Apart from its apparent crippling effects, chronic diabetes could also affect one’s sexual health. Mismanagement of blood glucose, particularly in middle age, could give rise to severe complications in both men and women.
Diabetes and female reproductive health
Hyderabad-based counselling sexologist Dr Poosha Darbha says that both men and women with diabetes often experience poor control over sexual function. “Diabetes can affect the four domains of sexual functioning – desire, arousal, orgasm and in some cases, pain – in women. All these factors may impact the ability to have or enjoy sexual activity,” says Dr Darbha.
When it comes to sexual health, it is often a combination of diabetes and hypertension that plays the spoilsport, by severely compromising the blood circulation to reproductive parts.
Experts also highlight the role of hormones, particularly estrogen, in sexual health. “High blood sugar levels along with other chronic conditions can disrupt pituitary function, leading to reduced estrogen production,” says Dr Sonali Kagne, deputy consultant, department of endocrinology, Sir HN Reliance Foundation Hospital, Mumbai. She also adds that prolonged diabetes and hypertension could trigger a horde of physiological and psychological conditions which could adversely affect sexual health.
“Unmanaged diabetes and hypertension can result in psychological stress, depression, reduced libido, vaginal dryness and pain during sexual intercourse,” she adds.
How menopause and diabetes overlap
Dr Sandeep Reddy, a senior endocrinologist at Kamineni Hospitals, Hyderabad, says that women with diabetes who also have polycystic ovary syndrome (PCOS) may encounter sexual dysfunction issues due to common pathogenic factors, mainly hormonal and vascular. He also adds that some of these diabetes-related sexual problems are often confused with menopause, as the onset of these problems often coincides with that of menopause.
“Sexual dysfunction in women with diabetes has been relatively understudied. Many women may not report these problems, assuming they are related to menopause or because they don’t realise the connection to diabetes,” says Dr Reddy. However, experts recommend more research into the dynamics between diabetes and female sexual health for more clarity.
Some of the main diabetes-related sexual complications in women include:
1. Vaginal Dryness
Vaginal dryness is a common sexual issue among women with diabetes. Dr Reddy points out that among several sexual issues, vaginal dryness is a prevalent problem in women with diabetes. It is primarily due to decreased lubrication because of reduced blood flow to the vagina.
The American Diabetes Association (ADA) states that women with diabetes are twice as likely to experience vaginal dryness due to nerve damage compared to those without diabetes.
2. Extreme pain during sexual intercourse
The stimulation of the vagina through lubrication becomes severely reduced in women with chronic diabetes. This is often seen in women closer to menopause and dismissed as a sign of menopause. Lack of lubrication can cause pain during sexual intercourse.
Dr Reddy says that dyspareunia, or pain during sexual intercourse could be due to vaginal atrophy (thinning and drying of the vaginal wall) due to less estrogen secretion. Dyspareunia is common among diabetic patients because of the impact of high blood sugar on the functioning of the endocrine glands leading to hormonal imbalance. Estrogen is the main hormone which is responsible for lubricating the vagina.
3. High risk of UTI and yeast infections
Women with diabetes are more prone to urinary tract infections (UTIs) and yeast infections, says Dr Reddy. Uncontrolled blood sugar levels create a conducive environment for bacterial and fungal growth, leading to these recurring infections. “Maintaining good blood sugar control will reduce the risk of such infections,” adds Reddy.
4. Inability to have an orgasm
Chronic diabetes could often lead to a drastic dip in sexual arousal in women. An article published by the American Diabetes Association states that middle-aged women with chronic diabetes will have more trouble reaching an orgasm than non-diabetic women.
According to Ooha Susmita, consultant psychiatrist, Allo Health, Mumbai, the lack of sexual desire, vaginal dryness and difficulty to have an orgasm are closely connected; these can lead to tremendous psychological stress on the individual.
Dr Reddy adds that diabetes could affect the secretion of mood-altering hormones such as estrogen, progesterone and follicle-stimulating hormones (FSH) which also contribute to sexual dysfunction.
5. Infertility
Dr Reddy says that the causes of infertility in women with diabetes are multifactorial. It is not solely due to sexual dysfunctions but may also involve factors like decreased ovulation and hormonal imbalances. Women with diabetes and obesity, who also have insulin resistance, are more prone to polycystic ovary syndrome (PCOS), which can affect ovulation and menstrual regularity, he adds.
