Health @ Heart
Sex and Diabetes
(First of two parts)
Does diabetes affect sexual function?
Yes. In men, diabetes mellitus can cause a varying degree of erectile dysfunction (inability to attain or sustain erection satisfactory for intercourse) as the diabetes progresses. Most of the time, however, the exaggerated and unfair condemnation of diabetes as causing severe erectile dysfunction leads to a psychological deterrent and a self-fulfilling prophecy in most men. Many well-adjusted and well-treated diabetics enjoy sex without problems. In women, loss of vaginal lubrication is a major sexual effect of diabetes. It is also theorized that there could be some erectile dysfunction of the clitoris (female anatomical counterpart of penis) among women with diabetes. Viagra (Sildenafil), which has been found to be effective for male erectile dysfunction, has now been shown in some preliminary studies to be of help also among females, lending further support to the medical contention that perhaps diabetes also impairs female (clitoral) erectile function.
Is this condition the same as impotence?
No, this was a scientific "error," a harsh diagnosis overkill in the past. Erectile dysfunction has since then been considered a distinct and remediable medical entity and has replaced the term impotence, in this particular context. Impotence is now relegated to its proper "domain" where the male (himself) is unable to cause pregnancy. This clearer definition is more medically accurate and has given more hope and psychological relief to the millions afflicted by erectile dysfunction, which today has great treatment success rate.
How common is erectile dysfunction?
It is very common. While impotence (accurately diagnosed) affects very few men, erectile dysfunction affects an estimated 10 to 20 million men aged 19 and older in the United States. The prevalence is 52% in men aged 40 to 70 and increases with age. However, today, men---and women---can enjoy sexual activity throughout life, with proper care and strategy. Erectile dysfunction is not inevitable with aging, even into the 70s and 80s. With proper medical counseling and aids like Viagra, etc., most males and females can enjoy sex at any age.
What are the other complications of diabetes?
Diabetes has a lot of potential complications. Among them are the effects on the small arteries and big arteries in the body, causing blockages in the circulation, leading to damages (poor supply of blood, oxygen and nutrition) to the various organs of the body: the eyes (retinopathy that results in blindness), kidneys (nephropathy resulting in kidney failure), legs (resulting in leg an feet ulcers, gangrene and amputation), nerves (neuropathy that causes numbness and pains in the feet), and cellular immunity (weakens the immune system leading to infections). This is the reason why all diabetic patients must be under the care of a physician and why the blood sugar must be well-controlled at all times.
What are the causes of erectile dysfunction?
Erectile dysfunction is rare in diabetic men until their mid-30s. Erectile dysfunction is very common in the general male population, especially in these modern times. Contributing to cause this condition are psychologic factors (severe anxiety, fear of intimacy, fear of unwanted pregnancy, sexual guilt, depression), drugs (most medications for high blood pressure and coronary heart disease, psychotropic drugs, CNS depressants-tanquilizers, etc. do affect erection), arteriosclerosis/vascular (blocking arteries that supply blood to the male organ), and, rarely, biogenic (associated with low testosterone levels and reflecting disorders of the hyphothalamic-pituitary-gonadal axis).
Does alcohol affect erection?
Alcohol definitely affects erection, either in diabetics or non-diabetics. While the first shot of alcohol may cause a little euphoria and a sense of well-being in most persons, and therefore, perhaps helps in improving the sexual climate, the second and subsequent drinks will impair erection in most men, depending on their tolerance to alcohol. As Shakespeare wrote "Alcohol increases the desire but diminishes the performance."
Does diabetes cause gangrene of the male organ?
This is a myth that has been used to scare men to seek medical treatment for diabetes in the olden times. While there was wisdom in the intent, the medical truth is that the small arterioles in the penis have not been found to be affected by arteriosclerosis (hardening of the arteries) compared to arteries of the heart, brain, kidneys, abdomen and legs. If there is any report in the medical literature about diabetes causing gangrene of the penis, it must be so rare physicians have not encountered it. On the other hand, trauma and other conditions, like priapism (abnormally prolonged, painful and persistent erection), have been well-known to cause gangrene, when intractable and not amenable to treatment.
What is the treatment for these side-effects of diabetes on sex?
Making the correct diagnosis is very important, since the treatment depends on the cause. Once the diagnosis of erectile dysfunction is confirmed, Viagra is the
current drug of choice. Erection is achieved about one hour to one hour and a half following ingestion of the pill, which comes in 25 mg, 50 mg and 100 mg. Persons on nitroglycerine (medications for coronary heart disease) are strictly warned against taking Viagra, the combination of which could cause intractable shock and death. Viagra, if taken properly under a physician's supervision, is a safe and very effective wonder drug. It is essential that the diabetes is well-controlled at all times for this to work. Quitting smoking, exercising at least 3 times a day, and a conducive environment, will help tremendously in improving sexual performance.
To be continued next week: Role of Viagra, Lubricants, etc. on Diabetic Women and Sex.
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The main objective of this column is to educate and inspire people to live a healthier lifestyle to prevent illnesses and disabilities, and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.
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Dr. Philip S. Chua is Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, and is the Chairman of Cardiovascular Surgery of the Cebu Doctors' University Hospital in Cebu City. He is also the Vice-President for Far East Operations of the Cardiovascular Hospitals of America, a hospital builder in Wichita, Kansas. His health column appears in 8 newspapers (4 in the United States and 4 in the Philippines), 3 magazines, and 9 websites on the Internet. His email address is scalpelpen@gmail.com