Diabetes - Sexual and Reproductive Health

Diabetes mellitus is classified among the most notorious and prevalent metabolic conditions that are known to affect individuals of all age groups. It is marked by persistently raised blood glucose concentration due to aberrations in the metabolism and tissue uptake of dietary sugars. Based on the pathophysiology and management; diabetes can be classified into two major clinical varieties; type I or insulin-dependent diabetes which is more common in younger individuals and diabetes type II (also known as non-insulin dependent diabetes); which is more common in middle-aged, obese females.

Due to metabolic derangements, long standing diabetes can significantly affect the functioning of all major systems; but most deleterious effects are reported on the sexual and reproductive health. According to latest statistics reported by Centers for Disease Control and Prevention (1), 29.1 million people in the United States are currently living with Diabetes mellitus. This corresponds to 9.1% of the entire US population.

Reproductive and Sexual health in Diabetes

The sexual and reproductive health of diabetic individuals is largely compromised in the setting of long standing and poorly managed diabetes mellitus. The pathophysiology revolves around the damage caused to the nerves as a result of microvascular inflammation and neuropathy (nerve damage and swelling).

Sexual and Reproductive Dysfunction in Females

It is very important to identify and diagnose the cause and pathogenesis of abnormal blood glucose concentration in females; in order to address the primary issue. For example, high blood glucose levels due to diabetes should be differentiated from PCOS. Polycystic ovary is an endocrine disorder which affects functioning of multiple systems including insulin sensitivity, reproductive system, hormonal balance etc. Due to insulin insensitivity, PCO can result in constant high sugar levels in the blood. Metformin and/or thiazolidinedione are considered as the drug of choice for controlling blood sugar levels in PCOS women.

The primary complaints in females are:

• Libido issues: Low sex drive or poor libido is a very common complaint that is mainly attributed to the poor lubrication in the vagina. Women also reports delayed orgasms. The symptoms are more common in type 2 diabetics as compared to type 1.

• Menstrual problems: Women with diabetes also experiences menstrual issues. Based on clinical data, females who are diagnosed with diabetes before entering menarche phase, are at a much greater risk of experiencing missed periods and irregular menstrual flow. It is also observed that women with diabetes achieve menopause earlier than non-diabetic women. It is therefore advised to diabetics to regularly monitor their blood glucose levels to maintain optimal sexual and reproductive health.
• Urinary problems: Women with diabetes encounters more issues with urinary system as compared to non-diabetic females. The most commonly observed issues are urinary incontinence, compromised urinary flow and increased frequency of urination. It is estimated that the frequency of urination is 50-percent higher in diabetics. Needless to say that urinary infections and complaints translates into sexual discomfort; and thus should be thoroughly investigated.
• Infections: Fungal infections such as candidiasis are more common in diabetic females. This is mainly because, high sugar levels promotes the growth of fungus and bacteria in the genital tract, thus increasing the incidence of vaginal thrush. In long standing cases, the infection can compromise the sexual and reproductive health.
• Diabetes and pre-conception counselling: Based on latest statistics, poorly managed diabetes aggravates the risk of congenital defects and malformations in the babies. The pregnancy is usually complicated in the setting of chronic diabetes due to high risk of miscarriage and early neonatal death.  Thus diabetic females require intensive pre-conception and pregnancy care to reduce the risk of developmental malformation in the baby. HbA_1c levels are recommended to have a better idea of blood glucose management. In addition, Blood sugar levels should be ideally managed under strict limits via drugs and diet modification.

Sexual and Reproductive Dysfunction in Males

• Erectile dysfunction: Neuropathy and damage to blood vessels that supply male reproductive system can result in erectile dysfunction. According to latest statistics, some degree of erectile dysfunction is reported in 35 to 75% diabetic males (3). The nerve damage also affects the libido, sexual desires and quality of sex life.
• Inflammation of Penile head: Also known as balanitis; inflammation of penile head is fairly common in the setting of chronic diabetes. In addition, diabetic males also develop urinary tract infection and related urinary complaints.
• Retrograde Ejaculation and Infertility: Issues like retrograde ejaculation are common in diabetic males and can affect the fertility. Impaired blood glucose concentration also promotes the production of reactive oxygen species (free radicals) that may exert toxic effects on the sperms (4).
• Androgen deficiency: Poor insulin and glucose metabolism eventually affects the biochemical environment of the body; thereby aggravating the risk of other endocrinopathies as well. Testosterone deficiency is very common in diabetic males.

Hence diabetes can directly affect the functioning of reproductive and sexual health in affected individuals. It is highly recommended to seek advice from your physician regarding optimal blood sugar management in addition to sexual counseling and reproductive counseling for an uneventful pregnancy and healthy sex life.

References:

1. Fedder, J., Kaspersen, M. D., Brandslund, I., & Højgaard, A. (2013). Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus: a prospective, controlled study. Andrology, 1(4), 602-606.

2. JOHANNES, C. B., ARAUJO, A. B., FELDMAN, H. A., DERBY, C. A., KLEINMAN, K. P., & McKINLAY, J. O. H. N. (2000). Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. The Journal of urology, 163(2), 460-463.

3. Ramalho-Santos, J., Amaral, S., & Oliveira, P. J. (2008). Diabetes and the impairment of reproductive function: possible role of mitochondria and reactive oxygen species. Current diabetes reviews, 4(1), 46-54.