The Most Overlooked Barrier When Treating Diabetes Patients

By Delica Johnson, RD, CDE

Diabetes has the potential to impact many systems of the body. Healthcare providers consistently assess and educate patients on the importance of annual eye exams, kidney function screenings, and regular foot care. However, sexual health is often overlooked despite the fact that it is an important aspect of a person’s life that can influence relationships, self-esteem, and diabetes self-management.

Sexual Dysfunction (SD) is common among individuals with diabetes. “Sexual dysfunction is the lack of satisfaction with sexual function resulting from pain or a deficiency in sexual desire, arousal, or orgasm/climax” (Huether & McCance, 2017, p. 829). Ozcan et al. (2011) found that almost half of women with diabetes experience SD. Similarly, Yildiz and Bölüktaş (2015) reported that almost half of men, who have had diabetes for greater than 10 years, experience erectile dysfunction (ED), a form of SD.

So, what’s the connection between sexual health and diabetes?

Biologically, diabetes may impact sexual health by altering neuropathic and endocrinological processes and may cause vascular complications that lead to SD (Ozcan, Sahin, Bilgic, & Yilmaz, 2011). The best way to reduce the impact of diabetes on sexual health is by controlling blood glucose levels. Sexual health also involves mental health. The stress of managing a chronic disease, such as diabetes, may cause anxiety or depression, leading to SD. At the same time, SD can strain personal relationships and lead to poor self-esteem, which can, in turn, impact the patient’s ability to effectively self-manage their disease. Together, the combined stress of managing diabetes and SD can become a barrier to overall patient health.

Even if they are experiencing SD, individuals may be reluctant to discuss with their healthcare provider because they are embarrassed or uncomfortable. In order to identify and address SD, it is essential that providers develop good communication and trust with their patients. If they are not currently doing so, providers need to incorporate routine sexual health assessments for diabetic patients. Limited time may be a barrier to evaluating the vast impact diabetes may have on various systems of the body. Utilizing other members of the diabetes care team, such as certified diabetes educators (CDEs), is one way to provide a more comprehensive diabetes treatment plan without adding extra time to the provider’s visit. Once identifying SD, the provider (or CDE) can work with the patient to develop an appropriate treatment plan.

In summary, SD is common among people with diabetes. Communication is key! It is essential that providers assess patient sexual health in order to identify SD and set the patient up for success. Fortunately, good blood glucose control may reduce the likelihood that diabetes will impair sexual health. Additionally, there are many effective treatment options for those who experience SD.

Take a look at this tip sheet from the American Association of Diabetes Educators (AADE) and includes a section with specific questions for patients to discuss with their provider concerning sexual health.

Sources:

Ozcan, S., Sahin, N., Bilgic, D., & Yilmaz, S. (2011). Is sexual dysfunction associated with diabetes control and related factors in women with diabetes?. Sexuality & Disability, 29(3), 251–261. doi:10.1007/s11195–011–9209–5

Raper, M. (2013). Sexual dysfunction: Reflections on a neglected area of diabetes care. Practice Nursing, 24(10), 505–509

Yıldız, H., & Bölüktaş, R. (2015). Evaluation of sexual dysfunction in males with diabetes. Sexuality & Disability, 33(2), 187–205. doi:10.1007/s11195–015–9397–5