The high prevalence of diabetes is unquestioned, and middle-aged and older “sugar addicts” abound at the dinner table. What about the relationship between diabetes and sexual function? Of course, we usually talk about how high or low the blood sugar level is more, and talk about its impact on sexual function is less, often avoid talking about it.
A, the impact on the sexual function of men
Diabetes is an endocrine disease caused by insufficient insulin secretion. As early as 200 years ago, people noticed that diabetic patients are prone to ED (erectile dysfunction), and the incidence is quite high, up to 40% to 60%. In the United States, for example, in a total of 2 million diabetic patients there are about 1 million patients with ED, which is a considerable number. Young (30-35 years old) diabetic patients have a 25% chance of ED, while more people over 50 years old, 60-65 years old diabetic patients ED incidence rate of 75%, reflecting the older patients with more pronounced atherosclerosis and aggravate the existing lesions of the circulatory system.
Diabetes is a common cause of ED. Among the many causes of organic ED, neurogenic ED is one of them. Neuropathic changes that result in impaired nerve conduction, i.e., impaired neurotransmitter release at the neuromuscular junction located between the pons cavernosa nerve and the smooth muscle surrounding the blood sinusoids and spiral arteries, can lead to neurogenic ED. diabetes, lumbar disc disease, paraplegia, multiple sclerosis, transverse myelitis, alcoholism, peripheral neuropathy, etc., all fail to transmit the appropriate nerve messages to the The smooth muscle of the penile corpus cavernosum, and therefore the changes in blood filling and storage necessary for penile erection, cannot be produced.
The literature reports that diabetic men often have peripheral neuropathy (especially in the legs, but also involving the pelvic and genital regions), such as hyperalgesia, or with painful sensations, muscle weakness, and atrophic changes in the skin and joints. It is estimated that about 60% of diabetic patients with impotence develop pathological changes in the pelvic parasympathetic nerves, and they tend to develop ED at a much earlier age than normal. It is generally believed that the combination of neuropathic changes in diabetic patients is the main causative factor of diabetic ED.
Since diabetes is an endocrine disorder caused by insufficient insulin production. It will also affect the body’s metabolic and vascular system. For example, it leads to atherosclerosis and accelerates small-vessel lesions. This small-vessel lesion particularly affects the eyes, kidneys, central and peripheral nervous system. Therefore, ED due to diabetes is considered to be primarily a neurological and vascular problem, rather than an endocrine problem. The clinical course of the onset of diabetic ED, which increases with age, is often gradual, beginning with a decrease in penile hardness followed by progressive deterioration.
The incidence of ED is not significantly correlated with the duration of diabetes, medication, quality of glycemic control, etc. Once the ED occurs, even if the medication controls the condition well, it often fails to correct the ED. the ED occurs before, and even more so in patients with diabetes diagnosis.
A more effective treatment for diabetic ED is to take 50 to 100 mg of Viagra orally one hour before intercourse, followed by full effectiveness stimulation. Vasoactive drugs can also be injected via the urethra or directly into the cavernous body of the penis. Such as poppies, prostaglandin E1, etc., can induce penile erection, which usually lasts about 2 hours.
This injection method, with training, allows the patient or spouse to master the treatment by injecting the drug before sexual intercourse, but the dosage of the drug must be decided by the doctor after prior trial. If used for a long time, it is especially important to prevent infection and to pay attention to aseptic operation. Side effects may include local bleeding, pain, and cavernous fibrosis. If the patient is younger and in basic health, penile prosthesis implantation may also be considered. This can solve the difficulties in sexual function once and for all. According to domestic and international experience, this procedure has a low adverse effect and a high success rate. But diabetic ED is not always caused by diabetes itself, especially if the patient can get a full erection with masturbation or oral sex, it suggests that ED is caused by mental factors, such as trauma, depression, anxiety, marital conflict, work stress, economic difficulties, etc.
And when ED is an early symptom of diabetes, it may reflect poor control of the patient’s metabolic status. Therefore, the adoption of appropriate control of diet, the use of insulin or oral hypoglycemic drugs and other treatment measures can often lead to rapid improvement in sexual function. If improvement does not occur after treatment, the patient clearly has an excessive anxiety problem. When impotence occurs early in the course of the disease despite better glycemic control, cure is more difficult. Psychological treatment is still worth a try, as long as there is no confirmation that organic factors of diabetes do exist.
Another common sexual dysfunction in diabetes is retrograde ejaculation, with a low incidence of about 1 to 2 percent. This is because the sympathetic nerve fibers that innervate the closure of the bladder neck in their bodies are also damaged, and because of the failure of the bladder and urethral sphincter, semen will flow retrograde into the bladder rather than forward out of the urethral opening during the ejaculatory phase. This is because the bladder neck sphincter, which should have been closed during ejaculation, is open at this time, while the external urethral sphincter, which should be open, is closed. These patients often have signs and symptoms of extensive autonomic injury such as upright hypotension, nocturnal diarrhea, and bladder volume expansion due to high residual urine flow. It is unclear how a patient can have problems with retrograde ejaculation when the discharge to the posterior urethra is normal. Retrograde ejaculation is also seen in patients who have undergone surgery via the urethra, patients with infections, injuries and congenital anomalies in the posterior urethra, and some antihypertensive drugs can also cause retrograde ejaculation.
II. Effects on female sexuality
It is not known how the sexual desire of women with diabetes differs from that of women without diabetes. Theoretically, diabetes should not affect the cerebral cortex, but it is widely believed that the patient’s self-concept may have a negative impact. Diabetic women are prone to view themselves as defective or dysfunctional and, therefore, no longer aspire to romance, marriage, or both, and they consciously or unconsciously control or repress their sexual expression as a defensive measure against possible harm or rejection. In this case, negative thoughts or feelings can block sexual desire, arousal or expression.
In all branches of the medical field, the most difficult clinical phenomenon is the overlap of physical and mental factors, both in the presence of clear organic pathological changes and in the presence of mental factors such as severe internal conflicts. This is often seen in the sexual complaints of diabetic patients. It is necessary for the physician to distinguish their respective roles.
(i) the diabetic disease itself ;
(ii) Prevailing medical beliefs (sometimes prematurely) such as “this must be caused by diabetes”;
(iii) organic comorbidities of diabetes, vaginitis, cystitis, drug overdose, etc;
(iv) Cognitive factors such as ignorance of the body or sexuality, emotional factors (e.g., body image problems, always thinking of oneself as sick, weak, or defective), sexual inhibition, clinical depression or other psychological problems, interpersonal problems and marital conflicts, intimacy fear (using the illness as a reason to refuse intimacy);
⑤ All of the above factors work in combination. Of course the various cognitive factors listed in ④ can also occur in non-diabetic women with sexual problems.
So what factors are at play in diabetes? For diabetic women with sexual anxiety who are not adequately educated about sex, if they are still physically healthy, the first step is to reassure them that there is no serious problem. The next step is to take a sexual history and suggest some reading to them to enhance their sexual education. This guided self-help education is enough to reverse sexual symptoms due to mild anxiety or to forget how severe her diabetes is or how severe her sexual dysfunction is.
Specific sexual issues will relate to: the onset of sexual symptoms; the relationship between its occurrence and the onset of diabetes; her personal response to the disease, medication and controlled diet; her sense of body image now and before diabetes; concerns about her injection sites; changes in dress and activities (swimming, etc.); shyness about her body; other family members’ history and outcome of diabetes; fear of transmission to her spouse through kissing, touching or sexual intercourse special fears about spouse transmission through kissing, touching, or sexual intercourse; and concerns about pregnancy, disability, and death.
Important issues include early positive or negative sexual experiences; sexual fears and fantasies; the influence of religious beliefs on sexual functioning, etc.; and her current sexual and marital relationships, whether marital conflicts exist and whether they are brought into the bedroom. Are there any financial, family, or work-related problems that interfere with her sexual enjoyment or feelings prior to or during sexual activity? The presence of clinically untreated depression must be noted and aggressively treated, as depression itself can cause low sexual desire.
Somatic factors in diabetic women may quite obviously cause temporary but often correctable sexual avoidance, e.g., ketosis, poor glycemic control, irregular menstruation (fear of pregnancy), and candidal vaginitis. Vaginitis can cause temporary painful intercourse, or vaginal cramps, and they disappear when the vaginitis is cured. The anticipation of pain may cause persistence of sexual symptoms.
Comorbidities of advanced diabetes such as irreversible neurological or vascular pathology can lead to decreased vaginal lubrication and cause painful intercourse or vaginal spasms. Diagnosis can be obtained by careful physical and neurological examination. The use of artificial lubricants (or saliva) often helps these sexual symptoms to disappear. Choosing a woman-on-top position can also make intercourse more comfortable.
Sexual dysfunction, which sounds like a disease that only men suffer from, can actually occur in women as well, but female sexual dysfunction has been overlooked. The woman is generally in a passive position in sexual life, in fact, many women are deep in the distress caused by sexual dysfunction.