Diabetes can have some unfortunate sexual side effects, including decreased sex drive, vaginal dryness, and pain during intercourse, and there are many other ways that diabetes can get in the way, or just put you out of the mood. Though these complications may seem less pressing than more dangerous diabetic complications, they can affect your relationship, physical comfort, self-esteem, and overall mental health.
According to a recent report, many women aren’t getting the support that they need. The study shines a spotlight on the underacknowledged intricate challenges of diabetes, sexual health, and mental health, firmly concluding that women are not receiving adequate empathetic care or support.
“This review underlines the intricate nature of diabetic women’s sexual experiences,” explains the report, written by researchers from multiple universities in Antalya, Turkey. “Acknowledging the substantial impact of diabetes-related complications and the associated emotional stress on their quality of life and intimate relationships.”
A Lack of Education about Sexual Side Effects
One of the most concerning findings in the report explained that some women are getting education and support for the impact diabetes can have on their sexual health — while others have received no education.
Unfortunately, this means they are unaware of short-term and long-term diabetes-related complications affecting their sexual health.
Short-term complications include the immediate impact of high and low blood sugars.
“The first of these issues is the physical problems experienced during sexual intercourse due to high or low blood sugar levels, such as lack of vaginal lubrication, pain, and inability to reach orgasm,” explains the report.
Long-term complications include chronic yeast infections, nerve damage, vaginal dryness, and restricted blood flow.
A Tough Thing to Talk About
Persistently high blood sugars are the root cause behind most diabetes-related complications, but the better-known complications include less personal parts of one’s health. Retinopathy in the eyes, neuropathy in your feet, nephropathy in your kidneys — these are frequent focuses of annual exams, blood work, and discussions during appointments with your healthcare team.
For the person with diabetes, retinopathy may be easier and more comfortable to discuss than sexual health.
Diabetes can contribute to sexual dissatisfaction in many other ways, too.
“Individuals with diabetes have a doubled risk of depression, which can lead to a decrease in sexual desire,” adds the study. “Specific problems unique to diabetes, such as swelling from injection sites, the use of medical devices, and scars, form a third issue by negatively impacting body image related to sexuality.”
“Moreover, it is essential to consider the psychological and interpersonal effects of these issues on the individual,” encourages the report.
“I Just Hate My Body At the Moment”
Study participants shared insightful personal details on the day-to-day effect diabetes can have on their sexual health and intimate relationships. Their experiences also reveal a great deal of fear, self-consciousness over changes in their body, and shame for struggling to manage their blood glucose levels.
“If I have had a slightly bad day regarding glucose levels, then sex comes pretty far down the priority list.”
“Although it has become easier to talk about sexual problems, but not for people like me, because I have diabetes, so people may be wondering why I am worried about my sexual problems, while I have other severe diabetes complications.”
“My libido has gone down as well, although it is hard to tell if it is related to diabetes …. I remember my previous relationship before I was diabetic it was very much me wanting sex.”
“I feel, my sexual desire has reduced dramatically in comparison to before diabetes. During sexual intercourse, I feel vaginal dryness, which makes it all painful for me.”
“Since getting [diabetes], now I feel pain during intercourse.”
”When I had the insulin pump, I felt it was a nuisance. My husband did not see it as bothering me at all, but I thought about it a lot. I was afraid I would tear it off during sex.”
“Due to uncontrolled diabetes, I have lost so much weight that I hate looking at my own body. I feel I’m sexually unattractive.”
“It affects me that people see the injection sites on my stomach…, I just hate my body at the moment, that really affects it [sexual dysfunction].”
“I don’t like to have sex. I had uncontrolled blood sugar, and my baby was born with a congenital heart defect. I feel guilty. …my husband blames me a lot, and I can not forgive myself.”
These insights paint an undeniable picture of how significantly diabetes can affect every part of a woman’s sexual well-being, but bringing this topic to the doctor’s office isn’t easy.
“Many women [with diabetes] face unaddressed sexual health concerns and require education and empathetic care from knowledgeable health professionals,” explains the report. “There is a pronounced need for integrating sexual health into diabetes care routines.”
From Puberty to Menopause: The Challenges Persist
While it has been acknowledged that menstrual hormones affect insulin sensitivity and blood glucose levels in women with type 1 and type 2 diabetes — making diabetes management more challenging for women — many women do not feel they’ve received enough support.
Diabetes Daily interviewed Amy Woods, who’s lived with type 1 for 32 years, diagnosed at age 7 in 1991.
“I’ve been told by doctors that I’m too emotional about this,” says Woods. Today, at 39 years old, Woods is certain she’s experiencing perimenopause, and the impact on her diabetes has been significant.
“The impact of my menstrual cycle on my blood sugars is getting so unpredictable,” says Woods. Before this phase of life, Woods says she was usually able to predict necessary changes in her insulin needs a couple of days before the start of her cycle. This consistency meant she could adjust her insulin doses and successfully maintain her time-in-range blood glucose goals.
Now, she says her menstrual symptoms and the hormonal impact on her diabetes arrives often 10 days before her period. Her premenstrual symptoms (PMS) have been more dramatic and painful, too.
“The older I get, the worse my symptoms are and the more drama there is in my blood sugars,” says Woods.
She’s experienced significantly more pelvic and back pain, unexplainable exhaustion, and unreasonable fatigue during and after exercise. She’s even taken days off from work due to menstrual cycle pain.
Doctors Don’t Always Understand
“I told my healthcare team about these increasingly dramatic symptoms,” says Woods, feeling frustrated and exhausted. “They tested my iron levels. They came back normal but my ferritin levels were low,” recalls Woods, adding that low ferritin can be a sign that your iron stores are low. “They told me I was fine.”
Routine bloodwork shows that her ferritin levels continue to drop but Woods says her healthcare team “doesn’t care.”
Today’s most advanced diabetes management technology doesn’t cut it either, points out Woods.
“Automated insulin delivery systems can’t predict these hormone fluctuations quickly enough,” she explains. “I’ve heard many women explain that they have to switch to manual mode because the automated system can’t keep up.”
“If insulin pumps contained insulin as fast as Afrezza, inhaled insulin, maybe that would work, but no insulin used in a pump is fast enough to deal with those unpredictable hormonal spikes.”
For years, Woods managed menstrual symptoms with birth control, but only after stopping did she realize how much it was contributing to her depression. Now, despite feeling better off the birth control, she’s feeling increasingly anxious every month over the unpredictable changes in insulin sensitivity and severe PMS symptoms.
“It’s tough. I’m a pretty positive person,” says Woods. “I’m pretty good at looking at things with a problem-solving perspective, but this peri-menopause phase could persist for 10 to 15 years. The hormone swings have just been so challenging. I feel so good in other parts of my life at this stage, but this particular part is so frustrating, and painful.”
Feeling unsupported by her healthcare team makes the next 10 to 15 years look daunting and lonely.
“I’m not getting any answers, and maybe there aren’t any answers, but it’s terrible, and I wish we could talk about it more.”
It All Adds Up to Depression, Anxiety, and Stress
“I’m post-menopausal now, but diabetes is tough enough on its own,” says Melissa Slemp, a women’s health coach at Abundant Health and podcast host of Type 1 in Midlife. “Then we get this layer of what is happening with my body, my blood sugar, the impact it has on your energy, your relationships. I’ll be honest, my libido went into the tank, too.”
Slemp has lived with type 1 diabetes for over 40 years.
“I think women, in general, are dismissed when it comes to sexual health, and changes like menopause, because it’s something we’re just supposed to swallow — like this is just the way it’s supposed to be.”
Slemp says most doctors won’t perform hormone testing to establish baseline levels during peri-menopause, and they rarely recommend helpful treatments for severely heavy bleeding like endometrial ablations.
“I learned about endometrial ablation as a treatment for debilitating periods from my friend,” says Slemp. “It was life-changing. The doctors just wanted to put me on birth control.”
All of the above, she adds, compounds to feeling increasingly depressed, anxious, and stressed.
“You have to do all of your own research, but many women don’t know where to go or what to ask, so just suffer in silence.”