Overview
Sexuality not only implies sexual activity but includes the full spectrum of sexual activity which is dependent upon the medical, psychological and
sociocultural aspects of an individual. Two areas of great interest with respect to women with diabetes are contraceptive choices and whether women with diabetes have differences in their sexuality because of their diabetes.
Contraception
There is no single contraceptive which is ideal for all women with diabetes. Each method has some disadvantages and some advantages.
- Oral contraceptives - Combination estrogen/progestin pills are best avoided in women who are more than 35 years of age or who are smokers. Also, if you have uncontrolled hypertension you should speak to your physician before using this form of birth control. Oral contraceptives with less than 35mg of estrogen and a low progestin dose are recommended.
- IUD's (Intrauterine Devices) - Hormonal IUD’s (Mirena) consist of a progestin (levonorgestrel) - Recent information suggests that there is no greater risk of uterine infections in women with diabetes. Women with multiple sexual partners or with a history of uterine infections should avoid this form of contraception.
- Barrier methods - Diaphragms with spermicidal jelly or condoms with spermicidal foam have no medical problems associated with diabetes but are less efficacious.
- Tubal ligation - This is a reasonable but permanent option for women who have completed their child-rearing. There are no complications with respect to sugar or cholesterol metabolism.
Fertility
Poor blood sugar control is associated with higher miscarriage rates during the first three months of pregnancy. Also, some women with type 2 diabetes may be overweight and have polycystic ovary syndrome which is associated with more difficulty conceiving.
Sexual dysfunction
In 1974, the World Health Organization reiterated the importance of human sexuality to the health and well-being of the individual. They further emphasized the need for basic information about the biological and psychological aspects of sexual health if preventive and curative health services are to meet
sexual concerns and needs.
Sexual function in America
Sexual dysfunction may be due to disturbances in sexual desire and/or in the psychophysiological changes associated with the sexual response cycle in men and women. Based on the few available community studies, it appears that sexual dysfunctions are highly prevalent in both sexes, ranging from 10% to 52% of men and 25% to 63% of women. Data from the Massachusetts Male Aging Study 7 (MMAS) showed that 34.8% of men aged 40 to 70 years had moderate to complete erectile dysfunction, which was strongly related to age, health status, and emotional function. We know far less about the epidemiology of female sexual dysfunction. Changing cultural attitudes and demographic shifts in the population have brought to the forefront sexual concerns in all ethnicities and age groups. In the February, 1999 Journal of the American Medical Association, a representative sample of 1749 women and 1410 men aged 18 to 59 years were surveyed. The survey found sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. For women, there was an unaffected group (58% prevalence), a low sexual desire category (22% prevalence), a category for arousal problems (14% prevalence), and a group with sexual pain (7% prevalence).