Diabetes And Female Sexuality

Sexuality is a broad term that includes sexual activity along with all other physical, emotional and biochemical aspects that determines the quality of sex such as desires and thoughts. Sexual dysfunction refers to any imbalance or disparity in the sexual response cycle that interferes with the capacity of an individual to engage in a satisfying sexual encounter.

There are four primary stages of a typical sexual response cycle; these are:

• Excitement: This includes desires and sexual arousal in response to visual, tactile, auditory or any other form of stimulation.
• Plateau: State of continued or persistent sexual pleasure during the act of intercourse is referred to as plateau.
• Orgasm: When sexual pleasure or excitement reaches its peak, it is referred to as orgasm and is marked by rhythmic, involuntary vaginal contractions in women.
• Resolution: Return of sexual excitement to basal levels is referred to as resolution and it is marked by the completion of the act of intercourse.

Types of Sexual Dysfunction in Women

Sexual dysfunction is fairly common in women as suggested by various clinical and research studies. There are four varieties or types of sexual dysfunction; these are:

• Pain Disorder: Onset or exaggeration of genital pain during the act of sexual intercourse that interferes with sexual activity is classified as pain disorder.
• Orgasm Disorder: Inability to achieve orgasm (or significant delay in experiencing orgasm) during the act of sex is known as orgasm disorder.
• Arousal Disorder: Inability to achieve physical or sexual excitement/ arousal during sexual activity.
• Desire Disorder: Lack of interest or desire in engaging in sexual encounter.

How Diabetes Contributes To Sexual Dysfunction In Women?

A number of clinical studies have provided statistical evidence that uncontrolled diabetes can lead to a variety of complications in men and women due to neurovascular damage. Based on latest data, following sexual side effects are usually reported in diabetic women:

• Poor vaginal lubrication that is partly attributed to poor vaginal circulation and partly due to nerve damage

• (decreased sensitivity). Dryness of vagina also translates into painful or discomforting sex.
• Impairment of sexual desires is another compliant that is fairly common in diabetic women. This can put a bar on relationships and may lead to conflicts with the partner.
• Poor or inadequate sexual response that is marked by an inability to reciprocate the sexual advances of the partner. Most women report inability to stay aroused after initial sexual stimulation. Diabetic neuropathy is believed to contribute to this dysfunction.

Other common sexual complaints in diabetic women include:

• Poor relaxation of vaginal muscles that may hinder with copulation.
• Inability to achieve orgasm.

Pathophysiology Of Sexual Dysfunction In Diabetic Women

Besides neurovascular damage as suggested above, a variety of other factors can also explain sexual dysfunction in diabetic women; these are:

• Metabolic syndrome as most diabetics have other metabolic disorders too due to shared pathophysiology (such as hypertension, cardiovascular damage etc.)
• Diabetes related hormonal changes.
• Adverse effect of a variety of hypoglycemic drugs (or other drugs due to metabolic dysfunction).
• Recurring risk of genital infections due to impaired blood glucose concentration.
• Psychological dysfunction/ disorders due to chronic nature of illness such as depression, anxiety etc.
• Individuals who consume alcohol or smoke cigarettes or other drugs often experience more severe symptoms of sexual dysfunction.

It is imperative to mention that poor glycemic control can also affect your fertility. Study reported in the Journal of Sexual Medicine (3) suggested that diabetic women are more likely to get diagnosed with fertility issues such as miscarriage, polycystic ovarian disease and other related ailments. Study also suggested that the risk of complications is higher in obese females.

How To Manage Sexual Dysfunction In Diabetic Women?

It is highly recommended to speak to your therapist if you are experiencing complications of diabetes. Experts believes that optimal glycemic control can delay (or even prevent) some complications of diabetes.

You can also talk to a sex therapist to learn some effective remedies to address sexual dysfunction; for example, use of vaginal lubricants can help in reducing dryness of vagina.

References

1. Esposito, K., Maiorino, M. I., Bellastella, G., Giugliano, F., Romano, M., & Giugliano, D. (2010). Determinants of female sexual dysfunction in type 2 diabetes. International journal of impotence research, 22(3), 179-184.

2. Enzlin, P., Mathieu, C., Van den Bruel, A., Vanderschueren, D., & Demyttenaere, K. (2003). Prevalence and predictors of sexual dysfunction in patients with type 1 diabetes. Diabetes care, 26(2), 409-414.

3. Pontiroli, A. E., Cortelazzi, D., & Morabito, A. (2013). Female sexual dysfunction and diabetes: A systematic review and meta‐analysis. The journal of sexual medicine, 10(4), 1044-1051.