Nearly 60% of diabetic patients have sexual problems, according to a recent study conducted by OpinionWay for Roche Diabetes Care France. Sexologist Dr Sébastien Doerper, head of the Territorial Health Center and head of the Sexual Health Service at the Lunéville Hospital Center, discusses this little-known complication of the disease.
Why Doctor: the survey for Roche Diabetes Care France, conducted among 500 people with type 1 or type 2 diabetes, reveals that nearly 6 out of 10 diabetic patients encounter sexual difficulties. What is the origin of this complication?
Dr Sebastien Doerper : Whether type 1 or type 2, diabetes is an insidious disease. The pathology impacts the cardiovascular and nervous systems. Vasocongestion, that is to say the increase in blood flow, cavernous and spongy bodies present in the penis in men and the pelvic area in women will be impacted, resulting in an erection problem for men and lack of lubrication in women.
In addition, in people with diabetes, loss of sensitivity in the extremities (hands, feet) can be observed. However, we often forget that the penis and the clitoris are also extremities. This loss of sensitivity is likely to lead to less arousal during sex.
Moreover, the difficulties encountered in the intimate sphere by diabetics are not limited to the genital and functional aspect. The psychological and affective components must also be taken into account. Many men see their sexuality only through the coital prism. Thus, when they have difficulty maintaining their erection, some then stop all sexuality. However, sexuality is not just about penetration, it also includes affective, emotional and sensory components. Unfortunately, when this psychological dynamic is in place – if erectile dysfunction is left untreated – everything falls apart. This has a much more powerful impact than the organic problem. It is therefore necessary to take care of all the affective and psychological components and not to focus solely on the genital aspect.
What are the most common problems you see in diabetic patients?
Diabetic men mainly suffer from erectile dysfunction and women from vaginal dryness. The rates are 32% and 27% respectively according to the Roche Diabetes Care France study. In addition, regardless of their gender, 35% of respondents also reported a decrease in libido.
Very often, these disorders are linked. Indeed, if one suffers from erection or lubrication disorders, one tends to space out intercourse. Sexuality is like sport: the less you do, the less you want to do; there is a decrease in libido. In addition, there is more risk of having pain during penetration if the lubrication is insufficient and if there is pain, the urge decreases.
Do patients make the link between diabetes and the sexual disorders they encounter?
Patients do not necessarily make the connection between their sexual difficulties and their diabetes. For some, the disease usually appears at an advanced age, so they put it on their aging and / or menopause for women. Moreover, the link between diabetes and intimate disorders is little known. Health professionals do not talk enough to people with diabetes about these possible complications.
Our department has created posters on the impact of diabetes on sexual disorders. In all departments of the hospital, we have placed these posters on the walls. This knowledge reassures patients. They will say to themselves that they are not the only ones having difficulties in their sexuality, that the problem does not come from them, but from their pathology. They will dare to talk to the doctor about it. This makes it possible to initiate sexological care.
In addition, erectile dysfunction may already appear in prediabetic patients. Sometimes we discover the existence of their disease at an early stage. Whether you are a man or a woman, you should not hesitate to talk about these sexual dysfunctions to your health professionals, because the search for what causes the disorder leads to the detection of pathologies that are not yet known, such as cardiovascular pathologies, benign prostatic hypertrophy, sleep apnea…
What advice would you give to diabetic patients having problems in bed?
I advise diabetics to consult a sex therapist once a year. In the same way that at the time of diagnosis, it is recommended that they go to see a cardiologist, an ophthalmologist and a podiatrist every year in order to prevent complications related to diabetes, an annual sex consultation should be planned. This would make it possible to make an assessment of intimate life and to anticipate what may happen. In sexology too, the earlier the disorders are caught, the less the consequences on health are important.
Also, do not hesitate to talk with your partner. The study showed that for 24% of patients in a couple, there are no exchanges concerning intimate life. Discussing it is nevertheless essential in order to avoid the isolation caused by this type of situation and to think together about alternatives or solutions to improve your sexual health. When this subject is not discussed openly, the difficulties of the intimate sphere can weigh on the life of a couple and/or cause them to lose their self-confidence.
The spouses of diabetics must for their part be aware that their partner’s disorders such as erectile dysfunction have their origin in diabetes and not a lack of desire for them. However, beyond the chronic disease, other determinants enter into the etiology of the sexual disorder, in particular sexuality before diabetes, personal, marital and sexual factors before the onset of the disease.
