If you've noticed your sex life isn't what it used to be, and your bladder doesn't have the staying power that it once did, it may be time to talk to your doctor. A growing body of research finds that those with diabetes are more prone to urologic and sexual problems than those without the diagnosis.
The good news: these problems can be treated and improved, or even eliminated. Paying attention to good lifestyle habits may also help, experts say.
Dr. Sarma conducted a study to tease out the effects of age versus the effects of diabetes on how likely men and women would be to develop urologic and sexual problems. "We know now with our data that the burden of these [complications] is greater in those with diabetes, and their diabetes affects the complications." Among the findings from her research and that of others:
• If men report type 2 diabetes, they have almost twice the risk of urinary problems as men without the diagnosis. Urinary problems include infections, incontinence, and bladder cancer.
• Having type 2 diabetes increases the risk of getting bladder cancer by about 70%, especially in those who have been diagnosed less than five years, some research finds. Almost 50% of men with diabetes have erectile dysfunction, or ED (those with type 1 are even more likely, about 62%), while the overall percent among those men without diabetes is about 25%.
• While about 15% of women in one study who did not have type 2 diabetes had stress incontinence (urine leaks when you laugh or sneeze) about twice as many with type 2 diabetes reported it. Urge incontinence, in which you always feel like you have to ''go,'' was about four times as likely in those with type 2 diabetes compared to those without, research has also found.
• Sexual problems in women with type 2 diabetes were more common, especially if they take insulin. The problems included lubrication difficulty, orgasm difficulty and pain or discomfort with intercourse.1
Diabetes can damage blood vessels and nerves, of course. Beyond that reality, research is focusing on what interventions matter. "A1C matters," says Hunter Wessells, MD, FACS, professor and chair of urology and the Nelson-Endowed Chair, University of Washington, another speaker at the meeting. However, he is not aware of a research study to determine if reducing A1C reduces ED and other issues.
Having a very high blood sugar, hyperglycemia, over time, can result in the muscle controlling the exit of urine from the bladder not working properly, says Michael Albo, MD, professor of urology at UC San Diego Health, the third speaker. He cited other research finding that 50% of those with diabetes have some sort of bladder problem, such as getting up at night to urinate, feeling the need to go often, having a reduced stream of urine or incomplete bladder emptying. The longer you have had your diagnosis, Dr. Albo says, the more likely the bladder problems are.1 Additionally, research has found that men with type 2 diabetes, but not women, have a higher risk of bladder cancer, especially if their diagnosis was less than five years ago.
Medications to help men get and maintain erections, called PDE5 inhibitors (Viagra, Cialis) can help, Dr. Wessells says. So can the ''second line'' therapies such as injection therapy, vacuum erection devices, and penile prostheses.
Women hoping to pep up their sex life have fewer options, Dr. Wessells says. The Food and Drug Administration has approved only one medicine, flibanserin (Addyi), prescribed for low sexual desire. However, he notes, the drug carries a caution about not drinking alcohol, as symptoms of very low blood pressure can occur. And it is not meant for women who have gone through menopause, the company says.3
To minimize bladder issues, Dr. Albo recommends weight loss if needed, pelvic floor therapy and, as a last resort, medications. Research on dietary changes, such as reducing caffeine intake, has produced mixed results.
The statistics are no surprise, says Elena Christofides, MD, FACE, an endocrinologist in Columbus, Ohio. She often hears her patients talk about issues in both areas.
She does find that she often has to broach the subject first, and encourages patients to tell her what's on their minds—it's not like she hasn't heard it before. Often, once she breaks the ice with a patient, they will feel more comfortable bringing up issues in the future. From her observations, she says, low blood sugar, or hypoglycemia, tends to produce sexual problems. High blood sugar, or hyperglycemia, is linked with urological problems, she has observed.
This leads to her first recommendation to avoid either problem: "Good glucose control is the first measure," she says. She also works with patients to determine if there are any secondary causes, besides the diabetes that might be driving the problems, such as poor lifestyle habits.
The speakers reported no relevant disclosures. Dr. Christofides reports receiving grants or research support from Pfizer, GlaxoSmithKline, Janssen, Sanofi-Aventis, Novo Nordisk and Lexicon. She is a consultant for Novo Nordisk, Eli Lilly and Chiasma. She is on the speakers' bureau for Pfizer, Novo Nordisk, Eli Lilly, Boehringer Ingelheim, PamLab and Shire.