[COLUMN] Diabetes and sex

DOES diabetes affect sexual function?

Yes. In men, diabetes mellitus can cause a varying degree of erectile dysfunction (inability to attain or sustain erection satisfactory for intercourse) as the diabetes progresses. Most of the time, however, the exaggerated and unfair condemnation of diabetes as causing severe erectile dysfunction leads to a psychological deterrent and a self-fulfilling prophecy in most men. Many well-adjusted and well-treated diabetics enjoy sex without problems. In women, loss of vaginal lubrication is a major sexual effect of diabetes.

Is this condition the same as impotence?

No, this was a scientific “error,” a harsh diagnosis overkill in the past. Erectile dysfunction has since then been considered a distinct and remediable medical entity and has replaced the term impotence in this particular context. Impotence is now relegated to its proper “domain” where the male (himself) is unable to cause pregnancy. This clearer definition is more medically accurate and has given more hope and psychological relief to the millions afflicted by erectile dysfunction, which today has great treatment success rate.

How common is erectile dysfunction?

It is very common. While impotence (accurately diagnosed) affects very few men, erectile dysfunction affects an estimated 10 to 20 million men aged 19 and older in the United States. The prevalence is 52% in men aged 40 to 70 and increases with age. However, today, men – and women – can enjoy sexual activity throughout life, with proper care and strategy. Erectile dysfunction is not inevitable with aging, even into the 70s and 80s. With proper medical counseling and aids like Viagra, etc., most males and females can enjoy sex at any age.

What are the other complications of diabetes?

Diabetes has a lot of potential complications. Among them are the effects on the small arteries and big arteries in the body, causing blockages in circulation, and leading to damage (poor supply of blood, oxygen and nutrition) to various organs of the body: the eyes (retinopathy that results in blindness), kidneys (nephropathy resulting in kidney failure), legs (resulting in leg an feet ulcers, gangrene and amputation), nerves (neuropathy that causes numbness and pains in the feet), and cellular immunity (weakens the immune system leading to infections). This is the reason why all diabetic patients must be under the care of a physician and why blood sugar must be well-controlled at all times.

What are the causes of erectile dysfunction?

Erectile dysfunction is rare in diabetic men until their mid-30s. Erectile dysfunction is very common in the general male population, especially in these stressful modern times. Contributing to the cause of this condition are psychologic factors (severe anxiety, fear of intimacy, fear of unwanted pregnancy, sexual guilt, depression), drugs (most medications for high blood pressure and coronary heart disease, psychotropic drugs, CNS depressants-tanquilizers, etc. do affect erection), arteriosclerosis/vascular (blocking arteries that supply blood to the male organ), and, rarely, biogenic (associated with low testosterone levels and reflecting disorders of the hyphothalamic-pituitary-gonadal axis).

Does alcohol affect erection?

Alcohol definitely affects erection, either in diabetics or non-diabetics. While the first shot of alcohol may cause a little euphoria and a sense of well-being in most persons, and, therefore, perhaps helps in improving the sexual climate, the second and subsequent drinks will impair erection in most men, depending on their tolerance to alcohol. As Shakespeare wrote, “Alcohol increases the desire but diminishes the performance.”

What is the treatment for these side-effects?

Making the correct diagnosis is very important, since the treatment depends on the cause. Once the diagnosis of erectile dysfunction is confirmed, Viagra is the current drug of choice. Erection is achieved about one hour to one hour-and-a-half following ingestion of the pill, which comes in 25 mg, 50 mg and 100 mg doses. Persons on nitroglycerine (medications for coronary heart disease) are strictly warned against taking Viagra, the combination of which could cause intractable shock and death. Viagra, if taken properly under a physician’s supervision, is a safe and very effective wonder drug. It is essential that the diabetes is well-controlled at all times for this to work. Quitting smoking, exercising at least 3 times a day, and a conducive environment will help tremendously in improving sexual performance.

If Viagra does not help, what next?

Viagra helps alleviate erectile dysfunction in about 90% of diabetics and more in non-diabetics. Other assistance may come from sex therapy, other medications (penile erection suppository; yohimbine, which is still controversial; prostaglandin E1), vacuum constricting devices, male hormone testosterone, which is rarely needed, and which increases the chances of cancer of the prostate; and, surgery (aorto-iliac procedures for blocked arteries in the pelvis that partly supply the male organ, and implantation of penile shaft prosthesis, but this keeps penis rigid at all times and not too comfortable. With the advent of Viagra, most of these “other aids” have been relegated to the background and used only in dire cases that do not respond to the drug.

How about in diabetic women?

Among diabetic women, the major sexual side-effect is loss of the natural vaginal lubrication, which makes sexual encounters most uncomfortable and even painful. Master and Johnson, pioneering sex researchers in the 1960s, stressed the importance of vaginal lubrication during the initial sexual arousal in women and throughout the sex act. With proper vaginal lubrication, proper “ambiance,” and well-controlled blood sugar (and other medical conditions, if any), diabetic women can enjoy pleasurable sex at any age.

What are the other causes of vaginal dryness?

Other causes of loss in vaginal lubrication are stress or psychological factors, undesired partner, drugs (Tricyclic Antidepressants, like Elavil, Anafranil, Tofranil, Sinequan, birthcontrol pills, antihistamines, cold formulas, etc), alcohol, cigarettes and marijuana. Other conditions include jet lag from travel across time zones, excessively prolonged foreplay or lovemaking, pregnancy and childbirth. Those who have this lubrication problem do not have to be disheartened. The condition is easily solved. There are now a lot of commercially available (no prescription needed) sexual lubricants. These can be applied before sex.

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The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Public Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian and anti-graft foundation in the United States. Visit our websites: philipSchua.com and FUN8888.com; Email: scalpelpen@gmail.com.

Dr. Philip S. Chua

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States.

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