Let’s Talk about Sex and Diabetes
By Matthew Garza
Though certain sexual disorders are well-understood in men with diabetes, we know a lot less about the prevalence, impact, and management of sexual dysfunction in women with diabetes. At the ADA Scientific Sessions, Dr. Sharon Parish gave a broad overview of what we do know about this topic.
Dr. Sharon Parish, professor of medicine, clinical psychology and professor of clinical medicine at Weill Cornell Medicine, delivered a fascinating presentation on the third day of the 82nd ADA Scientific Sessions that included a broad overview of sexual disorders and dysfunction in women with diabetes.
What sexual disorders do women with diabetes face?
There are a number of sexual disorders that can affect women and women with diabetes specifically. These include hypoactive sexual desire disorder (HSDD) (reduced sexual desire and motivation), female sexual arousal disorder (reduced sexual arousal), and female orgasm disorder (reduced frequency, intensity, or pleasure of orgasms, and/or delayed, spontaneous, or premature orgasms), among many others.
How common is sexual dysfunction?
The prevalence of these conditions is disheartening. Research shows that in sexually active women with type 2 diabetes, as many as:
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50% experience desire problems
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34% experience arousal problems
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36% experience lubrication problems
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36% experience orgasm problems
More recent data shows these rates may actually be slightly lower, and there are differences with type 1 vs. type 2 diabetes. Women with type 1 diabetes having a greater prevalence of sexual dysfunction, including decreased desire, lubrication, and arousal. In women who do have sexual dysfunction, there are also higher rates of diabetes distress, impaired emotional well-being, and anxiety.
The reasons these conditions show up more prominently in women with diabetes could include hormonal reasons, infections, hyperglycemia that affects vaginal lubrication, neurological damage, and increased rates of mental health conditions like depression.
What are the risk factors?
Risk factors for these sexual dysfunctions include older age, obesity, smoking, higher A1C, and longer duration of diabetes. Interestingly, depression and marital status are significant predictors of sexual dysfunction in women.
The importance of screening for sexual dysfucntion and reducing stigma
Parish stressed that screening is key, but that these conversations should be initiated by healthcare providers by asking open-ended questions. “Have them tell you a story, ask follow-up questions,” she said.
And as a person with diabetes, being honest with your healthcare provider about how diabetes affects your sex life can help them help you. If they don’t bring the topic up, and you are comfortable, initiate the conversation yourself. This can help normalize talking about sex and reduce the stigma associated with these conversations – all people deserve to have a healthy and fulfilling sex life.
Treatment options for some sexual disorders in women with diabetes
For women with HSDD, Parish broke down three treatment options. If you have this condition, ask your healthcare provider if any of these may be available to you.
For pre-menopausal women, Flibanserin could elevate hormones in your brain that lead to sexual desire and Bremelanotide (an injection taken on-demand) can increase desire and decrease distress. Though there is less research in the area, there is some evidence that testosterone injections given off-label could moderately improve desire in post-menopausal women.
In addition, if the root cause of HSDD is determined to be tied to a psychological or relationship/lifestyle issue, counseling, cognitive behavioral therapy, or psychotherapy could also be good options for treatment.
Finally, Parish explained some signs and symptoms of vulvovaginal atrophy (VVA) and genitourinary syndrome of menopause (GSM) and treatment options. These conditions, which occur post-menopause, can lead to loss of elasticity, soreness, dryness, irritation, and burning. They may be able to be treated with lubricants and moisturizers or low-dose vaginal estrogen.
Why is sexual health important?
Sexual health is an important part of your overall health. Talking to your healthcare team about how diabetes affects your sex life, and finding ways to address the root causes of any issues you notice, could improve not only this area of your life but also your emotional and mental well-being. It’s also important for healthcare providers to help initiate these conversations in their clinics.
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