Scientific support: Dr. Gidon Bönhof
People with diabetes suffer more frequently from sexual dysfunction disorders than people without diabetes. Around half of men with diabetes suffer from a sexual dysfunction disorder, for example, orgasm- or ejaculation-related disorders.
Approx. one third of women with diabetes will suffer a sexual dysfunction disorder during their lifetime, such as reduced feelings of desire or pain during sexual intercourse. As the available data for the incidence in women is incomplete, there may be even more women with diabetes suffering from sexual dysfunction disorders.
There are numerous reasons for the onset of a sexual dysfunction disorder. They can be caused or aggravated by diabetes-related nerve damage or circulatory and hormonal disorders. Certain types of medication can further impair sexual function.
However, impaired sexual function can have many other causes that are not limited to diabetes. Unfulfilled needs within the relationship, stress at work, and depressive episodes are all circumstances that can lead to an unsatisfying sex life. It is important to consult a physician as soon as possible to make use of supportive measures while still in the early stages.
Sexual dysfunction disorders are not infrequently a complication of diabetes.
Elevated blood sugar levels, insulin resistance and also poor blood fat levels alter mechanisms in the reproductive organs that are controlled by nerves and blood vessels. For example, the inflow of blood to the genitals / erectile tissue may be impaired.
- What increases the risk of developing sexual dysfunction disorders?
- Sexual dysfunction disorders in men with diabetes
- How are sexual dysfunction disorders in men with diabetes treated?
- Sexual dysfunction disorders in women with diabetes
- How are sexual dysfunction disorders in women with diabetes treated?
- How can sexual dysfunction disorders in patients with diabetes be prevented?
- What is the role of urinary tract infections?
The incidence of sexual dysfunction disorders increases with age, especially in men but also in women. Lifestyle and various health impairments or diseases also play a role.
Factors that increase the risk of developing sexual dysfunction disorders besides diabetes include:
- Abnormal blood fat levels
Older men who have had diabetes for many years and who have poor blood sugar management or additional diseases, such as high blood pressure or elevated cholesterol, are very often affected by sexual dysfunction disorders.
Men can suffer from various types of sexual dysfunction disorders:
- Erectile dysfunction
- Ejaculation problems
- Orgasm disorders
New evidence suggests that men with diabetes may also be at increased risk of low testosterone levels. Low testosterone levels can lead to a decrease in sexual desire and contribute directly or indirectly to erectile dysfunction.
Men with diabetes are affected by erectile dysfunction about 3.5 times more often than men without diabetes.
Erectile dysfunction is when the penis is unable to achieve or maintain an erection adequate enough for sexual intercourse. Erectile dysfunction is the primary problem in 50 percent of men with a sexual dysfunction disorder. In people with diabetes, poor blood sugar management can lead to frequent and early-onset erectile dysfunction. Other risk factors include obesity, smoking, high blood pressure, and elevated cholesterol levels.
Several mechanisms are involved in the development of erectile dysfunction associated with diabetes. Damaged blood vessels and nerves that are necessary for erection play an important role.
Erectile dysfunction in men with diabetes is also considered a warning sign of increased cardiovascular risk. A physician should be consulted while sexual dysfunction disorder is still in the early stages.
Ejaculatory dysfunction associated with diabetes mellitus probably is the consequence of long-term effects of diabetic neuropathy, which also affects the autonomic nervous system. There are various forms of ejaculatory dysfunction:
- Premature ejaculation (ejaculatio praecox)
- Delayed ejaculation (ejaculatio retarda)
- Failure to ejaculate (anejaculation)
- Retrograde ejaculation (the ejaculate does not come out of the front of the penis, but into the bladder and is then later excreted with the urine)
With increasing age, the likelihood of ejaculatory dysfunction increases. Studies showed that men with diabetes who were older than 50 years were twice as likely to have premature ejaculation compared to younger men with diabetes. Often, ejaculatory dysfunction – especially premature ejaculation – is accompanied by erectile dysfunction.
There are effective prescription drugs for the treatment of erectile dysfunction in men with diabetes known as PDE-5 inhibitors (phosphodiesterase type 5 inhibitors). Their use must also be discussed with a doctor to help avoid any health-related risks and to assess potential side effects.
Along with tablets, there is the option of using mechanical erection aids, such as vacuum pumps, or injecting blood vessel-dilating substances directly into the erectile tissue or applying them via the urethra. These methods are not free from side effects and can be uncomfortable.
If a testosterone deficiency is diagnosed, hormone replacement therapy can be used. However, this should only take place after thorough medical examination and under medical supervision. In very rare cases, and if sexual potency is a major issue for the patient, surgical interventions can help when all other alternatives have been unsuccessful.
In the event of ejaculatory dysfunction, the decision for or against treatment usually depends on whether and how much the affected man feels limited by the dysfunction. There are several prescription drugs that can be taken into account. In case of delayed ejaculation or failure to ejaculate, vibroejaculation (Penile Vibration Stimulation, PVS for short) is another treatment option. This procedure attempts to trigger the ejaculatory reflex with the help of vibratory stimulation.
Urologists specialize in diseases of the urinary organs (kidneys) and urinary draining organs (bladder, ureter and urethra) as well as the male sex organs (testicles, epididymis, vas deferens, seminal vesicles, penis and prostate) and are therefore appropriate contacts for sexual dysfunction disorders.
Diabetes therapy is also an important factor, for example, better blood sugar management, a balanced diet, regular physical activity, or weight loss. In many cases, a psychotherapeutic adjunctive therapy can be beneficial.
Further information and a collection of addresses of the largest urological clinics in Germany can be found on the Impotenz.net portal (Link in German).
The Information Center for Sexuality and Health e.V. has developed a questionnaire on erectile dysfunction in men (Erectile Dysfunction in Men – Interactive Questionnaire, FRED) (Link in German). This can help in the decision to seek medical treatment.
The correlation between women with diabetes and sexual dysfunction disorders is unclear. Little is known about the influence of blood sugar management and the length of time suffering from diabetes. However, the consequences of long-term elevated blood sugar levels, such as frequent infections and damage to blood vessels, as well as psychological stress, can be expected to have a detrimental effect on sexual function. The following symptoms may indicate a sexual dysfunction disorder in women with diabetes.
- Reduced sexual excitability or ability to orgasm
- Reduced sexual desire
- Pain during sex
Pain during sexual intercourse is often caused by the fact that the natural moisture content in the vagina is reduced. In the long term, inadequate diabetes management can damage nerves and blood vessels involved in normal vaginal moistening (lubrication). Vaginal moistening is then slowed down or is weaker overall.
There are vaginal and pelvic floor training aids for women that improve the muscles and circulation of the pelvic floor, which can help with incontinence and orgasm problems. For lubrication disorders, i.e., a lack of moisture in the mucous membranes, lubricants or locally applied hormone creams containing estriol can help. Hormone replacement therapy may be considered for sexual dysfunction disorders associated with menopause under gynecological and endocrinological medical supervision. Furthermore, it can be attempted to use sex hormones in the form of patches, vaginal capsules or tablets.
To enable patients to better assess if they are suffering from a sexual disorder or not, the Information Center for Sexuality and Health e.V. has developed a questionnaire on sexual disorders in women (Sexual Disorders in Women – Interactive Questionnaire, STEFFI) (Link in German). Those affected can also visit a gynecologist for an examination. A specialist in urology may also be the right person to contact.
Sexual dysfunction disorders can worsen psychological factors. Women with diabetes and a depressive episode should therefore take the situation seriously and seek professional support if needed.
Keeping blood sugar levels as close to normal as possible is key to preventing or reducing sexual dysfunction disorders in patients with diabetes. In addition, attention should be paid to blood pressure and blood fat levels.
Lifestyle adjustment with weight control and a balanced, healthy diet, as well as adequate exercise, also have a beneficial effect on sexual function. For example, there is evidence that weight loss helped improve or even reverse erectile dysfunction in some men.
Other studies have focused on nutrition. It has been observed that, in some cases, men can return their erectile function to normal in the long term when they eat a Mediterranean diet with plenty of fresh fruits and vegetables. A study of women with sexual dysfunction and metabolic syndrome also showed improvements in sexual function when a Mediterranean diet was followed for an extended period of time.
In addition to the sexual function, diabetes can also affect other functions and structures of the lower urinary tract, including the bladder and prostate. Among others, this can lead to complications such as urinary incontinence, inadequate bladder emptying and bladder infections. It is estimated that the risk of lower urinary tract complications is increased by at least 25 percent in men with diabetes and by at least 50 percent in women with diabetes, compared to people without diabetes.
Diabetes-related nerve damage which affects urinary bladder function can cause problems emptying the bladder. The result is urinary retention, which provides breeding ground for bacterial growth. This increases the likelihood of bladder infections.
Another significant risk factor for urinary tract infections in women with and without diabetes is sexual intercourse. Those who have diabetes and suffer from frequent urinary tract infections should therefore pay special attention to the proper care of their genital area:
- Wash with running water before sexual intercourse. Avoid using soaps or intimate detergents that attack the skin's protective acid mantle and thus provide a breeding ground for bacteria.
- After sexual intercourse, visit the toilet as soon as possible to urinate. This allows germs to be flushed out.
- Make sure to drink enough. This will allow you to excrete enough urine and mitigate the spread of bacteria.
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As of: 17.04.2023