You’ve probably heard that having diabetes can impact sex. After all, high blood glucose affects your whole body, even your most private parts. “For a lot of people, their sexual life is important,” says Evan Sisson, PharmD, CDE, an associate professor at the school of pharmacy at Virginia Commonwealth University in Richmond, adding that checkups should leave time for an open conversation about a patient’s sexual life and concerns.

Why Aren’t My Erections Like They Used to Be?

For years, it has been well known that erectile dysfunction (ED) is more common in men who have diabetes. A study published in July 2017 in the journal Diabetic Medicine offers clues on the prevalence of this issue: Men with diabetes are 3.5 times more likely to have ED than men without diabetes.

High blood glucose damages nerves, meaning the “let’s have sex” signal doesn’t make it to the penis. It also narrows the penis’s blood vessels so you don’t get enough blood to the penis for an erection.

You can’t reverse damage to nerves and blood vessels in your penis, but you can prevent further damage by lowering your A1C, says urologist Ajay Nangia, bacholor of medicine and bachelor of surgery, a professor of urology at the University of Kansas Medical Center in Kansas City.

Treatments for ED include pills, such as Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). Dr. Sisson says these pills can be highly effective, especially if you can still sometimes get an erection. People who take nitrates for chest pain should not take ED medication, as it may cause dangerously low blood pressure, he adds. Dr. Nangia says that other treatment options include injection therapy, a vacuum erectile device, or a penile implant or prosthesis.

Why Can’t I Ejaculate?

Nangia says that he sees young men, mostly with type 1 diabetes, with ejaculatory dysfunction. High blood glucose over time damages nerves so semen discharges back inside the bladder rather than out the penis. You may still experience orgasm, but a lack of ejaculation can cause infertility. Treatment includes medication, such as pseudoephedrine (Sudafed), and infertility procedures that can be used to collect semen for artificial insemination.

Why Don’t I Feel Like Having Sex Anymore?

“Libido is multifactorial,” says Nangia. Besides the physical issues of, say, ED or ejaculatory dysfunction, he says libido is tied to depression, marital status, hormones, emotions, gender, and sexuality.

Sisson also points to the complexity of sexual desire, including your partner’s interest in sex. When a man complains about trouble having sex, Sisson says he always asks: “Well, do you want to? And does your spouse want to?” Your partner’s interest in sex can’t be discounted, says Sisson. “If you’re having marital strife, you’re having a fight, that’s not conducive to a healthy sexual relationship,” he adds. Talking about relationship problems with your spouse or a family counselor could help.

Does Low Testosterone Matter?

Low sexual libido can be sign of low testosterone in men, which is more common in men with diabetes than men without, according to a study published in April 2007 in the journal Diabetes Care. Sisson says your healthcare provider can test you for low testosterone, and it can be treated with testosterone replacement medication, such as patches.

Nangia says that low testosterone is also linked to metabolic syndrome — a cluster of risk factors, such as high blood pressure and excess fat around your waistline, that increase your risk for heart disease — diabetes, and other health problems. You can treat metabolic syndrome by getting these risk factors under control. Exercise, lose weight, eat healthy foods, and quit smoking if you smoke.

Did I Eat, Drink, or Smoke Something to Ruin the Moment?

“Some people may not recognize the things they’re doing inadvertently that decrease their capacity to achieve an erection,” says Sisson. Smoking, drinking excessive amounts of alcohol, or using illicit drugs, such as marijuana, can impact erections. For example, eating a large meal full of saturated fat, drinking a bottle of wine, and smoking a cigar before sex doesn’t help, says Sisson. You can help improve your chance of achieving an erection by making healthy choices.

Why Do I Have to Pee So Often?

“Diabetes and urinary dysfunction is another common connection,” says Nangia, because high blood glucose damages nerves in the bladder. This can lead to frequent urination, as the bladder doesn’t fully empty each time. Separately, high blood glucose in urine can make people with diabetes urinate more often.

Although this sense of urgency probably doesn’t affect men in the heat of the moment, some men may “spill” a little urine when they ejaculate, says Nangia. He says frequent urination during the night also affects sleep, and therefore libido. Research suggests that men with ED often experience bladder problems, such as frequent urination. Cialis is approved by the Food and Drug Administration (FDA) to treat both ED and benign prostatic hyperplasia (BPH), in which an enlarged prostrate presses on the bladder.

Both Sisson and Nangia point to the complexity of sexual issues and the importance in discussing these concerns and possible treatments with your healthcare provider. Sisson says, “Like lots of things with diabetes, it’s not as simple as, ‘Hey, I’m having a problem. Give me a prescription for that little blue pill.’ There’s a lot more that goes into achieving an erection, so it’s important for patients to talk with their diabetes educator and their diabetes healthcare team to say, ‘What do you think is going on and what’s the best way to address this issue?’”

For more advice on sex with diabetes, check out Diabetes Daily's article "Let's Talk About Sex"!