Troublesome bladder symptoms and changes in sexual function are common health
problems as people age. Having diabetes can mean early onset and increased
severity of these problems. Sexual and urologic complications of diabetes are
related to the nerve damage diabetes can cause. Men may have difficulty with
erections or ejaculation. Women may have problems with sexual response and
vaginal lubrication. Urinary tract infections and bladder problems occur more
often in people with diabetes. By keeping your diabetes under control, you can
lower your risk of sexual and urologic problems.
When you want to lift your arm or take a step, your brain sends nerve signals
to the appropriate muscles. Internal organs like the heart and bladder are also
controlled by nerve signals, but you do not have the same kind of conscious
control over them as you do over your arms and legs. The nerves that control
your internal organs are called autonomic nerves, and they signal your body to
digest food and circulate blood without your having to think about it. Your
body's response to sexual stimuli is also involuntary, governed by autonomic
nerve signals that increase blood flow to the genitals and cause smooth muscle
tissue to relax. Damage to these autonomic nerves is what can hinder normal
Sexual Problems in Men With Diabetes
Estimates of the prevalence of erectile dysfunction in men with diabetes
range from 20 to 85 percent. Erectile dysfunction is a consistent inability to
have an erection firm enough for sexual intercourse. The condition includes the
total inability to have an erection, the inability to sustain an erection, or
the occasional inability to have or sustain an erection. A recent study of a
clinic population revealed that 5 percent of the men with erectile dysfunction
also had undiagnosed diabetes. (Sairam K, Kulinskaya E, Boustead GB, Hanbury
DC, McNicholas TA. Prevalence of undiagnosed diabetes mellitus in male erectile
dysfunction. BJU International. 2001;88(1):68–71.)
Men who have diabetes are three times more likely to have erectile
dysfunction as men who do not have diabetes. Among men with erectile
dysfunction, those with diabetes are likely to have experienced the problem as
much as 10 to 15 years earlier than men without diabetes.
In addition to diabetes, other major causes of erectile dysfunction include
high blood pressure, kidney disease, alcoholism, and blood vessel disease.
Erectile dysfunction may also occur because of the side effects of medications,
psychological factors, smoking, and hormonal deficiencies.
If you experience erectile dysfunction, talking to your doctor about it is
the first step in getting help. Your doctor may ask you about your medical
history, the type and frequency of your sexual problems, your medications, your
smoking and drinking habits, and other health conditions. A physical exam and
laboratory tests may help pinpoint causes. Your blood glucose control and
hormone levels will be checked. The doctor may also ask you whether you are
depressed or have recently experienced upsetting changes in your life. In
addition, you may be asked to do a test at home that checks for erections that
occur while you sleep.
Treatments for erectile dysfunction caused by nerve damage, also called
neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed
in the urethra, and shots directly into the penis, to surgery. All these methods
have strengths and drawbacks. Psychotherapy to reduce anxiety or address other
issues may be necessary. Surgery to implant a device to aid in erection or to
repair arteries is another option.
Retrograde ejaculation is a condition in which part or all of a man's semen
goes into the bladder instead of out the penis during ejaculation. Retrograde
ejaculation occurs when internal muscles, called sphincters, do not function
normally. A sphincter automatically opens or closes a passage in the body. The
semen mixes with urine in the bladder and leaves the body during urination,
without harming the bladder. A man experiencing retrograde ejaculation may
notice that little semen is discharged during ejaculation or may become aware of
the condition if fertility problems arise. His urine may appear cloudy; analysis
of a urine sample after ejaculation will reveal the presence of semen.
Poor blood glucose control and the resulting nerve damage are associated with
retrograde ejaculation. Other causes include prostate surgery or some blood
Retrograde ejaculation caused by diabetes or surgery may be improved with a
medication that improves the muscle tone of the bladder neck. A urologist
experienced in infertility treatments may assist with techniques to promote
fertility, such as collecting sperm from the urine and then using the sperm for
Sexual Problems in Women With Diabetes
Decreased Vaginal Lubrication
Nerve damage to cells that line the vagina can result in dryness, which in
turn may lead to discomfort during sexual intercourse. Discomfort is likely to
decrease sexual response or desire. (IOH Medical Tip: Try using a water-based personal lubricant available over-the-counter, or, ask your doctor to prescribe a specific product right for your needs).
Decreased or Absent Sexual Response
Diabetes or other diseases, blood pressure medications, certain prescription
and over-the-counter drugs, alcohol abuse, smoking, and psychological factors
such as anxiety or depression can all cause sexual problems in women.
Gynecologic infections or conditions relating to pregnancy or menopause can also
contribute to decreased or absent sexual response.
As many as 35 percent of women with diabetes may experience decreased or
absent sexual response. Decreased desire for sex, inability to become or remain
aroused, lack of sensation, or inability to reach orgasm can result.
decreased or total lack of interest in sexual relations
decreased or no sensation in the genital area
constant or occasional inability to reach orgasm
dryness in the vaginal area, leading to pain or discomfort during sexual
If you experience sexual problems or notice a change in your sexual response,
talking to your doctor about it is the first step in getting help. Your doctor
will ask you about your medical history, any gynecologic conditions or
infections, the type and frequency of your sexual problems, your medications,
your smoking and drinking habits, and other health conditions. A physical exam
and laboratory tests may also help pinpoint causes. Your blood glucose control
will be discussed. The doctor may ask whether you might be pregnant or have
reached menopause and whether you are depressed or have recently experienced
upsetting changes in your life.
Prescription or over-the-counter vaginal lubricant creams may be useful for
women experiencing dryness.
Techniques to treat decreased sexual response include changes in position and
stimulation during sexual relations. Psychological counseling, as well as Kegel
exercises to strengthen the muscles that hold urine in the bladder, may be
helpful. Studies of drug treatments are under way.
Diabetes and Urologic Problems
The Urinary Tract
Bladder dysfunction can have a profound effect on quality of life. Diabetes
can damage the nerves that control bladder function. Men and women with diabetes
commonly have bladder symptoms that may include a feeling of urinary urgency,
frequency, getting up at night to urinate often, or leakage of urine
(incontinence). These symptoms have been called overactive bladder. Less
common but more severe bladder symptoms include difficulty urinating and
complete failure to empty (retention). These symptoms are called a neurogenic
bladder. Some evidence indicates that this problem occurs in both men and
women with diabetes at earlier ages than in those without diabetes.
In neurogenic bladder, damage to the nerves that go to your bladder can cause
it to release urine when you do not intend to urinate, resulting in leakage. Or
damage to nerves may prevent your bladder from releasing urine properly and it
may be forced back into the kidneys, causing kidney damage or urinary tract
Neurogenic bladder can be caused by diabetes or other diseases, accidents
that damage the nerves, or infections.
Symptoms of neurogenic bladder include
urinary tract infections
loss of the urge to urinate when the bladder is full
leakage of urine
inability to empty the bladder
Your doctor will check both your nervous system (your brain and the nerves of
the bladder) and the bladder itself. Tests may include x rays and an evaluation
of bladder function (urodynamics).
Treatment for neurogenic bladder depends on the specific problem and its
cause. If the main problem is retention of urine in the bladder, treatment may
involve medication to promote better bladder emptying and behavior changes to
promote more efficient urination, called timed urination. Occasionally, people
may need to periodically insert a thin tube called a catheter through the
urethra into the bladder to drain the urine. Learning how to tell when the
bladder is full and how to massage the lower abdomen to fully empty the bladder
can help as well. If urinary leakage is the main problem, medications or surgery
Urinary Tract Infections
Infections can occur in any part of the urinary tract. They are caused when
bacteria, usually from the digestive system, reach the urinary tract. If
bacteria are growing in the urethra, the infection is called urethritis.
The bacteria may travel up the urinary tract and cause a bladder infection,
called cystitis. An untreated infection may go farther into the body and
cause pyelonephritis, a kidney infection. Some people have chronic or
recurrent urinary tract infections.
Symptoms of urinary tract infections may include
a frequent urge to urinate
pain or burning in the bladder or urethra during urination
cloudy or reddish urine
fatigue or shakiness
in women, pressure above the pubic bone
in men, a feeling of fullness in the rectum
If the infection is in your kidneys, you may be nauseous, feel pain in your
back or side, and have a fever. Since frequent urination can be a sign of high
blood glucose, you and your doctor should also evaluate recent blood glucose
Your doctor will ask for a urine sample, which will be analyzed for bacteria
and pus. If you have frequent urinary tract infections, your doctor may order
further tests. An ultrasound exam provides images from the echo patterns of
soundwaves bounced back from internal organs. An intravenous pyelogram (IVP)
uses a special dye to enhance x-ray images of your urinary tract. Another test,
called cystoscopy, allows the doctor to view the inside of the bladder.
Early diagnosis and treatment are important to prevent more serious
infections. To clear up a urinary tract infection, the doctor will probably
prescribe an antibiotic based on the bacteria in your urine. Current
recommendations are for a full 7-day course of antibiotic treatment in people
with diabetes, instead of the shorter course used for other people. Kidney
infections are more serious and may require several weeks of antibiotic
treatment. Drinking plenty of fluids will help prevent another infection.
Will I experience sexual and urologic problems sooner or later?
Risk factors are conditions that increase your chances of getting a
particular disease. The more risk factors you have, the greater your chances of
developing that disease or condition. Diabetic neuropathy, including related
sexual and urologic problems, appears to be more common in people who
have poor blood glucose control
have high levels of blood cholesterol
have high blood pressure
are over the age of 40
What can I do to prevent diabetes-related sexual and urologic problems?
You can lower your risk of sexual and urologic problems by keeping your blood
glucose, blood pressure, and cholesterol close to the target numbers your doctor
recommends. Being physically active and maintaining a healthy weight can also
help prevent the long-term complications of diabetes. Smoking is a particular
problem, and quitting will improve your health in many ways. For example, if you
quit smoking, you can lower your risk not only for nerve damage but also for
heart attack, stroke, and kidney disease.