sexual health

Let’s Talk about Sex and Diabetes

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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:

  • 50% experience desire problems
  • 34% experience arousal problems
  • 36% experience lubrication problems
  • 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. 

Sexual Well-Being in Women With Diabetes

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If you’re a woman with diabetes, you may be at greater risk for certain sexual issues. Here’s more on how to manage it.

Your sexual life is an important part of your well-being, but if you’re a woman with diabetes, you may be at greater risk for sexual problems like low libido, less sexual stimulation, and yeast infections.

It’s not always easy to talk about sexual problems with your clinician, but it’s a good first step toward finding the right treatment. It’s important to prioritize women’s sexual health and for both healthcare professionals and patients to bring up these issues.

Impact on women with diabetes

“The risk of sexual dysfunction is very high in diabetes, but we have a number of solutions if the issue is carefully addressed by doctors,” said Dr. Emmanuele Jannini, researcher and professor of endocrinology and sexual medicine at the University of Rome Tor Vergata.

In a 2023 review, researchers looked at sexual dysfunction in premenopausal women with type 1 diabetes. Among them, 36% experienced some type of sexual problem. The study also found that women with type 1 diabetes are three times more likely to experience sexual issues compared to those without diabetes. 

For women with type 2 diabetes, the numbers are even higher. A 2019 meta analysis found that roughly 67% of women with type 2 diabetes experienced sexual dysfunction.

Reasons for sexual dysfunction

There are several reasons why women with diabetes may be at greater risk for sexual problems, including:

  • Lubrication issues. When your blood sugar is consistently high, this can cause damage to your blood vessels, including those in your vagina. When this happens, your vagina may not be able to properly lubricate itself, leading to dryness.
  • Less stimulation. High blood sugar can also lead to nerve damage. When the nerves in your vagina and vulva are damaged, you may not be able to feel as much sexual stimulation.
  • Difficulty feeling aroused. Sexual arousal triggers increased blood flow to your vagina and vulva. If your blood vessels are damaged by diabetes, you may have restricted blood flow to these areas.
  • Urinary tract infections (UTIs). If you have diabetes, you’re at a greater risk for developing a UTI due to extra sugars present in the tissues of your urinary tract. This creates an environment that’s easier for bacteria to grow and cause an infection. Having a UTI can also seriously affect your sex life. Having sex may put extra pressure on your bladder, which can trigger intense pain or discomfort. 
  • Yeast infections. People with diabetes are more likely to get yeast infections because yeast grows more easily in urine that’s high in sugar. Yeast infections are also a side effect of SGLT-2 inhibitors, which are used to manage blood sugar in people with diabetes. Yeast infections can cause pain and itching in your vulva, and make sex extremely uncomfortable.
  • Low libido. Diabetes can disrupt the normal balance of sex hormones like estrogen and testosterone. Changes in these hormones can reduce your sex drive and make it harder to become aroused.

The importance of women’s sexual health in clinical care

According to some experts, most of the research on sexual problems focuses on men with diabetes – not women.

There is early research on medications that may help for sexual dysfunction in women, including testosterone therapy and Cialis (tadalafil). However, more studies are needed to prove these treatments work effectively for females.

Due to the general lack of research regarding women’s sexual health, healthcare providers don’t have a way to accurately measure sexual dysfunction in women. Developing this kind of assessment would help determine which women need treatment and shine a light on how common the problem truly is.

As a starting point, clinicians should directly ask patients if they’re having any sexual issues, as many may be uncomfortable bringing up the subject on their own. Along with testing, researchers and healthcare experts need to focus on developing treatment methods that specifically target women’s sexual health issues.

Education for doctors is also important. Many clinicians who specialize in endocrinology may not have education in sexual medicine, Jannini said, and this needs to change.

Treatment options

Despite the challenges around sexual dysfunction in women with diabetes, there are treatment options available. For those experiencing sexual pain or discomfort, hormone therapy, physiotherapy, and certain medications may help. There are tons of varieties of lubricants found at your local pharmacy or sex shop to help with vaginal dryness.

For issues with stimulation and sexual arousal, sex therapy or counselling can teach you more about ways to increase intimacy and learn more about your body’s sexual responses. While more research is needed, medications including sildenafil (Viagra) and buproprion (an antidepressant) have shown positive results in improving and even reversing sexual dysfunction in women.

The bottom line

Many women with diabetes experience sexual issues; getting the right testing and treatment can make a big difference. Doctors and medical policymakers need to prioritize this issue by developing better testing measures and treatments that specifically target women’s needs.

Under attack, global sexual health ‘can’t rely on US’

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Abortion rights chile

A campaigner displays a poster in Spanish saying, “My body is mine I decide” during a pro-choice march in Chile. Unsafe abortion is a leading cause of maternal death worldwide.

Speed read

  • Unsafe abortion a leading cause of maternal death worldwide
  • Reproductive health funding based on 100-year-old model
  • Global abortion laws linked to colonial penal codes

Religious campaigns and political interference could threaten hard-won reproductive health rights in the global South in the wake of the US Supreme Court decision on abortion, health advocates fear.

Cross-border solidarity and coordination will be needed to face down the growing global threat to reproductive rights, health and policy experts have told SciDev.Net.

Unsafe abortion is a leading cause of maternal death worldwide. Around ten per cent of abortion-related maternal deaths occur in Latin America and Sub-Saharan Africa, where abortion access is most restricted. Yet, evidence shows that legal restrictions do not reduce abortions – they occur most often where abortions are legally restricted.

Health advocates fear the US Supreme Court decision to eliminate the federal standard that protected the right to abortion, enshrined in Roe v. Wade, will have a cooling effect on funding and political support for sexual and reproductive health services in the global South.

“The fight for legalisation or decriminalisation of abortion has been going on in many, many countries.”

Marleen Temmerman, head of the Centre of Excellence in Women and Child Health at Aga Khan University, East Africa

But abortion should not be treated as a foreign funding policy issue, says Rasha Khoury, an assistant professor of obstetrics and gynaecology at Boston University. “[Abortion] is a medical provision and everyone should be entitled to it,” Khoury says.

For almost 40 years, the controversial US ‘global gag rule’ has been used by Republican presidents to block federal funding to non-US organisations that provide abortion counselling, referrals, and related services, or those that advocate for greater legal rights to abortion.

While President Joe Biden overturned the Trump administration’s gag rule in January 2021, there are constant efforts by members of Congress to permanently introduce the policy, according to Rebecca Dennis, associate director of US policy and advocacy at PAI (formerly Population Action International). Some opponents are working to have it permanently removed, she says.

The expanded reach of the global gag rule under the Trump administration meant that public health services were broadly affected, resulting in some clinics closing down if they refused to be gagged, says Dennis. “This policy really had the effect of weakening many health systems around the world right before we went into a massive global health crisis,” says Dennis.

Foreign expansion

Abortion opponents are taking their message to the world – and focusing their sights on the global South. Marleen Temmerman, an obstetrics and gynaecology professor and former Belgian senator, says nationalistic and religious groups are mobilising, leading some European governments to reverse reproductive health rights.

“The fight for legalisation or decriminalisation of abortion has been going on in many, many countries,” says Temmerman, a Partnership for Maternal, Newborn & Child Health board member and head of the Centre of Excellence in Women and Child Health at Aga Khan University, East Africa. “What we currently see here, at least in Kenya and African countries, is the evangelistic churches are getting more and more powerful.”

  • Religious opponents from the US are emboldening European groups to take their fight to Africa, says Martin Onyango, associate director of legal strategies for Africa at the Center for Reproductive Rights. “Opposition groups that operate across the continent – and particularly Sub-Saharan Africa – are led by church groups, they are transnational, traversing the US to Europe, Europe to Africa,” Onyango says.

“The same tactics you see being deployed in the US and Europe are the same tactics being deployed in Sub-Saharan Africa, they work with the same groups – largely the evangelical church groups. They have morphed from just being a religious focus group, [there are] also professional groups within those religious groups that then use tactics like litigation to further restrict access to reproductive healthcare.”

South Africa’s Choice on Termination of Pregnancy Act states that counselling of pregnant women must be “non-directive”. When the government proposed amendments to the act in 2004, the US-based Catholic anti-abortion organisation Human Life International (HLI) campaigned to overturn this provision.

HLI says it has branches in more than 100 countries, funds pregnancy care centres in 25 countries and carries out anti-abortion activities around the world, including increasing efforts to “keep Latin America pro-life”. The abortion advocacy group Equity Forward has reported that HLI has spent millions of dollars in developing countries to counter legal abortion campaigns, including in Rwanda, the Philippines, Mexico and El Salvador.

In Sub-Saharan Africa, anti-contraception messages are now being pushed on to teenagers, Onyango says, to disrupt their access to information and services.

Colonial hangover

Onyango points out that abortion bans have a colonial legacy. In North Africa and the Middle East, abortion is heavily restricted in more than 55 per cent of countries, says Khoury, a board member of Médecins Sans Frontières USA who has carried out surgical assignments in Iraq, Lebanon and Afghanistan.

“Those are laws that are based in penal code that often was instated by colonial entities,” says Khoury. “You can’t divorce the history of coloniality from the current restrictions on abortion and contraception access in these spaces. It is not an indigenous problem of trying to restrict women’s access to this very necessary health service, it’s really a vestige of coloniality.”

“The entire structure of who we are – as individuals, as families, as communities, as societies – is at stake.”

Sarah Hawkes, co-director Global Health 50/50

The systemic vulnerabilities in global reproductive health services have been 100 years in the making, says Sarah Hawkes, director of the Centre for Gender and Global Health at University College London.

Trump’s expansion of the reach of the global gag rule led to an estimated US$8-12 billion being withheld from health services around the world – up from $600 million under previous administrations, says Dennis. The UK, meanwhile, has slashed its support for family planning services via swingeing cuts to foreign aid.

“This is a situation that we’ve got ourselves into because we have relied on an incredibly old model that was developed back in the 1920s, of how population control programmes … were financed,” Hawkes says. “What we haven’t done is shared the responsibility, particularly within the countries that people live, operate, work within.”

Global solidarity

Hawkes says it is time for states to take control of funding and to support reproductive rights in their communities. “The entire structure of who we are – as individuals, as families, as communities, as societies – is at stake,” says Hawkes, who is also co-director of the non-profit Global Health 50/50.

Temmerman agrees: “We have to think how to organise ourselves better not to be dependent that much on the US. With the necessary efforts, we can have this debate at the level of the [Inter-Parliamentary Union], which we did for HIV. We could look to work toward parliament and having that structure revitalised for family planning and reproductive health.”

Advocates say a coordinated global response and allyship between rights movements could protect hard-won abortion rights.

Latin America and Caribbean campaigner Catalina de la Mar Calderón says that while there are political and social nuances between countries and regions, the US Supreme Court decision highlighted the need for more interaction between regional movements.

“We are under threat… the Dobbs decision is the best example of things going backwards instead of moving forward,” says Calderón, a member of the Women’s Equality Centre, referring to the Supreme Court case known as Dobbs v. Jackson Women’s Health Organization. “We need to be holding together: regardless of latitude, country, or which community this is happening in, it will affect the whole world.

“We’re here to share whatever we have learnt … but we also need to learn a lot from other countries. We’ve been conquering legal changes, but access – we’re far from it. And in countries where regulation is still needed, we’ve been fighting [in Latin America] for 20, 30 years, so we can also share what has and hasn’t worked, so you don’t have to go through that.”

Use It Or Lose It: How Age, Hormones, And Masturbation Predict Sexual Health

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This prompts some women to manage their “unacceptable” impulses by channeling them into acceptable behaviors. For example, these women may direct their sex drive toward their career. Women who are driven with ambition to reach the top, says Walfish, have sexual libido driving that energy. These women are putting out less in the bedroom and more at the office.

“This defense mechanism is known as sublimation. Women are sublimating sexuality into work,” Walfish said.

This unhealthy sublimation can lead to loneliness and reckless abandonment of our personal life. This puts all aspects of our life outside of work on hold — including sex. Soon, a month without sex turns into three months and three months turn into a year.

Before long, we begin to wonder: Where did our sex life go?

Sexual Dry Spell: A Woman And A Man’s Problem, Too

“Going through a dry spell” often gets labeled as a “woman’s problem.” The term is popularly used to describe a “sexless state” and isn’t given the best connotation. But these phases of celibacy, which could be months at a time, are actually normal.

A 2010 National Survey of Sexual Health and Behavior from The Kinsey Institute found these droughts are common in partnered and unmarried women in their 30s. More than 28 percent of these women reported having intercourse somewhere between once a month and not at all, with the frequency being slightly lower for married women. This is known as “double income, no sex” for married couples in a sex-starved marriage.

Surprisingly, women aren’t the only ones refusing sex in marriages. In a study conducted by Dr. Denise Donnelly of Georgia State University, she found out of 75 married people in sexually inactive marriages, in 60 percent of the cases, it was the man who stopped having sex first. Reasons for the couples’ dry spell included extramarital affairs and demanding jobs. Low frequency of sex in marriages is not a problem unless the partner perceives it as a problem. But how much sex is healthy for a happy couple?
“Couples of all ages who are either married or cohabitating should be having sex one to two times a week on average,” Walfish said. She believes when couples have sex less than once a week (excluding unexpected circumstances), this becomes a cause for concern. Sex and its frequency is usually reflective of communication, based on Walfish’s professional experience.

However, physiological changes in the body, like menopause for women, can impact the quantity and duration of sex.

Menopause: Moist In All The Wrong Places

Women will inevitably experience menopause between the ages of 45 and 50, with the average onset at age 51, according to the Mayo Clinic. This normal part of aging means the ovaries have stopped releasing eggs and making most of their estrogen. Symptoms of menopause include hot flashes, mood swings, and the dreaded vaginal dryness.

This is a different kind of “dry spell,” which close to one out of every three women experiences. The drop in estrogen levels reduces the amount of moisture available, making the vagina thinner and less elastic, which is known as vaginal atrophy. Although this dryness may seem like a small health issue, it severely impacts a woman’s sex life.

“When women go through menopause where vaginal dryness occurs, men can experience decreased sexual desire and some women can have a lower sense of themselves as sexual beings,” Walfish said.

Recently, though, Sprout Pharmaceuticals resubmitted the drug flibanserin to the Food and Drug Administration for approval for a third time. Flibanserin aims to treat hypoactive sexual desire disorder (HSDD) in women, defined as the persistent or recurrent deficiency or absence of sexual fantasies and a desire for sexual activity that causes distress or interpersonal difficulty, according to the press release. This drug is believed to help women, especially postmenopausal women who struggle to boost their sex drive.

Masturbation: A Cure-All To ‘Use It Or Lose It?’

Women can prepare for the effects of menopause even before they reach their 40s, without relying on drugs. Masturbation can help women remain sexually active — and men, too. It helps protect the nerve fibers and blood vessels responsible for erectile function. However, Walfish advises men be careful with this because they can become fascinated or obsessed with masturbation and begin to turn to it more accessibly.

“It becomes easier to do it yourself than communication. The hard stuff becomes the talking,” she said.

Why male birth control is a million disasters waiting to happen.

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It was 100 degrees out but I couldn’t stop shivering. I wore two shirts, jeans, and a heavy hoody but was still colder than I had ever been in my life.

Several months prior to the chills I started to have trouble sleeping. The urge to urinate woke me up about every two hours. I woke up about four times a night to take a piss. Each time hardly anything would actually come out.

At first I wrote it off.

Maybe I’m drinking too much water before bed, I thought. After all, I did drink tons of water throughout the day.

Then I started having problems urinating during the day. I’d whip it out to piss and then…nothing. Sometimes it’d be a full minute until I could actually get a stream going.

The pain started a few weeks later. It felt like a burning-hot screwdriver was being shoved up my phallus every time I tried to pee. There was pain even when I didn’t go to the bathroom. The sensation was as if everything beneath my stomach was crammed into a blender, torn apart, and then lit on fire. There was also pain in my sides. I don’t have quite as dramatic an explanation for that pain. If you’ve ever been punched before, imagine that but coming from the inside.

Regular visits to the gynecologist are essentially a must for a woman. While this has to suck, the upshot is that it forces them to understand their sexual health and reproductive health better than any man understands their own. It also, presumably, makes them less afraid of invasive tests since they have to endure them on a semi-regular basis. That’s why I put off going to the urologist for so long, because I was afraid of getting a tube put in my dick. Eventually, I couldn’t stand the pain and constant chills anymore, and I saw the doctor.

The doctor said I had a severe bacterial kidney infection that spread to the bladder and prostate—so basically a kidney infection, a urinary tract infection, and prostatitis.

I took the most powerful antibiotics they’re allowed to prescribe and after a while the pain went away…but the nocturia (getting up to pee a lot during the night) and the long delay before urinating. I went back to the doctor and he said the bladder muscle had become spastic and overactive as a result of the prolonged infection.

He prescribed a medicine to help me with my symptoms. I can’t remember the name, but I know it belonged to a class of medicines calledAlpha Blockers.

“One thing about this medicine,” the doctor said as he typed the prescription into the computer. “There’s a chance it can cause retrograde ejaculation.”

“Um…what?” I asked. I obviously knew what ejaculation meant but “retrograde” could’ve meant anything.

“Dry orgasms. No seminal fluid,” he said. In more specific terms, retrograde ejaculation is when semen gets sent into the bladder rather than out into a sock, condom, or, if you’re lucky, a crevasse belonging to your significant other.

I was weirded out but he said there was only a chance, right? So that meant there was a chance it didn’t cause retrograde ejaculation.

This pathetic bit of self delusion lasted until my first jerk-off session on the medicine. I felt the familiar build-up of pleasure and tension (I call it plension) and then… nothing. Not only was there no semen, there was no electric rush, no hip-bucking, and no release.

After about a month of this, I asked to switch to a different medicine. As far as I knew, that’d be the last time I’d ever have to think or hear about dry orgasms and retrograde ejaculation.

I was wrong.

Male birth control is swift becoming a highly discussed issue among social justice circles and the Internet in general.

One proposed method of male birth control is the use of alpha blockers to intentionally cause dry orgasms. Another, more recently publicizedstrategy is using gel to block the vas deferens—the tube sperm travels through—thereby preventing sperm from ever coming out of the penis (forgive the pun). The latter product could be available in three years.

The Daily Beast’s Samantha Allen, who is also a frequent contributor at the Daily Dot, noted that male birth control could have a multitude of wondrous impacts on society, and would greatly aid women since they would no longer be subject to the deleterious affects of The Pill.

Allen’s interpretation of the facts is accurate, but it paints too rosy a picture. The coming wave of male birth control will make conversations about reproductive health more vitriolic and hateful, not less.

First, insertion of gel into the vas deferens is an invasive procedure—far more invasive than popping a pill every day. A significant percentage of America’s 150 million-plus men will not go for it no matter how economical it is or how beneficial to society it is. American culture is too patriarchal and while #NotAllMen are this selfish, most are.

The bigger concern, however, isn’t the procedure but the dry orgasm.

“Dry orgasm” is a misnomer. Yeah it’s dry, but calling it an orgasm is just wrong. My dry “orgasms” felt like being 12 again—old enough to get a boner looking at porn illegally downloaded from Napster but not actually old enough for your member to spew forth any precious fluids.

I’m not alone in realizing that dry orgasms remove pleasure from sex. Astudy performed in 2009 found that “a strong decline in ejaculatory volume is associated with reduced sexual pleasure” when they gave men alpha blockers. The study noted the men were “greatly dissatisfied with the ejaculatory dysfunction” from the alpha blockers.

I lost all sex drive almost immediately once I started having dry orgasms. I didn’t even respond to a “booty call” I got while I was on the alpha blockers because I just didn’t care. What was the point of having sex if I knew I was incapable of enjoying it?

Cynics and jokesters would say “Well, if male birth control reduces libido then mission accomplished: No kids!”

Birth control isn’t just a preventative measure; it enables people to fully enjoy sex while avoiding the grave biological and financial consequences of sex. Male birth control, however, prevents pleasure as well as pregnancy.

Look, I’m not a men’s rights activist. I’m not trying to say women should be subjugated and forced to take the pill for as long as they live. I’m just saying that male birth control is highly imperfect. If you’re expecting it to take the world by storm in 2017, don’t. Once the first crop of men feel what a dry orgasm is like, it’ll start a new culture war. Imagine the GIF vs. JIF debate, but 10,000 times worse because it’ll be filled with more hate and it’ll be an issue that actually matters.

I guarantee you there will be a contingent of men comparing male birth control to female circumcision in that it robs both groups of pleasure. The web will be inundated with articles just like this one explaining just how awful male birth control is for men’s sexual health. And maybe we don’t deserve sexual health for all the atrocities we’ve committed against females, but good luck convincing America of that.

This birth control innovation isn’t a solution, it’s 150 million problems waiting to happen.