Diabetes and Women's Sexual Health
Uncontrolled blood glucose levels and diabetes-related complications can greatly effect sexual desire and performance for many women.
By Janis Roszler, RD, CDE, LD/N

There are several ways in which diabetes can play a role in sexual health for women. I discussed this issue in my online column at dLife (Your Diabetes Life), a Web site resource for individuals living with diabetes. The following is a summary of that information.

• Infections and irritation. Chronic high blood glucose promotes yeast infections and vaginal irritation.
• Low blood flow. Vascular damage caused by poorly controlled diabetes restricts the blood flow to the vagina, which causes vaginal dryness and interferes with arousal.
• Medication. Certain drugs, such as antidepressants, birth control pills, tranquilizers, and antihypertensives can cause decreased libido as a side effect.
• Menopause. "The change" and its effects on the body may cause a serious change in your female patients' sex life.
• Nerve damage. Women who have neuropathy to the genital area, the reproductive organs, or the vagina may have difficulty achieving orgasm.
• Neurogenic bladder. Women with nerve damage to the bladder may have incontinence problems that make sex difficult and/or embarrassing. It can also make urinary tract infections more common, which may make sex uncomfortable
• Vaginismus. Some women experience vaginismus, a tightening of the vaginal walls which can make penetration painful or impossible.

Many women find that their blood glucose levels are affected by their menstrual cycle. (For more information on this topic, see Review of Endocrinology, October 2008 issue, page 27.) Tracking glucose levels in tandem with the menstrual cycle can help your patients understand if hormones are having an impact on their diabetes control. Encourage women to discuss the results with you, as adjustments in medication, insulin, exercise, and diet may be necessary to bring these patients' glucose levels back to normal during this time. Below is a quiz that may help women determine if diabetes is affecting their sex life.

Depression and anxiety, particularly in newly diagnosed women who are just learning about diabetes management, can interfere with sexual desire (see sidebar, Diabetes Patients Feel Condition Has Impact on Sex Life, Mood). So can the mechanics of treatment (wearing a pump, for example, or the need to do a blood sugar check before sex) because they may make some women self-conscious with their partners and less likely to initiate or participate in sex. If your patients' lack of libido stems from diabetes-related depression or anxiety, therapy and/or medication can help. Make sure to encourage a conversation about the possible sexual side effects of any antidepressants. Some newer agents have fewer sexual side effects and may be preferred in depressed women with decreased sex drive.

Educate your patients to the fact that the best way to avoid diabetes-related sexual dysfunction is by disease management. Keeping blood glucose levels in control will also lessen your patients' risk for neuropathy, circulatory problems, and chronic infections.

Women with good diabetes management habits also have higher energy levels and less anxiety, which also contribute to more enjoyable lovemaking. Help your patients understand that if their blood glucose levels are not where they should be, adjustments to diet, medication, and weight loss are beneficial for diabetes control and self-esteem.

Be sure to ask your patients about vaginal dryness and follow up to see if low estrogen levels are the cause. Although hormone replacement therapy (HRT) can reverse this problem in some women, the safety of HRT is a matter of controversy. Estrogen can elevate blood glucose levels in some women; therefore, if vaginal dryness is diabetes related, over-the-counter lubricants may be a safer choice.

Janis Roszler, RD, CDE, LD/N, is the American Association of Diabetes Educators (AADE) Educator of the Year (2008–9). She coauthored the book, Sex and Diabetes: For Him and Her with Donna Rice, MBA, BSN, RN, CDE, and AADE Past President. It was recently nominated for Consumer Book of the Year by the Society for Sex Therapy and Research. Ms. Roszler may be contacted at janis@dearjanis.com.