Got diabetes? Here are ways to improve your sex life

Charles, a 55-year-old businessman, came to the Sexology Clinic lamenting on how unfair life can be.

"In my earlier years I worked hard and struggled to grow a business empire and I thought that at this age I would settle down and enjoy life," he said, "I now realise that this was a pipe dream and that I have wasted my life chasing after the wind."

The reason for this dirge was that I had just diagnosed him with erectile dysfunction which was caused by diabetes. Charles had been married for 26 years with three adult children. He had struggled with erection failure for six months before coming to the clinic; initially going flat in the middle of sexual activity then progressing to feeble erections unable to manage penetrative sex. 

"I thought the problem was my wife; that there was something about her that affected me and so I got involved in a liaison to test my vitality," he said, "that not only caused me problems at home but confirmed to me that I could not erect with any woman." 

Charles was among the 1.5 million Kenyans living with diabetes half of whom are not even aware that they have the disease because they do not check their blood sugars routinely. If he had not come to the clinic because of the erection failure, Charles would not have known that he was diabetic. Left untreated, diabetes progressively damages blood vessels and nerves resulting in various organ failures. For men, erection failure is among the first of many diabetes-associated failures including kidney failure, loss of eyesight, increased risk of stroke, and gangrene of the feet and legs leading to amputation.

While many health workers discuss complications associated with diabetes in detail, very few if any will discuss sex problems that they are likely to face. Progressive destruction of blood vessels and nerves makes erections hard. In addition, diabetes affects the production of testosterone, the hormone that is responsible for vitality. 

With low testosterone, the desire for sex also vanishes, complicating the situation further for diabetics. Low desire and failing erections give way to psychological effects. Anxiety becomes common and affected persons dread exposure to sexual situations. The thought that a partner is going to demand sex makes the affected person freak out. 

"I haven't told anybody this," Charles said, "can you imagine that sometimes I fake work trips out of town and hire a room nearby just to escape from my wife?" The performance anxiety was so much that he could not bear and these fake trips helped him cope.

Some people in Charles' situation lose self-esteem, feel lonely, hopeless, and useless. If not checked they easily slide into depression. A combined diagnosis of diabetes and ED is difficult to cope with. Unfortunately, these psychological effects of the disease themselves negatively impact sexual function further. Successful sex requires high self-esteem, self-confidence, and a positive outlook on life.

"Can I bring my wife so that you explain all these to her?" Charles asked. He was a traumatised man, cornered from all ends – medically, psychologically, and in his marital relationship. If only his diabetes had been discovered in good time before complications set in he would have escaped the pain and suffering that he was now going through.

Given the complex nature of his problem, I designed a multi-pronged approach to his treatment. I started him on treatment for diabetes with immediate effect. Further, I gave him medicine to help with nerve regeneration. The damaged blood vessels had to be repaired too through a special procedure called shockwave therapy which took twelve weeks.

Charles had to go through psychotherapy to recreate self-esteem and confidence. He had to once again develop the will to face life with many challenges. Erection-enhancing drugs were useful for him to start a new sexual journey as other problems were being worked on. 

Even more important was to repair the relationship which for a while had become sexless. Issues of infidelity had seriously damaged the relationship and the couple had lost emotional connection. They went through a series of couple therapy sessions which helped.

"For once in my life, I feel that I would be happier if I was born a woman," Charles said on his last visit to the clinic six months after I first met him, "at least they do not get all these effects of diabetes. I shook my head in disagreement.

"Women similarly have their share of sex problems," I said, "If not properly controlled, diabetes can damage nerves and blood vessels, including those needed for good sexual function. It can also inhibit blood flow to the genitals, which is needed for heightened sensation and lubrication. This causes vaginal dryness and loss of feeling which can make a woman less likely to get aroused or to have an orgasm," I explained. 

For feedback to the editor email [email protected]