Sexual Health: An Overlooked Part of Diabetes Care

Erectile dysfunction, vaginal dryness, painful sex, and ejaculatory disorders can all affect people with diabetes. The condition may also take a greater toll on intimacy than other chronic illnesses. In a 2024 study, Charlotte Leemans, a sexologist and psychologist in the urology department at the Notre-Dame de Grâce Clinic, Gosselies, and a doctoral student at UCLouvain, Ottignies-Louvain-la-Neuve, both in Belgium, found that among chronic conditions unrelated to genital health, diabetes had the greatest impact on sexuality. “When we compare diabetes with other chronic diseases, such as kidney failure, heart failure, or chronic pain, it really is the one that has the greatest impact on sexuality,” she said.When Sexual Complaints Point to DiabetesIntimate difficulties can even occasionally be a symptom of an undiagnosed blood sugar disorder. “Among patients who seek care for sexual complaints, it is not uncommon for a blood test to reveal undiagnosed diabetes or prediabetes that is developing. Once blood sugar levels return to normal, the patient’s symptoms often disappear, though this isn’t always enough. In terms of prevention, this is worth taking into account,” added Leemans.Don’t Wait for the Patient to Bring It UpYet conversations about diabetes and sexual health are often missing from clinical visits. “Healthcare professionals generally wait for patients to raise the subject. But if their clinician doesn’t bring it up, many patients may not realize diabetes can affect their sex life and may instead attribute problems to age, relationship difficulties, or stress. The healthcare professional should take the first step,” the sexologist said.What Are the Barriers on the Part of Healthcare Providers?Various studies, however, identify obstacles that can hinder this necessary dialogue about sexuality. “Sexuality is rarely the main reason for a consultation. It often comes up as a secondary, or even tertiary, issue,” emphasized Leemans. Other barriers include a lack of time during consultations, fear of offending the patient, personal embarrassment, the feeling that sexuality is a private matter, and misconceptions related to age or family situation, such as in the case of single people and residents in nursing homes.“Among healthcare providers who wish to address this complaint, many don’t know what to do next or where to refer the patient,” added the sexologist. On this point, Leemans pointed out the existence of the Flemish Association for Sexology and the Society of University Sexologists of Belgium; Leemans is the president of SSUB. “These two associations guarantee patients access to a qualified professional and reimbursement by most health insurance providers. All you need to do is enter your ZIP code on their website to quickly find a trained sexologist.” Leemans is currently conducting a study on sexual health care for patients with diabetes, to which any healthcare provider can contribute via a Google Form.Four Ways to Start the ConversationA single question is often enough to open a conversation about sexuality. “But it must be asked appropriately, and there must be enough time to listen to the answer,” said Leemans. She also recommends a kind, nonjudgmental approach; language that is accessible to the patient and comfortable for the healthcare professional; and a reassuring environment. “It can also be helpful to suggest not writing anything in the patient’s file.”Drawing on a study by Nathalie Michaud, MD, the sexologist suggests four approaches healthcare professionals can use to start a conversation, depending on the patient or on which approach the professional feels most comfortable with. The first focuses on how common the problem is: “Some diabetic patients experience sexual difficulties. Do you have any questions about this?” The second frames the topic as part of routine medical follow-up, like eye or kidney checkups. The third approach acknowledges up front that sexuality is an intimate subject, then asks whether the patient wants to discuss it. The last approach, which is more gradual, starts with a simple question: “How is your relationship?”“Even if the patient doesn’t answer right away, the healthcare professional has planted a seed: The patient knows their doctor is ready to talk about it,” Leemans said.Sex and Treatment AdherenceSexual health can also be an ally for healthcare providers in managing diabetes, explained Leemans in conclusion. When a patient values their sex life and understands that balanced blood sugar levels can improve it, they adopt healthier behaviors and adhere more closely to their treatment. It’s not a motivator for everyone, but for those who are receptive to it, it’s a real incentive.This story was translated from MediQuality, part of the Medscape Professional Network.