When you think of what it means to have diabetes, "great sex" may not come to mind. But it could.
"Someone who has diabetes should be able to enjoy sex as much and as regularly as someone who doesn't have it," says David G. Marrero, PhD, president of health care and education at the American Diabetes Association. "You just need to think about it a little more and educate yourself if you want a long, full sex life."
Skeptical? After all, in men, diabetes can cause issues from low libido to trouble getting an erection. But experts say that controlling your diabetes well can prevent sexual issues or make existing issues milder and easier to treat. In men with diabetes, most treatments work well.
Here are some of most common sexual concerns and how to prevent or treat them.
Erectile dysfunction (ED) -- not being able to get or keep an erection -- is the main sexual complaint for men with diabetes. Of course, all men have trouble with erections sometimes, especially as they age. But if you have diabetes, you're twice as likely to have ED and at a younger age.
You have ED if you have trouble with erections one out of every four times. Nerve and artery damage from poor diabetes control is a likely cause because it disrupts blood flow to your penis. You're also more likely to have heart disease because of this damage, which slows blood flow to your heart.
ED can bring your mood down. It can lower your self-esteem, make you depressed and anxious in bed, and cause stress between you and your partner.
Low Sex Drive
On the other hand, if you just don't have much desire for sex, you may have low testosterone. Like ED, low testosterone is more likely in men as they age. But having diabetes, especially if it is type 2 or you are overweight (or both), doubles your chances of having it.
You can feel the effects of low testosterone in many areas of life. Your energy, muscle strength, and mood may be low, as well as your sexual desire. You may have fewer and weaker erections.
Taking Control of Sexual Issues: Where to Start
If you have sexual problems and have diabetes, chances are you have chronic high blood sugar. Getting good control of your diabetes, blood pressure, and cholesterol is the No. 1 way to prevent and help ease sex troubles. It's a win-win strategy: You'll be healthier and have better sex. "Even if you already have nerve damage, it will help minimize sexual problems," Marrero says.
Make these tips part of your game plan:
- Lose weight if you need to. Here's good news if you are overweight or obese. A small 2011 study showed that obese men with type 2 diabetes who lost 5% or more of their body weight had better erections and more sexual desire in a matter of weeks. Why? Extra weight raises your chance of problems like nerve damage because it makes your body less able to use insulin. It also raises your chance of low testosterone. "Even modest weight loss of 5% or 7% can have a big impact," Marrero says.
- Get Moving. Being a couch potato makes you more likely to have ED. Regular exercise helps blood flow and protects against ED.
- Talk to your doctor. Don't be shy. About half of men with diabetes say they bring up sexual concerns with their doctor. Other health problems, like high blood pressure and kidney disease, may be to blame for your ED. Or you may have lost interest in sex because you're depressed, not low in testosterone. Your doctor can help pinpoint the problem and guide you to the right treatment.
- Learn about your medicines. This is another reason to talk to your doctor. You may take a medicine that causes sexual side effects. For instance, some blood pressure drugs can cause erectile dysfunction, and some antidepressants can lower sex drive. You may be able to cut back or switch to another medicine if one you take has stalled your sex life.
Treat Your ED
"There is a treatment for absolutely every man," says Janis Roszler, a diabetes educator, marriage therapist, and author of Sex and Diabetes: For Him and For Her. The best treatment for you depends on things like the nature of the problem and other health issues you have.
- Oral drugs. Sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil HCI (Levitra, Staxyn) boost blood flow to the penis during stimulation. The most common side effects, like headaches and stuffy nose, are usually mild and temporary. Side effects like erections that last for hours are rare. Oral drugs are the most common treatment and work well for up to 60% of men with diabetes who take them.
- Shots. A shot of alprostadil (Caverject, Edex) widens blood vessels, helping blood flow in up to 90% of men with diabetes. You can inject it into the base of your penis up to three times a week. The main downsides are burning in the testicles and lingering erections.
- Suppositories. Alprostadil (Muse) also comes in tiny pellets -- the size of a grain of rice -- that you put into the tip of your penis to relax the muscles and widen the blood vessels. You can use them twice a day. They work in about 35% of men.
- Devices. Vacuum pumps, available over the counter at drugstores, draw blood into the penis, helping it get hard. If you have trouble keeping an erection, you can follow with a constriction band around the base of the penis to keep the blood there once it's erect. Support sleeves, which hold the penis in place during sex, are also an option if you can't get an erection.
- Penile implants. This may be the best option if you have advanced diabetes and severe ED that doesn't respond to other treatments. The most natural implants are inflatable devices with fluid-filled cylinders that are placed in the erection chambers of the penis. You control an implanted pump that moves the fluid into the cylinders to create an erection.
Treat Your Low Testosterone
"Low testosterone can have a huge effect on your life, but the nice thing is it's so easy to treat," Roszler says. You can use testosterone gels, patches, shots, or pellets.
Testosterone replacement therapy can boost your energy, sex drive, erections, muscle mass, and mood. In a 2013 study, it improved all aspects of sex as well as the overall quality of life of obese men with type 2 diabetes. The impact was smaller for the men who were more obese or depressed, though -- another good reason to also lose weight or get help for depression.