Sexuality not only implies sexual activity but includes the full spectrum of sexual activity which is dependent upon the medical, psychological and sociocultural aspects of an individual. Two areas of great interest with respect to women with diabetes are contraceptive choices and whether women with diabetes have differences in their sexuality because of their diabetes.
There is no single contraceptive which is ideal for all women with diabetes. Each method has some disadvantages and some advantages.
- Oral contraceptives - Combination estrogen/progestin pills are best avoided in women who are more than 35 years of age or who are smokers. Also, if you have uncontrolled hypertension you should speak to your physician before using this form of birth control. Oral contraceptives with less than 35mg of estrogen and a low progestin dose are recommended.
- IUD's (Intrauterine Devices) - Hormonal IUD’s (Mirena) consist of a progestin (levonorgestrel) - Recent information suggests that there is no greater risk of uterine infections in women with diabetes. Women with multiple sexual partners or with a history of uterine infections should avoid this form of contraception.
- Barrier methods - Diaphragms with spermicidal jelly or condoms with spermicidal foam have no medical problems associated with diabetes but are less efficacious.
- Tubal ligation - This is a reasonable but permanent option for women who have completed their child-rearing. There are no complications with respect to sugar or cholesterol metabolism.
Poor blood sugar control is associated with higher miscarriage rates during the first three months of pregnancy. Also, some women with type 2 diabetes may be overweight and have polycystic ovary syndrome which is associated with more difficulty conceiving.
In 1974, the World Health Organization reiterated the importance of human sexuality to the health and well-being of the individual. They further emphasized the need for basic information about the biological and psychological aspects of sexual health if preventive and curative health services are to meet sexual concerns and needs.
Sexual function in America
Sexual dysfunction may be due to disturbances in sexual desire and/or in the psychophysiological changes associated with the sexual response cycle in men and women. Based on the few available community studies, it appears that sexual dysfunctions are highly prevalent in both sexes, ranging from 10% to 52% of men and 25% to 63% of women. Data from the Massachusetts Male Aging Study 7 (MMAS) showed that 34.8% of men aged 40 to 70 years had moderate to complete erectile dysfunction, which was strongly related to age, health status, and emotional function. We know far less about the epidemiology of female sexual dysfunction. Changing cultural attitudes and demographic shifts in the population have brought to the forefront sexual concerns in all ethnicities and age groups. In the February, 1999 Journal of the American Medical Association, a representative sample of 1749 women and 1410 men aged 18 to 59 years were surveyed. The survey found sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. For women, there was an unaffected group (58% prevalence), a low sexual desire category (22% prevalence), a category for arousal problems (14% prevalence), and a group with sexual pain (7% prevalence).
Risk factors for sexual dysfunction in women:
- Non-married status
- Lower education level
- Increasing age
- African-American > White > Hispanic
- Decrease in income level
- History of childhood abuse
- Other conditions: sexually transmitted diseases, bladder infections, etc.
Sexual function and women with diabetes
Sexual problems may mask an existing illness or be associated with other systemic symptoms. They may interfere with rehabilitation from an illness or be caused by stress. Although the effects of diabetes mellitus on male sexuality have been well documented, the extent of sexual dysfunction in women with diabetes has been controversial for over 30 years. The results have been confusing due to the difficulty in separating the general effects of illness versus the possible specific effects of diabetes on sexual function. Many studies have only looked at orgasmic function and not focused on other, equally important aspects of female sexuality.
Sexual function phases:
- Desire and excitement
For too long, society and studies have focused on phase 3 only, ignoring other aspects of female sexuality.
- In a 1971 study of 225 hospitalized patients, complete absence of orgasm was noted by 35% of women with diabetes while only 6% of non-diabetic women had a similar complaint.
- In 1977, when Ellenberg studied 100 women with diabetes, there did not appear to be any effect of neuropathy on orgasmic function. Approximately 18% of women with diabetes noted decreased or absent orgasm or libido.
- In 1981, Jensen noted that there was no difference in sexual function in women (Age range 26- 45 years) treated with insulin compared to 40 non-diabetic women. This was confirmed by a later study by Tyrer in 1983.
- Schreiner-Engel in 1985 found women with diabetes to have less satisfaction with relationships and more deficient global level of psychosocial functioning. She later found that those with type 1 diabetes were no different from non-diabetic women but type 2 diabetes had a negative impact on sexual function.
- Of importance, Newman and Bertelson in 1986 found women with diabetes to be more likely to be depressed and less satisfied with their sexual relationships.
- At the Cleveland Clinic, we compared 18 women with type 2 diabetes,12 individuals with hypothyroidism and 20 healthy subjects. Although 65% of women with diabetes felt that diabetes caused fair to poor health, 31% felt that diabetes adversely affected their sexual function. 10% of the healthy subjects had no interest in sexual activity, while 20% of diabetic women had no libido. We did find that with increasing obesity there was a higher prevalence of sexual dysfunction. There also appeared to be a trend between sexual dysfunction and more recent diagnosis of type 2 diabetes.
Diabetes and depression
Depression is three times more common among individuals with diabetes than the general population, affecting at least 15% of patients with diabetes. Depression may have a negative impact on self-management, glycemic control, and cause other complications. Unfortunately, depression is often under diagnosed in patients with diabetes.
Depression in people with diabetes has been successfully treated (57% remission rate) with tricyclic antidepressants (nortriptyline). Lustman randomized patients with depression and diabetes and treated some with a combination of cognitive behavior therapy and self-management training and treated others with only self-management training. After 10 weeks of therapy, remission of depression was 85% with cognitive behavior therapy versus 27% for those receiving only the self-management training. At 6-month follow-up, these remission rates were 70% versus 33.3%.
Potential effects of diabetes on female sexuality:
- Type 1 diabetes has little effect on libido
- Type 2 diabetes reduces libido due to changed body perception
- Diabetes increases risk of genito-urinary tract infections
- Accelerates atherosclerosis by causing vascular changes
- Diabetes increases stress, anxiety and depression
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/17/2011...#7826