Diabetes, Your Bladder and Your Sex Life: It's Complicated

Written by Kathleen Doheny

In years past, some experts tended to believe that those with diabetes weren't any more likely than others to have sexual issues or urological issues. With age, some figured, everyone has a bit higher risk of both sets of problems.

However, recent research has found that having diabetes may indeed make you more prone to developing sexual problems and urologic conditions, including infections, sexual dysfunction, bladder issues and those nasty yeast infections.1

As miserable as that may sound, however, good self-care (yes, we're once again talking again about good blood sugar control) can help minimize the risk. And, if you do develop either sexual or urologic issues, treatments and continued good self-care can get you back in the swing quickly.

What are the Risks?

If you have been diagnosed with type 2 diabetes, ''the chance of developing sexual dysfunction is high for men and women," says Hunter Wessells, MD, FACS, professor and the Nelson Chair of Urology at the University of Washington. About 50% of men with diabetes get erectile dysfunction (ED) by the age of 50, he says.

In comparison, about 12% of all men in the U.S. under age 60 report ED, the National Institutes of Health estimates. 2

Men with type 1 diabetes are even more likely to be affected with ED, with about 62 % of them reporting it by age 50, Dr. Wessells says. ''The odds of having urinary problems are not as high, but still substantially higher than the general population,'' Dr. Wessells says. "These issues take 10 to 15 years or longer to develop."

Researchers from the University of Michigan and other centers found that men with type 2 diabetes have nearly twice the risk of urinary issues as those without the diagnosis. Among the problems: infections,  incontinence and bladder cancer.1

Women with type 2 diabetes taking insulin are more likely than others to report sexual problems, with difficulties in lubrication and orgasm and pain or discomfort during intercourse, the researchers found.1

Yeast infections are more common in those with diabetes, both men and women, when blood sugar is out of control. (The fungi causing  yeast infections, Candida, thrive in an environment rich in glucose.) Often the yeast infection affects the vagina, but the infection can occur anywhere on the body, such as in skin folds.3,4

Why Are These Conditions Related?

Several things can explain the links, Dr. Wessels says. ''Diabetes imparts a risk of complications through a variety of mechanisms, including metabolic effects as well as indirectly through nerve and blood vessel damage," he says.

High blood sugar, over time, can result in fungi thriving, for instance, or can make the muscle controlling the exit of urine from the bladder work poorly, resulting in bladder problems. Low blood sugar tends to produce sexual problems.1,3,4  

Treatment & Self-Help Strategies

Minimizing urologic and sexual problem comes back to blood sugar control, Dr. Wessells says. "Close monitoring and control of blood glucose is a cornerstone, and better diabetes control is associated with reduced odds of male ED, women's urinary incontinence and urinary tract infections. Other factors may also be important, such as weight control, exercise, blood pressure control, and avoidance of smoking."

However, he adds, ''for female sexual dysfunction (FSD), these factors have not been associated with higher risk," he says. But depression, which can be effectively treated, has been linked with FSD, he says.

In addition, medication to help men get and maintain erections (Viagra, Cialis) can be tried, Dr. Wessells says. Or, therapies such as injections or vacuum erection devices or penile prostheses to get an erection may help.

Women with sexual issues, he says, have fewer options. A medication, flibanserin (Addyi) can be prescribed for women with low sexual desire. But they will need to skip the before-sex cocktail—the drug has a caution about not drinking alcohol, due to the risk of very low blood pressure occurring. Nor can it be used in women who have gone through menopause, the drug maker says.5

Your Doctor Has Heard It Before

Despite the relative newness of the research finding those with diabetes are more prone to sexual and urologic problems than the general population, rest assured your doctor has heard these complaints from other patients for years.

It's no time to be shy. If your diabetes doctor doesn't ask about your sexual and urologic health, bring up the topic yourself, reporting on any issues. The bright spot is that your doctor will have a treatment to offer or a self-help suggestion that can improve or eliminate the problems.

Dr. Wessells reports no relevant disclosures.

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