We spoke with Lois Jovanovic, M.D., clinical professor of medicine at the University of Southern California in Los Angeles and CEO of the Sansum Diabetes Research Institute in Santa Barbara.

How common is sexual dysfunction in diabetes?

About 20 percent of adults with type 1 or type 2 experience some degree of sexual dysfunction. It turns out, women have more problems than men-about 30 percent for women, 15 to 20 percent for men.

Men get more attention-in part because the pharmaceutical companies have pills to help them. And men usually know that diabetes is associated with sexual dysfunction, but it's rare for women to. So if women develop sexual problems, they rarely think it could be related to their diabetes.

What causes the problem in men?

In most men, damage to nerves and blood vessels (diabetic neuropathy) causes erectile dysfunction. Diabetes damages nerves and the arteries throughout the body. Just as damage to arteries can lead to heart attacks and damage to nerves can lead to foot pain and numbness, nerve and vascular problems can interfere with erection. In addition, some medications for blood pressure as well as certain diabetic conditions can cause impotence as a side effect. Finally, it's not uncommon for men with diabetes to experience depression, which often dampens sexual desire. So, with men the likely causes are: diabetes complications, drug side effects or depression-in that order. The appropriate treatments are modification of drug prescriptions and doses, medications for erectile dysfunction and treatment for depression.

What are the causes in women?

The order is completely reversed. The most common cause of sexual dysfunction in women with diabetes is depression and loss of sexual desire. Women need to be aroused to experience vaginal lubrication and engorgement. During foreplay and sex, you don't become engorged or lubricated simply from natural secretions. Without the trigger in your head-the libido, really-there's no enjoyment by your body. Intercourse can be very painful; this condition is called dyspareunia. You just don't feel like it, so you don't enjoy it. It hurts, and you don't look forward to the next time.

If depression isn't the cause, side effects from medication are the second place to look in women. Only lastly would one consider vascular and nerve problems. (This is good news for women, because depression is far more amenable to treatment than severe nerve and blood vessel disease.) Diabetic neuropathy occurs far later in the disease for a woman, and it has to be quite severe before it will affect her ability to engorge and lubricate. By then, she may already have eye disease (retinopathy) and kidney disease-that is, she's so sick that sex may not be much of a concern for her.

Can anything be done to prevent sexual dysfunction from diabetes?

Good blood glucose control can reduce the risk of all diabetes complications, including sexual dysfunction. Blood sugar that's bouncing around can cause depression all by itself. Women who notice their mood flagging or who find themselves developing sleep problems should take a step back and look at what's going on in their lives.

Sometimes depression itself interferes with good diabetes self-care, so it becomes a vicious cycle. Take care of yourself. Give yourself what you need so you don't go down the path of sadness and depression.

Getting Help
Knowledge that diabetes can contribute to depression and interfere with sexual satisfaction can begin the healing, but only if it empowers you to get help. According to Dr. Jovanovic, treatment requires a sensitive listener, coping strategies and, possibly, medication.
Act as your own detective and pay attention to what makes you irritated, anxious, angry or depressed.
Talk with your doctor about your feelings; you need the support of your physician, who should be able to help you work through the problem. Be willing to change-it may be key to moving from depression to happiness.
Don't be discouraged if you are prescribed a medication that happens to dampen sexual appetite. It may be a necessary intermediate step.

Don't hesitate to seek help if you're experiencing sexual dysfunction. Therapy can be the first step to restoring that pleasurable part of your life.

©MDminute: Diabetes, Issue 1, 2007