What is sexuality?
Sexuality not only implies sexual activity but includes the full spectrum of sexual topics which are dependent upon the medical, psychological and sociocultural aspects of a woman. Sexuality covers not only actual sexual activity, but thoughts about sex, physical attributes, and desire for sexual activity. Related issues include fertility and contraception.
What is sexual dysfunction?
Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response. Research suggests that sexual dysfunction is common, but many people are hesitant to discuss it. Because treatment options are available, it is important to share your concerns with your partner and health care provider.
What are the types of sexual dysfunction?
Sexual dysfunction generally is classified into four categories:
- Desire disorders: Lack of sexual desire or interest in sex
- Arousal disorders: Inability to become physically aroused or excited during sexual activity
- Orgasm disorders: Delay or absence of orgasm (climax)
- Pain disorders: Pain during intercourse
What are the symptoms of sexual dysfunction in women?
- Inability to achieve orgasm
- Inadequate vaginal lubrication before and during intercourse
- Inability to relax the vaginal muscles enough to allow intercourse
- Lack of interest in or desire for sex
- Inability to become aroused
- Pain with intercourse
How does diabetes affect sexuality?
It is fairly well-known that diabetes and complications can affect the sexuality in men, but it is true for women, also. Women are starting to bring questions about sexual function and diabetes to their healthcare providers. Here are some problems that might be found in a woman with diabetes:
- Less vaginal lubrication, leading to dryness and discomfort or pain during intercourse
- Less or no sexual desire
- Lower or no sexual response, including the inability to become or stay aroused, little or no feeling in your genitals, and the inability to orgasm, either occasionally or always
What causes problems with sexuality in females with diabetes?
Causes may include:
- Nerve damage
- Less blood flow to the genital and vaginal areas
- Hormonal changes
- Side effects of medications
- Alcohol abuse
- Psychological issues like anxiety, depression, stress
- Conditions related to pregnancy or menopause
- Other diseases
How are sexual issues in women with diabetes diagnosed?
It is important to note that if you are having these issues or noticing sexual problems, you should talk to your healthcare provider. He or she will ask you about:
- Your health history
- How often the problems happen and the details of them
- Possible infections
- Other diseases
- Whether or not you drink alcohol or smoke, and how often
- What type of medications you are taking
- Being pregnant or if you have reached menopause
- Whether or not you are depressed or have had any life changes
Your doctor might do a physical examination and/or order lab tests to help the diagnosis. Your doctor might also speak about blood sugar control.
How are sexual issues treated in women with diabetes?
Prescription or over-the-counter vaginal lubricants may be useful for women experiencing vaginal dryness. Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations. Psychological counseling may be helpful. Kegel exercises that help strengthen the pelvic muscles may improve sexual response. Studies of drug treatments are under way.
What type of contraception is best for women with diabetes?
There is no single contraceptive which is ideal for all women with diabetes. Each method has some disadvantages and some advantages. You and your healthcare provider should discuss the most appropriate method for you.
- Oral contraceptives - Combination estrogen/progestin pills are best for women who are younger than 35 years old and who do not smoke. Women with uncontrolled high blood pressure should speak to their doctors before using this form of birth control. Oral contraceptives with less than 35mg of estrogen and a low progestin dose are recommended.
- IUDs (Intrauterine devices) - Hormonal IUDs (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 do not work quite as well as some other methods.
- Tubal ligation - This is a reasonable but permanent option for women who are sure that they do not want more children. There are no complications with respect to diabetes.
How does diabetes affect fertility?
Poor blood sugar control is related to higher miscarriage rates during the first three months of pregnancy. Also, some women with type 2 diabetes may be overweight and/or have polycystic ovary syndrome, which may make getting pregnant harder.
Again, though, these are the types of issues that women with diabetes should talk about with their healthcare providers so that treatments can be explored.