Dear Dr Ren,
I’m a gay man in my early 40s. I have a job I like and am five years into a solid relationship. Life was looking good.
I went to my doctor because I was feeling “off.” He diagnosed me with diabetes. Previously I didn’t exercise with anything other than a computer mouse or a remote control. Now I’m learning to eat better and I’m being active on the weekends.
Still, I’m depressed about this turn of events and it’s affecting my sex life. Sometimes I feel too tired or I can’t come. Sometimes I think my erections aren’t as hard as they used to be. I don’t know if it’s the disease or knowing about the disease.
I didn’t get much info from the doctor about sexual side effects. There was a lot to learn in a short time and, to be fair, even though he didn’t bring it up, I didn’t ask.
What can I expect? Is this the beginning of the end of my sex life?
Sick and Unsexy
Dear Sick and Unsexy,
From the tone of your letter, and certainly from your signature, I presume you have been fairly recently diagnosed. It sounds like you are still mourning the loss of your carefree, healthy days. You are entitled. Any chronic illness demands a change in priorities and lifestyle and the facing of our vulnerability.
You are correct that successfully managing your disease requires learning all you can about how diabetes will and will not affect you. Of course it will upset your sexual equilibrium. Sexual changes are some of the many adjustments you will learn to make.
Expect this stressor to test the mettle of your relationship’s communication skills. Your roles may shift. You will grow together or apart during this transition depending on your willingness to adapt and trust. Get some support in place. Remember, transitions can be exciting!
Diabetes can affect your sex life in some subtle ways. For instance, many diabetics develop gingivitis (gum disease) which can lead to chronic bad breath. See your dentist regularly and boost your dental hygiene. Conversely, when your blood sugar is high, your breath may have a sweet, fruity smell. Ask your partner for feedback, but not as part of foreplay.
Sometimes incontinence becomes a problem due to bladder infections or nerve damage. Yes, even men are prone to yeast infections when diabetes is present.
You complain that you are more tired. Expect that. Rest accordingly and lower your expectations about your stamina. Negotiate with your lover how (not if) sex will change, especially as you learn how your illness affects you. Be mindful to keep sex a priority when you are feeling energetic, so that in six months you are not mourning its loss as well!
Diabetes affects nerves and blood vessels, the ‘managers’ of erections. When damage occurs to the nerves or blood vessels, the flow of blood to the penis decreases, diminishing erections. You may notice changes in your woodies, some temporary and some permanent, depending on the progression of the disease.
It is important that you be scrupulous in maintaining proper blood sugar levels and not become anxious about a few floaters. Some professionals estimate that diabetes-related erectile dysfunction affects about 40 percent of patients. That number increases in those who become anxious about erections.
Regardless of erection difficulties, expect and accept sexual changes. Surrender is inevitable. Your body has changed and the quicker you learn to accommodate the changes, the quicker you can get on to great sex again.
But change there will be. Add to the effects of diabetes itself its medications, as well as those taken for any other conditions, and you have a recipe for sexual side effects. Drinking, smoking and drugging can also cause problems.
It can be frustrating — and offset to some degree by taking care of yourself. And staying aware, which brings us to a less discussed diabetes-related sexual problem: difficulty with the focus necessary to reach orgasm, as happens with disrupted blood sugar levels.
Don’t mistake distraction for lack of desire (you’ll notice it with solo sex, too). Recognizing the symptoms and having a snack nearby may correct this troubling issue, along with humour and communication, vital when getting back to an interrupted orgasm!
From now on, you’ll have to consider your body when contemplating sex. Test your blood sugar beforehand and eat appropriately, as you do for any other exercise. A diabetes support group can help you learn to control the physiological aspects of your illness. Talking honestly with your partner about your hopes and fears surrounding the imminent and unavoidable changes ahead for you two, sexual and interpersonal, is likely your best protection against letting this new stressor degrade the stability of your relationship.
This is not a tragedy. You have been diagnosed with a manageable, treatable illness over which you have at least some control. Take this opportunity to deepen and expand your capacity for self-determination, communication, flexibility, and long-term commitment. Learn self-soothing and self-care. Help your lover help you adjust to whatever changes this surprise brings. Make lemonade.