Q:
My partner and I both have diabetes and high blood pressure. I often don't feel sexually aroused (and certainly cannot climax), and he cannot hold an erection long enough to please me. Is there some type of sexual act or position that we can explore that will please us both?
A:
Conditions like diabetes and high blood pressure are among the most common chronic health conditions that can affect your sexual functioning. Given that you and your partner have both may create an even greater challenge.
One large study of men with type 2 diabetes found their risk of erectile dysfunction (or not being able to have or maintain an erection) was nearly twice that of men without diabetes. The researchers also found that half the men in the study who had both diabetes and high blood pressure had erectile dysfunction (ED). Other studies find that between 40 and 80 percent of people with diabetes and hypertension (men and women) have sexual problems.
There are many reasons for diabetes' effect on erections. Over time, the disease damages nerves as well as blood vessels, both of which are required for an erection. It can also interfere with the production of nitric oxide, which helps blood vessels dilate (including those in the penis) and is required for erections. Another effect may be reduced levels of the hormone testosterone, also required for erection. One study found that a third of men with type 2 diabetes had low testosterone levels, which the researchers call "a new complication of diabetes."
We understand much less about the mechanisms behind sexual dysfunction in women with diabetes, although we know it exists. One study found sexual dysfunction in 71 percent of married women with type 1 diabetes and 42 percent of women with type 2 diabetes compared to 37 percent of women without diabetes. The disease may have some physical effect on women, such as decreased vaginal lubrication and a predisposition for vaginal infections, which can result in pain during or after intercourse, also called dyspareunia. One large study of women with type 1 diabetes found the women's sexual dysfunction was also closely related to a variety of emotional and lifestyle issues. These included satisfaction with their marriage, understanding of their diabetes, emotional adjustment to their diabetes, the impact of their diabetes treatment on their daily life, and satisfaction with their diabetes treatment.
As for the effects of high blood pressure on sexuality, one culprit may be the medication you're taking. Diuretics and beta blockers, both commonly prescribed for high blood pressure, can also cause sexual problems. We also know that the effects of high blood pressure on blood vessels, such as stiffness and narrowing, can interfere with the ability of the vessels in the penis to fill with blood and remain full. Again, we have less information on the effects of hypertension on women's sexual function.
The good news is that there are treatment options. The first thing your partner may want to consider is a medication for ED. Studies find the three available medications—Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil)—are safe for most men with diabetes and hypertension. An added bonus: If your husband's ED problem improves, you may find your own sexual satisfaction improves. The use of a glycerin-free lubricant may alleviate some of the vaginal dryness and resulting dyspareunia.
The first step, as with most health conditions, is a comprehensive medical evaluation. Your partner should probably see a urologist in addition to his regular health care professional; you may want to talk to a gynecologist or a pelvic and sexual health specialist in addition to your regular health care professional.
In addition to medical approaches, you may want to explore sexual therapy. A trained sex therapist can work with you both to help you discover ways to improve your sexual relationship. To find a qualified therapist in your geographic area, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT) at www.aasect.org and click on your state.
