especially at risk for sexual problems. Some women with type 1 diabetes have difficulty becoming aroused. Sexual arousal and vaginal lubrication both depend on an increased flow of blood to the vagina, a process that requires healthy nervous and circulatory systems. Inadequate blood flow to the vagina can cause irritation and pain during sexual activity.
Many women with type 2 diabetes tend to have low sexual desire, poor vaginal lubrication, difficulty reaching orgasm, and less satisfaction. Overall, women with type 2 diabetes tend to be less satisfied with almost every aspect of their sexual relationships compared to women without diabetes. These problems are likely due to a combination of psychological and physiological factors.
Women in general, and women with diabetes in particular, often report problems with sexual desire. Desire can mean different things to different people. For the most part, desire means having the motivation or the wish for a sexual encounter. It can be triggered by something external, such as viewing an erotic movie or feeling the embrace of a special person. Desire depends on having sufficient levels of certain hormones in your blood, but it can also be influenced by other physical and emotional factors.
Problems with desire can manifest themselves in different ways and it is important to figure out where they are coming from. You may feel no motivation for sexual relations at all with anyone. This might indicate a physical problem. Or you could have no desire for sex with your current partner. This might indicate a problem with the relationship. Maybe you have been fighting or are unable to communicate your feelings on any of a variety of subjects. Maybe you are unable to agree on money and cannot put those feelings aside in the bedrooms.
Your lack of desire may also stem from feelings about yourself. Maybe you are feeling depressed and find it difficult to get motivated about anything. Maybe you are overwhelmed from dealing with diabetes and have no emotional energy left for anything else. If you are obese, you may have a negative image of your body and feel little desire to initiate sex. If you have a low self-esteem, you may also be unmotivated to initiate a sexual encounter. Other feelings, such as anxiety, can also inhibit desire. Maybe you are worried about becoming pregnant or being infected by a sexually transmitted disease.
A lack of desire for sex can also have physical roots. Maybe you suffer from some of the complications of diabetes and do not have the physical energy to feel desire. Maybe you have mobility problems and sex is the last thing on your mind. Maybe your blood glucose levels are not well controlled, leaving you feeling overtired, irritable, or just not quite right. Maybe menopause has left you with little desire and you just don’t understand why.
Other emotional factors can also affect your desire for sex. Some may be obvious and others more subtle. The bottom line is that if the thought of a sexual encounter does nothing for you, then you may have a problem with sexual desire.
What You Should Do
First, ask yourself whether it is even a problem. If you have a partner or spouse who very much wants regular sexual encounters, then it could cause stress in the relationship and create problems. If you yourself wish that you had more desire and feel that you are missing something you once enjoyed, then it could be a problem. But if you don’t have a partner or your partner has no desire for sex, then you should ask yourself whether your low libido is a problem. You may want to seek the advice of a professional therapist to assess this situation and to make sure that you and your partner are not denying your true feelings. Many people can live quite happily without sex, but for others, the lack of sex can create problems when you would least expect it.
If you decide that living without sexual desire is not an option for you, then talk to your doctor or health care professional about what may be causing your low libido. Your doctor may want to first conduct a thorough examination to rule out any obvious physical factors.
Any physical conditions, such as circulatory problems, difficulty breathing, neuropathy, a bladder or yeast infections, or poor blood glucose controls, that makes you feel unwell or generally ill may affect your physical desire. Certain medications may also affect your libido. Together with your doctor, try to determine what physical factors could be affecting your sexual desire. Try to figure out what factors you can do something about and which problems you may have to learn how to accept.
Also, talk to your doctor about any emotional problems that could be affecting your desire for sex. If you have any symptoms of depression or anxiety, for example, you may benefit from individual psychological counselling and /or medication. If you and your partner are experiencing any relationship difficulties, marital or couples counselling may help. It is important that your partner understands what you are going through. It is also important that your partner understands what makes you feel aroused.
You can also help stir up your feelings of desire and achieve a positive state of mind by maintaining a healthy, active lifestyle. Try to eat a balanced diet and keep your blood glucose levels as close to normal as possible. Get some sort of exercise. Pursue those activities and interests that bring you joy and add balance to your life.
Sexual arousal is closely related to sexual desire. It is difficult to feel physically aroused if you have no desire. However, it is possible to feel desire but be unable to become physically aroused. Arousal often follows naturally from a stimulus such as a visual image or physical touch in combination with feelings of desire. Arousal depends on both emotional and physical factors, such as the emotionally charged excitement of anticipation as well as the physical process of increased blood flow to the genital tissues. The physical outcome of arousal in women is vaginal lubrication
For women, the most obvious sign of a problem with sexual arousal is poor vaginal lubrication. This is analogous to erectile dysfunction in men and occurs commonly among women with both type 1 and type 2 diabetes. Vaginal lubrication can also be affected by the phase of the menstrual cycle. During the ovulatory phase, many women secrete vaginal fluids with little sexual stimulation. Between periods of ovulation and menstruation, the vagina may be much dryer. In evaluating your ability to secrete vaginal fluids, also pay attention to your menstrual cycle and/or hormonal status.
What You Should Do
Talk to your doctor if you are experiencing any problems with sexual arousal. Vaginal dryness itself can have other causes and can, in turn, inhibit physical arousal. For example, certain medications may cause vaginal dryness, which can make physical intercourse uncomfortable. Vaginal infections can also interfere with feelings of sexual arousal. Your doctor will want to make sure that no medical conditions are interfering. Neuropathy and poor circulation, for example, could also inhibit sexual arousal.
Women who are postmenopausal may experience a general tendency toward vaginal dryness. If you have vaginal dryness, you may want to consider using a vaginal lubricant that can increase your feelings of sexual arousal. Postmenopausal women find that taking estrogen supplements also increases vaginal secretions.
Also, talk to your partner about what provokes feelings of arousal. If you are able to become aroused during masturbation, but not with your partner, there may be something you are doing to yourself that you could teach your partner to do. Many women are also helped by having their partners perform oral stimulation before vaginal intercourse.
Maybe you need more foreplay, but your partner is into quick sex. A candid talk with your partner about what brings you pleasure can go a long way in enhancing sexual arousal.
Orgasm is primarily physical culmination of sexual stimulation, but it is affected by both physical and emotional factors. Orgasms are controlled by the nervous system and consist of a series of rhythmic contractions of the muscles and tissues of the vagina and genital region.
Some women experience pain during or after intercourse, especially when there is not enough lubrication. This condition is known as dyspareunia. Other women may experience vaginismus, an involuntary contraction of the vaginal muscles during intercourse. This is literally a tightening up of the muscles of the vagina in response to penetration by the penis. Still other women may be unable to reach climax because of medical problems that inhibit physical activity. Other women may fail to achieve orgasm for unknown reasons.
What You Should Do
If you become physically aroused, but have problems achieving orgasm, talk to your doctor to rule out any physical reasons. If you are obese or have problems with your heart or respiratory system, for example, you may not have the physical stamina required to achieve orgasm. If this is the case, you may benefit from a medication or exercise program designed to improve heart and lung function. Obesity puts and extra burden on your heart and lung and can make orgasm difficult, even without underlying heart or lung disease. Talk to your doctor about weight-loss reduction programs. If your ability to achieve orgasms is inhibited by vaginal dryness, a vaginal lubricant may help. Talk to your doctor about these and other possibilities.
Also, talk to your partner about your feelings towards orgasm. If your partner typically climaxes before you, ask him to take steps to first ensure your satisfaction. Sometimes, women need more foreplay and stimulation than men. Some women find it easier to orgasm in certain positions than in others. If you are always on the bottom, try lying, sitting or kneeling on top, for example, because this position gives you more control. You might also find greater satisfaction lying on your side facing your partner during sex.
You may also need more clitoral stimulation than you are currently receiving. Many women find it difficult to achieve orgasm through penile-vaginal thrusting alone. Talk to your partner and try experimenting with different types of stimulation to see what works for you. If you have desire for sex but difficulty reaching orgasm, a candid talk with your partner may be in order.
If pain during intercourse is interfering with orgasm, there are some exercises you can do on your own. A group of muscles called pubococcygeal muscles often tense up during intercourse and can cause pain. You can feel them when you try to stop the flow of urine while urinating. You can also locate them by inserting a finger into your vagina. Now if you squeeze the same muscles, you can feel a slight vaginal contraction. Once you know how to contract them, you can practice squeezing them for a count of three and then releasing them. Repeat this 10 times in a session, several times each day. If you are feeling pain during intercourse, try squeezing and releasing before and during intercourse to relax the muscles.
If you have talked to your partner and your general care practitioner and are still feeling pain during intercourse, you may need to visit your gynecologist. Your gynecologist will check whether there is any tenderness around your vagina or pain deep in your vagina, as well as the general health of the mucous membranes around the vagina. If you have any tenderness, burning or pain with sexual stimulation, you may have a condition known as vulvar vestibulitis. If you have this condition, the glands around the vaginal opening may be inflamed. If you feel pain only on deep thrusting, you may have endometriosis, pelvic adhesions, abnormalities of the uterine ligaments, or ovarian cysts. None of these conditions is specifically associated with diabetes, but one or more could be contributing to your problem.
Also, don’t forget to pay attention to your blood glucose levels. High blood glucose levels can lead to neuropathy. Often, symptoms of neuropathy are improved with better blood glucose control. This could affect your ability to orgasm, since it is under control of the nervous system. If you don’t already do so, try to incorporate regular exercise into your daily routine. Sex is a physical activity and the better your physical condition, the better you will be able to enjoy its pleasures.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Sexual Dysfunction in Young Women with Type 1 Diabetes Edyta Cichocka, Janusz Gumprecht and Michal Jagusiewicz
Urinary Tract Infection in Patients with Diabetes Mellitus by Lindsay Nicolle, Kurt Naber et al
Sexual Dysfunction in Women with Type 2 Diabetes Mellitus by Zahra Kashi, Adele Bahar et al