Does diabetes affect sex?

Dear Alice,

I have been diabetic for 19 years now (I'm 20 years old) and I was wondering: does having this disease for so long have long-term effects on my sexual health? I am a man and so far I have no issues.

Dear Reader,

It’s great that you're asking about potential complications you could face in the future — while diabetes may not be affecting your sexual health as of yet, it’s always a good idea to be prepared and informed. Research indicates that about 75 percent of cisgender men and 35 percent of cisgender women with diabetes do experience some sexual issues, mostly as a result of diabetic neuropathy (nerve damage) to the nerves that stimulate normal sexual response, which is caused by high blood glucose levels (or high blood sugar). The good news: research has found that individuals who take manage their condition by controlling blood glucose levels — which lowers blood pressure, cholesterol, and triglyceride levels — can lower their risk of developing diabetes-related sexual problems by preventing damage to the blood vessels and nerves.

In addition to neuropathy, cis men with diabetes are also at increased risk of experiencing erectile dysfunction (ED). ED, defined as the inability to achieve or maintain an erection satisfactory for sex, can develop as a result of a testosterone deficiency. According to the American Diabetes Association (ADA), over 13 million cis men suffer from low testosterone, 90 percent of whom go untreated. Cis men with type 2 diabetes are also two times more likely to suffer from low testosterone than those without diabetes. Low testosterone can also cause low libido, or a drop in sex drive, in cis men. A simple blood test can detect this deficiency and it can be treated quite easily with gels, patches, or injections to increase the amount of testosterone in the body.

However, diabetic cis men may also experience a drop in libido due to diabetes-related weight gain, depression, stress, or high blood pressure. Diabetes can also make it difficult for cis men to reach an orgasm and ejaculate, due to a lack of blood flow or sensation caused by neuropathy. Difficulty with ejaculation could also be a sign of retrograde ejaculation, which, though rare, occurs when semen travels into the bladder during ejaculation, rather than out of the penis. The semen then mixes with urine and is urinated out, but it's possible that cis men experiencing retrograde ejaculation may never ejaculate properly at all. The inability to ejaculate could also cause complications with fertility. Even if a cis man is able to ejaculate in an attempt to conceive, some studies have shown that their sperm is more likely to move too slowly or never reach or fertilize the egg. Cis men are also more likely to develop Peyronie’s disease, also known as penile curvature, which means that their penis curves when erect due to a plaque of scar tissue in their penis. This curve in the penis can cause issues during sex, making it painful or difficult.

For cis women, the long-term effects of diabetes on sexual health can include decreased vaginal lubrication, low libido, difficulty achieving orgasm, and pregnancy issues. Vaginal dryness caused by low lubrication can make sex painful or uncomfortable. Yeast infections and urinary tract infections (UTIs) are also more likely in cis women with diabetes, both of which can make sex painful and uncomfortable as well. The hormonal swings that often accompany menstruation and menopause require increased attention to blood glucose levels. In addition, cis women with diabetes are at an increased risk of heart disease after menopause due to a loss of estrogen. While this litany of possible complications may sound overwhelming, for each problem, there are several solutions. Water-based lubricants can be very effective against persistent vaginal dryness and are widely available. 

For anyone, though, it’s critical to bring sexual health concerns to a health care provider who can diagnose and treat any conditions. If you find yourself experiencing any of these issues, it's wise to consult your health care provider as soon as possible. Studies have found that only roughly 50 percent of cis men and 19 percent of cis women with diabetes willingly bring up the subject of sexual difficulty with their health care provider. However, the sooner you do so, the faster your health care provider can help you address the problem and potentially receive treatment. After all, if you’re experiencing issues with sexual performance and satisfaction due to your diabetes, this can signal other health issues such as blocked arteries and unbalanced hormones. As long as you’re open and honest with your health care provider about any and all symptoms you’re experiencing, you could prevent any further damage to your body. Sexual issues caused by diabetes can also lead to potential mental health problems due to the emotional and psychological toll these struggles can take on a person. If this is the case, it may feel beneficial to meet with a mental health provider.

So, in short, Reader, it's great that you aren't experiencing negative effects of diabetes on your sexual health. To keep it that way, it would be wise to continue to monitor and treat your diabetes, keep your weight and blood pressure at healthy levels, and be sure to see a health care provider if you notice any changes in your libido, mood, or erectile abilities.

Last updated Jan 14, 2022
Originally published Dec 31, 2010

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