Where to begin?
The most common question I encounter as a family physician is the problem of erectile dysfunction related to diabetes. With all the television advertisements on "ED" more patients are speaking up.
Is Viagra the answer? For some – yes. But for many patients the problem is more complex.
For the most part we are talking about Type II diabetes, the variety that occurs primarily in overweight men and women. In addition to the hormonal imbalance that leads to diabetes, a decrease in serum testosterone is common, resulting in decreased libido (sexual desire). Men especially suffer from this problem, although women are not immune. Diabetes may impair the circulatory and nervous systems, making it difficult for both men and women to become physically aroused.
Associated chronic diseases complicate the issue further. Many diabetics take high blood pressure medications, drugs that sometimes lead to impotence or loss of desire. Depression is common, and can lead to sexual dysfunction in both diabetics and nondiabetics. Unfortunately, some antidepressants also cause sexual disorders. Heart disease itself usually does not cause impotence, but worrying about it can do so.
If you're diabetic and are experiencing a sexual difficulty, explain the problem to your doctor. Although physicians are encouraged to initiate discussions about sexual functioning, this vital question is commonly overlooked.
Before you visit your physician, organize your thoughts. How long has the problem existed? Is it primarily a physical problem or an emotional one? Can you even tell the difference? Is it related to problems with your spouse, or did it come on when you began a certain medication? Was the onset gradual, over the course of months to years, or more rapidly? Do you suffer loss of interest, loss of ability, or both? Is there any discomfort? Is the problem always present or does it come and go? What solution are you seeking? Is the problem a threat to your marriage?
Your doctor will want to review your history carefully, including a complete list of your medications, then perform a physical exam to rule out other physical problems such as prostatitis or vaginitis. He may want to do blood testing for hormone levels or other endocrine disorders.
The good news is: there's an answer for everybody. If low hormone levels are the cause, hormone replacement therapy may be the answer. If decreased circulation is the cause, there are methods to improve blood flow (Viagra being one of them – including for some women). For men, if all else fails, there are implantable devices. If the problem is one of an eroding relationship, counseling is often helpful.
But not everyone desires to improve sexual function. Many individuals and couples decide to focus on other areas of intimacy, such as companionship. Sometimes just understanding you're not the only one with a problem is all a person needs to stop worrying and relax.
Copyright 2010 Cynthia J. Koelker, MD