Diabetes and sex drive

Published:

Dear Dr. Myrtle,

My husband has recently become impotent. We are both 34 years old, and he is diabetic. The problem started about a year ago and has grown increasingly worse - at this time he is unable to maintain an erection at all. To say the least, I am not taking this well and believe it to be psychosomatic; he believes it is medical. I have a hard time believing it’s a medical problem even though he’s diabetic, because he maintains his blood sugar within normal limits. What do you think?


Oooh, I sense a lot of tension behind this question, so be gentle with yourselves while you read along.

First of all, diabetes (type 1 or 2) is one of the leading causes of impotence in men. Why? Well, think of impotence as being caused by three major categories of things: blood-supply related, nerve-related, or emotional factors. We will talk about the emotional part below, but I want to focus on the medical causes first.

It’s important to realize that diabetes has profound effects on both the neurological system and the blood (vascular) system. For men with diabetes, their chances of experiencing partial or complete impotence is fairly high at some point in their lives. The fact that your husband is relatively young doesn’t mean much in the scheme of things, particularly if he has had diabetes for a number of years.

Good control of glycemic levels is critical for staving off some of the blood vessel and/or nerve complications of diabetes, but this information really wasn’t available to people with diabetes until about 1994. Before that time, what healthcare providers thought "good blood-sugar control" was, was, in fact, much higher than the optimal levels we try to achieve today. Realistically, this means that despite your husband’s (and healthcare provider’s) best efforts, his blood sugar was probably allowed to be somewhat higher a few years ago than what we consider to be optimal by today’s standards.

High blood-sugar levels can make a mess of sensory nerves in particular. When your partner’s mind might be thinking, "I’m aroused now", his penis may not be getting the message, literally. Does it mean that he doesn’t want to make love? No, it doesn’t, but his penis might not be able to respond to his brain’s arousal message. High blood-sugar levels also muck about with people’s arteries, so even if his nervous system says, "Hey down there, we’re aroused up here, so open up the gates!", the flood gates of his penis might not open up enough to allow enough blood into the penis to make an erection possible.

I mentioned above that there are emotional reasons why men can have difficulty with their erections (performance anxiety among them). You might not realize that the tension that you are describing in your question ("I believe it to be psychosomatic, he believes it is medical") may be adding to your sexual difficulties and frustrations. Your "not taking this well" may add another load of performance stress to an already difficult situation.

There are medical tests that your partner can undergo which can help him discover the cause of his impotence. But the bottom line is, he has a difficult disease, and he can’t make it go away. He has to deal with his diabetes in the best way that he can, and his erections may be altered by damage caused by the diabetes.

I’m not saying that you shouldn’t be disappointed. You both may have some grieving to go through - each of your sex lives has changed, and not by choice. Does that mean that you should give up on having sex? Not at all. Just because a man doesn’t have blood in his penis, doesn’t mean that he has lost all sensation or desire for sex. Some couples have discovered a whole new world of sexual intimacy because they have gotten away from (willingly or not) society’s focus on "Sex = Penetration". Does your husband feel the loss in the same way as you do? Does he want to try new things? Are you still in a place where you can work together as a couple to find solutions?

If you’re missing pleasure from your intimacy, there are strategies that will lead both of you to sexual fulfillment and satisfaction, but it means that both of you have to be in a place *as a couple* where you can work together, rather than needing to assign blame. For example, you may need to take responsibility for your own sexual satisfaction. Beginning to play with sex toys may be the most satisfying decision you two have made, and with your pleasure being valued and provided for, the tension about his erections may become a thing of the past.

Many men who have talked with us in the store have been very satisfied with exploring their alternatives, both medical and non-pharmacological. There are many resources out there for you, so it’s up to you to start the conversation.

Dr. Myrtle