Sex and Diabetes
Tips for navigating sex, intimacy, and relationships with diabetes
Sex can be wonderful. But with diabetes, you may have a few extra distractions in bed with you: challenges with stimulation, twisted pump tubing, the beeps and burps of a continuous glucose monitor (CGM), or a stash of glucose tablets that pop up in the heat of the moment.
While these things can add stress to your sex life, open communication and a playful approach can take the anxiety out and let intimacy in, says Donna Rice, MBA, BSN, RN, CDE, a diabetes educator and coauthor of Sex and Diabetes: For Him and Her. With that in mind, we asked people living with diabetes for their stories, insights, and advice on relationships and intimacy.
So, let’s talk about sex, shall we?
When taking a relationship to the next level of intimacy, communication is key. For people with diabetes, the question is often, “When should I tell my date that I have diabetes?”
Not everyone has the same philosophy, says Susan Guzman, PhD, director of clinical educational services and cofounder of the Behavioral Diabetes Institute in San Diego. “Some people are very protective of their diabetes management, and other people are very open,” she says. “I always encourage openness, but it really depends on the situation and when a person feels safe with their new [partner].”
Sometimes these things work themselves out on their own. Just ask Katie Truitt, 32, who didn’t have to think too hard about when to tell her date (and now husband) about her type 1 diabetes. Her pump made the decision for her.
“We went on a first date dancing at a club, and I had a tubed pump that I kept in my bra,” she says. “While dancing, it fell out of my bra and was swinging under my dress on the dance floor. That was before I had even told him that I have diabetes, and I was super embarrassed. But afterward, we had a conversation, and I said, ‘I have diabetes. This is the deal.’ And he was really cool, really supportive. It was just a positive reaction.”
LizMari Collazo, 40, didn’t want to waste her time with an unsupportive love interest. That’s why she told her long-distance partner of six months about her type 2 diabetes right away.
“Always present your cards up front, and if somebody doesn’t like it, they can move along,” Collazo says. “Mostly people are just curious, and if you explain to them how you take care of yourself, [they’re] comfortable with that.”
Talking about diabetes can even make couples stronger. Christina Rodriguez, 32, found that discussing her type 1 management helped her fiancé, Jose Angel Estrada, 39, manage his type 2 diabetes. Rodriguez encouraged Estrada to eat a healthier diet, which helped him lower his A1C.
“His doctor is thrilled that I’ve been able to get him to eat healthier and manage his diabetes better. And now that we’re both taking care of ourselves, it does bring us closer together,” says Rodriguez.
Let's Get Physical
You may find that your body is saying, “Let’s go!” but your brain is saying, “Can I perform? Should I disconnect my pump? What if I go low in the middle of sex?”
People with diabetes are constantly having to problem-solve and make judgments, says Nicole Bereolos, PhD, MPH, CDE, a clinical psychologist and certified diabetes educator working in private practice in north Texas. “I think [sex] is an opportunity to go with the flow,” she says. That’s not to say that there won’t be some interruptions if, for instance, you pause to disconnect your pump. “It’s really not much different than when people are in the moment and they have to stop to put on a condom,” says Collazo.
With a little planning ahead, sex can still be spontaneous and fun, says Reva Berman, 29, who has type 1 and is in a new relationship.
“To me, there’s not much of a difference in terms of my diabetes between a spontaneous bike ride or sex,” she says. “In either situation, you need to be prepared for high or low blood sugars and everything in between.”
Phyllisa Deroze, 36, who has type 2, likes to check her glucose in private before intimate moments with her husband of 10 years so as not to kill the mood.
“It’s not really romantic to kiss your husband and then say, ‘Wait, honey, I have to check my blood sugar now.’ But, these things are important, so I try to check my blood sugar in the bathroom,” Deroze says. “You’re about to have this wonderful moment with your man, and you don’t want to see your meter is right there.”
Let’s face it: If you take insulin or a sulfonylurea, you may go low once in a while during close encounters. Hypoglycemia can make it difficult for you to concentrate on the task at hand and can cause problems with erection, says Guzman. “Any time you plan for hypoglycemia ahead of time, such as [leaving] glucose tablets on the nightstand, it’s less disruptive,” she says. And be sure your partner knows how to recognize and treat lows—in bed and out.
Regardless of preparation, lows can take you out of the moment, says Brian Cohen, 57, who has type 2 and takes insulin.
“I can end up, right in the middle of things, having my blood sugar drop, and it’s a buzzkill,” Cohen says. “When you have a hypo, you can have lots of ill feelings and just lose the whole mood. Then having to get up and treat a hypo just interrupts things.”
Lows aren’t all bad, says Berman. It can also lead to a different kind of physical intimacy:
“I’ve come to appreciate and enjoy the cuddling that usually happens while I wait for my blood sugar to rise, so even challenges can have a positive aspect, too,” Berman says.
Insulin pumps are great for diabetes management but can be not so great for self-esteem when it comes to getting naked. Insecurities may pop up, and tubed pumps may hinder your ability to let loose. For that reason, some people may choose to disconnect from their pump during sex. “I always say to be careful and know what your blood sugar is before and after,” Rice says. There is no hard and fast rule when it comes to how long you can safely disconnect, but it’s a good idea to discuss this and when to check for ketones (a concern when there’s a lack of insulin) with your health care provider.
Stephen Saul, 55, who has had type 1 for 26 years and been married for 23, says he disconnects from his pump and doesn’t let that process get in the way of his excitement.
“As far as having the robot parts, the pump and the CGM, I don’t concern myself so much with how it makes me feel emotionally or how it makes me feel in the moment,” he says. “If there is [sexual] interest, that’s what I care about, and I will work around the rest of it.”
Maddie Maloney, a single 20-year-old student at Seattle University with type 1 diabetes, focuses less on how her devices make her look and more on educating about diabetes.
“If you’re not super comfortable with your devices, that definitely is an inhibiting factor when getting into a relationship,” she says. “I know people who say, ‘I don’t want [him or her] to see my scar tissue from my pump sites or the fat deposits from where I insert insulin.’ I have bruising all over my thighs from injections. But I use my devices and my scar tissue as an advocacy tool now, even in intimate relationships.”
Sometimes Kelly Kunik, who’s in her 40s and has type 1, takes her pump off, and sometimes she keeps it on. But, Kunik says, she has to be careful in both scenarios:
“The only problem, if I take it off, is if [I forget about it on the] bureau on the other side of the room and fall asleep. The pump alarm goes off, and I’m like, ‘Oh darn it! I forgot to reconnect!’ ” says Kunik. “Sometimes you don’t have time to take it off. You’re just really careful with the tubing, because that can rip out.”
Your CGM can get in the way, too, says Kelly Gibbs-Kent, 33, who is hyper-aware of her sensor being bumped.
“I keep my CGM on my upper hip area, and I’ve found that it can sometimes interfere [with sex],” she says. “If you hit it, it can be less accurate. I have to be careful not to hit it weirdly, because then I have to change it. That actually happened recently where my husband hit it with his hand, and I freaked out!”
Due to complications from type 1 diabetes, Rick Phillips, 59, has a penile implant, a surgically implanted rod that helps him get an erection. This, he says, can interrupt spontaneity more so than his pump or CGM. You adjust the implant before sex to create an erection. But after more than 40 years of marriage, sex has become more carefree, says his wife, Sheryl, 60.
“You have to allow yourself to be a little more playful and lighthearted in life in general,” Sheryl says. “And Rick and I have the luxury of both being retired, and I would have to say that since I don’t have work responsibilities and our children are grown and gone from home, I can come to a place where I am intentional about being lighthearted.”
Hers is a healthy attitude, says Rice, as couples sometimes have trouble pivoting when a new device or medication changes their sexual routine. Her advice? “Build it into the excitement of foreplay.” For instance, take the lead when it comes to adjusting your partner’s implant before sex, she says. If you’re waiting for a pill, such as Viagra, to kick in, use that time to stimulate your partner in other ways. This can be very sensitizing for people, says Rice.
Creativity is important for those who experience nerve damage related to diabetes, which can affect feeling in the genitals in both sexes, and lubrication in women, says Rice. The good news is there are lots of treatment options, both medical and nonmedical, that can help you to perform and enjoy sex again (see “Back in Action,” below).
The Mental Game
Stress, body image, sexual dysfunction, and diabetes burnout can all affect your desire and ability to have sex to varying degrees. “If you feel bad about your diabetes and it affects your self-esteem or makes you feel less attractive, that can show up in the bedroom,” Guzman says.
One way to ease these feelings is to actually have sex, says Kunik. Sex activates the pleasure center of your brain, releasing the chemical dopamine and boosting your mood, says Bereolos. The degree to which sex can improve mood varies by person and situation.
“I think sex can be empowering if you’re feeling a bit of burnout,” Kunik says. “It makes you feel better and releases endorphins.”
Or, maybe a little soul-searching is in order. That’s how Deroze got to a place of self-confidence:
“It was important for me to get to the point where I could say, ‘I’m still me, even though I have diabetes. I’m still a woman. I’m still lovable. I’m still loving. I’m still sexy,’ ” she says. “So when you’re with your husband, your wife, or your partner, if they’re into you, they’re into you. They’re not concerned about a pump or any of those things.”
If you’re feeling down, talk with your partner, says Guzman. Sharing what you want and need, both sexually and with respect to your diabetes, is very important for a healthy relationship. Don’t shy away from the sex talk either. “Being able to have discussions about sex is always a predictor of a more healthy and happy sex life,” Guzman says.
Want to Expand Your Family?
For a safe pregnancy for mom and baby, women with diabetes need to carefully plan for conception and pregnancy. Blood glucose should be in the target range and eyes, kidneys, and more checked for any complications. That’s why, if you’re sexually active, effective birth control is essential. Learn more about diabetes and pregnancy.
Back in Action
Treatments for sexual dysfunction in men and women
Discussing sexual problems with your health care provider can be intimidating, but it’s important to talk about them, and you should not feel embarrassed to seek treatment, says Donna Rice, MBA, BSN, RN, CDE, a diabetes educator and coauthor of Sex and Diabetes: For Him and Her.
Men and Women: Keep your blood glucose and blood pressure numbers in target range. Both are important for maintaining sexual function.
Men: Quite a few devices and medications are aimed at improving sexual dysfunction in men. It’s just a matter of choosing the right option for you.
- Oral Medications. Drugs such as sildenafil citrate (Viagra) and tadalafil (Cialis) provide help for men struggling with erectile dysfunction, who can’t get and/or maintain an erection. It’s fine for men with diabetes to take these drugs, says Rice, as long as they aren’t taking medications that prohibit their use. These drugs may also help with sensation issues from diabetes-related nerve damage.
- Implants. If you can no longer get or maintain an erection, even with pills, you may need the help of a surgical device to have sex. Your doctor may suggest implanting a rod in your penis, which can be moved into position for sex. Other devices allow you to inflate the implant to produce an erection, and then deflate when not in use.
- Pumps. For those who need a little help maintaining a firm erection, a handheld vacuum constriction device—or penis pump—can be used before sex to draw blood into the shaft of the penis. Check with your insurer to learn whether the device is reimbursable.
- Injection Therapy. These drugs are injected into the penis to dilate the arteries and create an erection within five to 15 minutes, lasting 30 minutes to an hour.
Women: Treatment for women is less straightforward than treatment for men, says Rice. Often emotional issues put a damper on libido, and that can be harder to treat.
- Hormone Replacement Therapy. This can help boost sexual desire in postmenopausal women.
- Oral Medication. Flibanserin (Addyi) is a prescription medication that helps boost desire, a treatment for low sex drive in premenopausal women.
- Lubricants. Often women with diabetes experience vaginal dryness, which can make for painful sex. Over-the-counter lubrication may be all you need to feel pleasure again.
- Relaxation. Simply relieving stress could put you back in the mood, says Rice. Take time with your partner every month or so to get back in the swing of things. Try a relaxing bath or take turns giving each other a massage.
No matter what you’re experiencing, there are treatment options out there, says Rice. You just have to talk to your doctor about sex. And really, you won’t be the first patient to do so.