When you have diabetes your sex life, just like everything else, is much more complicated. Whatever type of diabetes you have, whatever your gender and whoever you choose to have sex with, intimacy comes with a number of caveats and precautions that have to be negotiated. But thanks to the persistent taboo that surrounds talking about sex, as well as a lack of understanding about diabetes, the issue is rarely discussed.
As Emma Elvin, Senior Clinical Advisor at Diabetes UK puts it to R29: "Many people will experience sexual problems at some point in their lives. If you have diabetes, it doesn’t mean you’ll definitely have a problem with your sex life. But people with diabetes are more at risk of sexual dysfunction."
The disruption to men’s sex lives is slightly more discussed (a quick google of the words ‘diabetes’ and ‘sex’ prioritises results about erectile dysfunction) but the effect is marked for women too, both physically and psychologically.
Simone*, a 29-year-old type 1 diabetic in Glasgow, tells R29 that her diabetes absolutely affects her sex life.
"Thrush is a common thing with diabetics – it tends to happen when your BG's [blood glucose] run high, meaning higher levels of sugar are then in the blood as well as in sweat, saliva and urine; this creates the perfect environment for yeast." Another complication from high blood glucose is nerve damage, which can also affect the nerves and blood vessels in your genitals, leading to vaginal dryness. "If I have had high BG for a day or two I find this happens to me," Simone says, adding that "in the past these conditions have affected me at different times. When I was first sexually active it was so embarrassing, either trying to make up excuses so I didn't need to confront the issue with a sexual partner or just hoping they never noticed."
As well as vaginal dryness, the damage to blood vessels and nerves can restrict the amount of blood flowing to your sexual organs, meaning you can lose sensation. Emma explains that this means "you could have difficulty getting aroused, both physically and in how you feel." And just as an increased level of sugar in your urine can increase the likelihood of developing thrush, it can also lead to urinary tract infections (UTIs).
For Rebecca, a 32-year-old type 1 diabetic in London, the impact on her sex life hits her when she’s experiencing both high and low glucose levels.
"It's very easy to experience a hypoglycaemia (low blood sugar) during or after sex, as it is exercise," she tells R29. "This means that I have to stop and treat the low sugar before being able to continue; there have been times [during and after sex] where I'm extremely weak, shaky and feel so close to fainting – at times I don't even have the strength to puncture a juice carton with a straw and require support." She adds that this hasn’t always gone down well. "On one occasion, a partner did not help me and was moody because we had to stop being intimate (why would you want to continue when I could possibly faint?)."
High blood sugar is also disruptive, even if it doesn’t lead to physical symptoms like thrush or loss of sex drive. "When I experience a hyperglycaemia (high blood sugar)," Rebecca says, "I frequently need to pee, and am thirsty and fatigued. This can interfere with intimate moments as I'm not physically able to be intimate or in the mood to have sex."
The process of treating these blood sugar fluctuations can be disruptive in and of itself, and with less supportive partners can cause tension.
"When you don't have an understanding partner it can be very challenging," Rebecca adds. "In the moments where I'm experiencing a high or low blood sugar, I have felt vulnerable – especially when I've needed a little assistance. It is difficult to find someone who is empathetic and willing to support me every now and then."
This plays into how encompassing diabetes is – the treatment and monitoring doesn’t take time off for sex. Even getting an insulin pump (a small electronic device that gives your body the regular insulin it needs throughout the day and night), which would make treating blood sugar levels easier, can lead to new areas of worry.
"The devices I now wear were another insecurity I had," Simone shares. "I actually put off getting an insulin pump for years because when I was single and dating I couldn't face having to explain to people what it was. Depending on the pump, I might have been given one that had tubes attaching it to me so that was a definite put-off because I didn't want to have to navigate sex with tubing or run the risk of ruining a moment by having to disconnect myself."
Balancing all these factors, as well as the regular anxieties that pop up around sex, can take a toll emotionally. This is why it’s so important to educate people that diabetes is a constant – even when it ruins the mood – and why we must take women’s sexual dysfunction seriously.
Emma echoes this: "Our emotions have a big impact on how interested we are in sex. Feelings of fear, embarrassment or even being tired can play a role and be a lot to cope with. But there is support available whether it’s talking to your partner, a friend, counsellor or your healthcare team."
If you’re looking to discuss the issues raised in this story, Diabetes UK advises talking to your healthcare team for more advice and support. Alternatively, you can contact the Diabetes UK helpline, which is managed by trained counsellors who are ready to answer your questions or just listen. Call 0345 123 2399 (Monday-Friday, 9am-6pm).
*Name changed to protect anonymity.