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Diabetes: Sex, Urinary, and Bladder Problems

Sexual and urological problems of diabetes facts*

*Sexual and urological problems of diabetes facts Medically Edited by: Melissa Conrad Stöppler, MD

  • Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves.
  • Both women and men can develop sexual problems from diabetes.
  • Sexual problems in men with diabetes include erectile dysfunction and retrograde ejaculation.
  • Sexual problems in women with diabetes include vaginal dryness, painful intercourse, decreased libido, and decreased or absent sexual response.
  • People with diabetes may experience bladder problems such as overactive bladder, poor control of sphincter muscles that surround the urethra, urine retention, and
    urinary tract infections.
  • Those people with diabetes who are at risk of sexual or urologic problems include people who have poor glucose and blood pressure control; have high levels of cholesterol; are
    overweight, are over the age of 40 years, those that smoke, and lack of physical activity.
  • Individuals with diabetes can lower their risk of sexual and urologic problems by controlling glucose, blood pressure, and cholesterol numbers; being physically active and maintaining a healthy weight; and
    smoking cessation.

Food to Improve Your Sex Drive

Medical Author: Betty Kovacs, MS, RD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Viewer Question: Is there anything I can eat to improve my sex drive?

Doctor’s Response: If the recipe for a better sex drive was found in food, grocery shopping would take on a whole new meaning! This is a great question that has some compelling and some controversial answers.

Before deciding which to foods to try, you will need to figure out if there is an underlying cause for lack of sex drive. And the best person to help you with this would be your doctor. The compelling answers are based on research and often revolve around uncontrolled medical conditions. Fortunately, your diet is a key factor in controlling many of these conditions. Here are some examples:

Diabetes

  • Men who have diabetes are three times more likely to have erectile dysfunction as men who do not have diabetes.
  • As many as 35% of women with diabetes may experience decreased or absent sexual response.
  • Keeping your blood sugar under control is the key. A diet rich in vegetables, lean meats, whole grains, and fresh fruit and with limited quantities of sugar, refined grains, and processed foods is one of the keys to this.

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    What sexual problems can occur in women with diabetes?

    Many women with diabetes experience sexual problems. Although research about
    sexual problems in women with diabetes is limited, one study found 27 percent of
    women with type 1 diabetes experienced sexual dysfunction. Another study found
    18 percent of women with type 1 diabetes and 42 percent of women with type 2
    diabetes experienced sexual dysfunction.

    Sexual problems may include

    • decreased vaginal lubrication, resulting in vaginal dryness
    • uncomfortable or painful sexual intercourse
    • decreased or no desire for sexual activity
    • decreased or absent sexual response

    Decreased or absent sexual response can include the inability to become or
    remain aroused, reduced or no sensation in the genital area, and the constant or
    occasional inability to reach orgasm.

    Causes of sexual problems in women with diabetes include nerve damage,
    reduced blood flow to genital and vaginal tissues, and hormonal changes. Other
    possible causes include some medications, alcohol abuse,
    smoking, psychological
    problems such as anxiety or depression, gynecologic infections, other diseases,
    and conditions relating to pregnancy or menopause.

    Women who experience sexual problems or notice a change in sexual response
    should consider talking with a health care provider. The health care provider
    will ask about the patient’s medical history, any gynecologic conditions or
    infections, the type and frequency of sexual problems, medications, smoking and
    drinking habits, and other health conditions. The health care provider may ask
    whether the patient might be pregnant or has reached menopause and whether she
    is depressed or has recently experienced upsetting changes in her life. A
    physical exam and laboratory tests may also help pinpoint causes of sexual
    problems. The health care provider will also talk with the patient about blood
    glucose control.

    Prescription or over-the-counter vaginal lubricants may be useful for women
    experiencing vaginal dryness. Techniques to treat decreased sexual response
    include changes in position and stimulation during sexual relations.
    Psychological counseling may be helpful.
    Kegel exercises that help strengthen
    the pelvic muscles may improve sexual response. Studies of drug treatments are
    under way.




    QUESTION

    Diabetes is defined best as…
    See Answer

    Diabetes and urologic problems

    Urologic problems that affect men and women with diabetes include bladder problems and urinary tract infections.

    Bladder Problems

    Many events or conditions can damage nerves that control bladder function,
    including diabetes and other diseases, injuries, and infections. More than half
    of men and women with diabetes have bladder dysfunction because of damage to
    nerves that control bladder function. Bladder dysfunction can have a profound
    effect on a person’s quality of life. Common bladder problems in men and women
    with diabetes include the following:

    Overactive bladder. Damaged nerves may send signals to the bladder at the
    wrong time, causing its muscles to squeeze without warning. The symptoms of
    overactive bladder include

    • urinary frequency – urination eight or more times a day or two or more times
      a night
    • urinary urgency – the sudden, strong need to urinate immediately
    • urge incontinence – leakage of urine that follows a sudden, strong urge to urinate

    Poor control of sphincter muscles. Sphincter muscles surround the
    urethra – the tube that carries urine from the bladder to the outside of the
    body – and keep it closed to hold urine in the bladder. If the nerves to the
    sphincter muscles are damaged, the muscles may become loose and allow leakage or
    stay tight when a person is trying to release urine.

    Urine retention. For some people, nerve damage keeps their bladder muscles
    from getting the message that it is time to urinate or makes the muscles too
    weak to completely empty the bladder. If the bladder becomes too full, urine may
    back up and the increasing pressure may damage the kidneys. If urine remains in
    the body too long, an infection can develop in the kidneys or bladder. Urine
    retention may also lead to overflow incontinence – leakage of urine when the
    bladder is full and does not empty properly.

    Diagnosis of bladder problems

    Diagnosis of bladder problems may involve checking both bladder function and
    the appearance of the bladder’s interior. Tests may include x rays, urodynamic
    testing to evaluate bladder function, and cystoscopy, a test that uses a device
    called a cystoscope to view the inside of the bladder.

    Treatment of bladder problems

    Treatment of bladder problems due to nerve damage depends on the specific
    problem. If the main problem is urine retention, treatment may involve
    medication to promote better bladder emptying and a practice called timed
    voiding – urinating on a schedule – to promote more efficient urination. Sometimes
    people need to periodically insert a thin tube called a catheter through the
    urethra into the bladder to drain the urine. Learning how to tell when the
    bladder is full and how to massage the lower abdomen to fully empty the bladder
    can help as well. If urinary leakage is the main problem, medications,
    strengthening muscles with Kegel exercises, or surgery can help. Treatment for
    the urinary urgency and frequency of overactive bladder may involve medications,
    timed voiding, Kegel exercises, and surgery in some cases.

    Urinary Tract Infections

    Infections can occur when bacteria, usually from
    the digestive system, reach
    the urinary tract. If bacteria are growing in the urethra, the infection is
    called urethritis. The bacteria may travel up the urinary tract and cause a
    bladder infection, called cystitis. An untreated infection may go farther into
    the body and cause pyelonephritis, a kidney infection. Some people have chronic
    or recurrent urinary tract infections. Symptoms of urinary tract infections can
    include

    • a frequent urge to urinate
    • pain or burning in the bladder or urethra during urination
    • cloudy or reddish urine
    • in women, pressure above the pubic bone
    • in men, a feeling of fullness in the rectum

    If the infection is in the kidneys, a person may have nausea, feel pain in
    the back or side, and have a fever. Frequent urination can be a sign of high
    blood glucose, so results from recent blood glucose monitoring should be
    evaluated.

    The health care provider will ask for a urine sample, which will be analyzed
    for bacteria and pus. Additional tests may be done if the patient has frequent
    urinary tract infections. An ultrasound exam provides images from the echo
    patterns of sound waves bounced back from internal organs. An intravenous
    pyelogram uses a special dye to enhance x-ray images of the urinary tract.
    Cystoscopy might be performed.

    Early diagnosis and treatment are important to prevent more serious
    infections. To clear up a urinary tract infection, the health care provider will
    probably prescribe antibiotic treatment based on the type of bacteria in the
    urine. Kidney infections are more serious and may require several weeks of
    antibiotic treatment. Drinking plenty of fluids will help prevent another
    infection.

    Female Anatomy

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    Who is at risk for developing sexual and urologic problems of diabetes?

    Risk factors are conditions that increase the chances of getting a particular
    disease. The more risk factors people have, the greater their chances of
    developing that disease or condition. Diabetic neuropathy and related sexual and
    urologic problems appear to be more common in people who

    • have poor blood glucose control
    • have high levels of blood cholesterol
    • have high blood pressure
    • are overweight
    • are older than 40
    • smoke
    • are physically inactive

    Can diabetes-related sexual and urologic problems be prevented?

    People with diabetes can lower their risk of sexual and urologic problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their health care provider recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease.

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    Sexual and Urologic Problems of Diabetes At A Glance

    The nerve damage of diabetes may cause sexual or urologic
    problems.

    • Sexual problems for men with diabetes include
      • erectile dysfunction
      • retrograde ejaculation
    • Sexual problems for women with diabetes include
      • decreased vaginal lubrication and uncomfortable or painful intercourse
      • decreased or no sexual desire
      • decreased or absent sexual response
    • Urologic problems for men and women with diabetes include
      • bladder problems related to nerve damage, such as overactive bladder, poor control of sphincter muscles, and urine retention
      • urinary tract infections
    • Controlling diabetes through diet and exercise can help prevent sexual and
      urologic problems.
    • Treatment is available for sexual and urologic problems.

    Hope through research

    The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) was established by Congress in 1950 as one of the National Institutes of Health of the U.S. Department of Health and Human Services. The NIDDK conducts and supports research on diabetes, glucose metabolism, and related conditions. NIDDK-supported research on the sexual and urologic complications of diabetes includes research conducted as part of the Epidemiology of Diabetes Interventions and Complications (EDIC) study. The EDIC is an observational follow-up study of people who originally participated in the Diabetes Control and Complications Trial (DCCT). The DCCT showed that intensive blood glucose control can reduce the risk of complications of type 1 diabetes. EDIC study results suggest that tight glucose control can delay the onset of erectile dysfunction in men with type 1 diabetes.

    A recent study focused on urinary incontinence in women at high risk for developing type 2 diabetes who participated in the NIDDK-sponsored Diabetes Prevention Program (DPP). The women had pre-diabetes, a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Women who were in the DPP group that used a lifestyle change approach to diabetes prevention and lost 5 to 7 percent of their weight through dietary changes and increased physical activity were compared with those in other DPP groups who received standard education and maintained a stable weight. The women in the lifestyle intervention group had fewer problems with urinary incontinence than women in the other groups. This finding adds to other results of the DPP study that indicate the value of lifestyle changes for preventing or delaying the development of type 2 diabetes.

    Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit
    www.ClinicalTrials.gov.

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