Sexual dysfunction is a common, underreported and largely underappreciated complication of diabetes. A large number of cases go unrecognised owing naturally to the traditional reluctance both on the part of the patient as well as the physician in discussing such issues which are considered too personal to be discussed outside the bedroom. It is now well known that diabetes has a major impact on both male as well as female sexual functioning. Just as a good blood sugar control is necessary to lead a healthy life free from the well known complications of diabetes on kidney, eye, nerve, foot and heart, it is also very important for leading a normal sexual life.
Statistics on diabetes and sexual dysfunction in Indian Men
Various studies have effectively documented the relationship between diabetes and sexual dysfunction. In males, the common problem is that of erectile dysfunction (ED) which is the inability to initiate or maintain an erection. Studies show that approximately 35 percent-75 percent of men with diabetes face this issue as compared to 26 percent of the general population. Also, diabetic men suffer from this problem 10-15 years early in their life as compared to their normal counterparts. It should be noted that this occurrence is gradual and never happens overnight.
In diabetes, it involves both vascular as well as neural mechanisms with atherosclerosis in the penile and pudendal arteries which are the major causes of erectile dysfunction. Another major contributor to the high incidence of ED in diabetic males is autonomic neuropathy arising due to chronic uncontrolled diabetes.
Other problems associated with sexual dysfunction
Sexual dysfunction is thus related to marital dissatisfaction, depression, poor emotional acceptance of diabetes and sexuality as well as a reduced acceptance of the problem and its treatment. Sudden onset of the problem could most likely have an emotional or psychological effect such as stress, depression, disaffection and performance anxiety. A complete examination of medical history focusing on high risk factors such as cigarette smoking, alcoholism or drug abuse, hypertension, trauma or endocrine disorders such as hypothyroidism, raised prolactin levels and reduced testosterone levels should be done. A large number of medicines as well as emotional issues need to be ruled out. It is important to note that sexual desire is not lost with ED-only the ability to act on those emotions.
Prevention and treatment
Once a diagnosis is made, preventive measures such as improving glycaemic and blood pressure control, de-stressing, quitting smoking and reducing alcohol intake have shown to be beneficial in patients with ED. Once ED has developed, oral agents can be prescribed by the doctor as a first line therapy. Testosterone injections or patches should be tried in patients with documented low testosterone levels. For patients who cannot be given oral therapy, intracavernosal injections of vasoactive drugs under the training of a trained urologist or andrologist are an acceptable alternative. Mechanical therapy involving vacuum-assisted erection devices as well as penile prosthesis are also a viable option. Psychotherapy should routinely be offered to all patients and their partners.
Sexual dysfunction can be a huge psychological burden on patients with diabetes and can have a negative impact on marital relations that are already burdened by the existence of a chronic illness. Thus, the recognition and identification of this problem and proper treatment and counselling by the treating doctor go a long way in restoring normalcy in the lives of many couples who quietly suffer the agony of this disorder. It is very important to recognise that sexual dysfunction is a common complication of diabetes and it is alright to discuss it with your doctor who can help you get over it.