As a urologist who specializes in sexual medicine, I’ve witnessed firsthand how chronic disease can significantly impact sexual function. Two conditions that frequently come up in my concierge urology practice are diabetes and hypertension (high blood pressure). Today, I want to shed some light on how these common health issues affect your sex life and what you can do about it.
The Silent Impact of Diabetes on Sexual Health
Diabetes is a very insidious disease since its effects can be gradual, subtle and minimally symptomatic. However, its impact on sexual function can be profound. Here’s how diabetes can negatively affect your sex life:
1. Erectile Dysfunction (ED)
Erectile dysfunction is perhaps the most well-known sexual complication of diabetes in men. Studies suggest that men with diabetes are 3-4 times more likely to develop ED compared to those without diabetes. The reasons for this include:
- Nerve damage (neuropathy): Diabetes can damage the nerves that innervate the penis and control erections.
- Blood vessel damage: High blood sugar levels can damage the endothelium which is the internal lining of arteries, reducing blood flow to the penis.
- Hormonal imbalances: Diabetes is often associated with low testosterone which can have its own deleterious effects on erectile function and libido.
2. Reduced Libido
Many men with diabetes report a decrease in their sex drive or libido. This can be due to:
- Hormonal changes such as low testosterone or high estrogen levels.
- The psychological impact of managing a chronic condition
- Fatigue, which is common in poorly controlled diabetes
3. Retrograde Ejaculation
This condition, where semen enters the bladder instead of exiting through the penis during ejaculation, can occur due to nerve damage from long-standing diabetes. Retrograde ejaculation can cause bother to men and their sexual partners. It also causes infertility.
4. Increased Risk of Yeast Infections
High blood sugar levels can increase the risk of genital yeast infections particularly in uncircumcised men, which can cause discomfort during sex.
Hypertension: More Than Just a Heart Issue
High blood pressure has been called the silent killer because it quietly damages blood vessels to the heart and brain increasing the risk of heart attack and stroke. Hypertension might seem unrelated to sexual function, but it can have significant effects, especially on erectile function:
1. Erectile Dysfunction
Like diabetes, hypertension can lead to ED by damaging the blood vessels that supply the penis. It can reduce the amount of blood flowing into the penis, making it difficult to achieve or maintain an erection.
Hypertension will damage blood vessels in every organ including the heart and kidneys. The arteries that supply blood to the penis are smaller than the arteries carrying blood to the heart. Therefore, ED can be the first sign of vascular disease in men with high blood pressure.
2. Reduced Libido
The stress of managing hypertension, along with some of its symptoms like fatigue and headaches, can decrease sex drive.
3. Ejaculation Problems
Some men with hypertension report difficulties with ejaculation, including delayed ejaculation or inability to ejaculate.
4. Medication Side Effects
There are several classes of drugs used to treat hypertension. Many of them can cause ED or have a negative effect on testosterone levels.
The Compound Effect
It’s worth noting that diabetes and hypertension often occur together, compounding their effects on sexual function and cardiovascular health. When I see a patient with diabetes, hypertension and ED I assume they have cardiovascular disease until proven otherwise. Cardiac testing is ordered to exclude life threatening heart disease before any ED treatment is implemented.
One of the most dangerous things a man with these medical issues can do is get online and obtain a Viagra or Cialis prescription from some bogus health care “provider” claiming to be an expert on sexual health. That Viagra or Cialis may work well, right up until the patient has a massive widowmaker heart attack because an appropriate cardiac work-up was not done.
What Can You Do?
If you’re dealing with diabetes or hypertension and experiencing sexual problems, don’t lose hope. There are several steps you can take:
- Prioritize Disease Management: Good control of your diabetes or hypertension can significantly improve sexual function and prevent worsening of sexual dysfunction. This means:
- Taking medications as prescribed
- Following a heart healthy diet
- Exercising regularly
- Monitoring your blood sugar or blood pressure as recommended by your doctor
- Close medical supervision and follow-up
- Open Up to Your Healthcare Provider: Many patients feel embarrassed to discuss sexual issues with their physician for a variety of reasons. Be honest about your concerns so we can address them effectively. Some men specifically come to see me only because they felt more comfortable discussing sexual issues with a sexual medicine expert versus their primary care doctor.
- Consider Medication Adjustments: Sometimes, changing the type or dosage of your medications can help alleviate sexual side effects. Never adjust medications on your own; always consult with your doctor. Your doctor will work closely with your urologist to make medication adjustments that may enhance sexual performance.
- Explore Treatment Options: Depending on your specific sexual dysfunction, treatments may include:
- Oral medications for ED
- Testosterone replacement therapy
- Psychological counseling or sex therapy
- Vacuum devices or other mechanical aids
- Penile microinjections or urethral suppositories
- Surgery
- Look at Lifestyle Factors: Quitting smoking, reducing alcohol intake, maintaining a healthy weight, and managing stress can all contribute to better sexual function. More importantly, positive lifestyle modifications can prevent worsening of sexual dysfunction.
- Stay Active: Regular exercise can improve blood flow, boost mood, and enhance overall sexual health.
- Be Patient and Persistent: Addressing sexual issues related to chronic diseases often requires time and may involve some trial and error. Don’t get discouraged if the first approach doesn’t work perfectly.
Sexual medicine is complex and should be viewed as an art based on science. Urology is the ONLY medical subspecialty with expertise in male sexual dysfunction. If you are not seeing a urologist, you are not seeing an expert.
The Importance of a Holistic Approach
As a sexual medicine urologist, I can’t stress enough the importance of viewing sexual health as part of overall cardiovascular health. Chronic conditions like diabetes and hypertension don’t just affect one part of your body; they have systemic effects. By the same token, improving your overall health can have positive impacts on your sexual function.
Moreover, sexual health issues can be early warning signs of these serious medical conditions such as cardiovascular disease. Cardiovascular disease is the #1 killer of men, hard stop. It kills ten times as many men as cancer. If you’re experiencing new or worsening sexual problems, it’s essential to have a comprehensive work-up by a urologist who specializes in sexual medicine. One thing we tell our patients at Obsidian Men’s Health is that there is no sex in the graveyard. Our first priority is to make sure your cardiovascular health is intact. Our second priority is ensuring that you reach your sexual performance goals.
Remember, you’re not alone in dealing with these issues. Many men face similar challenges, and there are more treatment options available today than ever before. With proper management of your chronic health conditions, open communication with your urologist, and a willingness to explore various treatment options, many men can regain satisfying sexual function.
Don’t let embarrassment or resignation prevent you from addressing these important health issues. A fulfilling sex life is possible, even with severe chronic conditions. Take the first step by starting a conversation with your healthcare provider today. Request consultation with a urologist who specializes in sexual medicine.
