Endocrine Disorders and Sexuality III: Diabetes and Sexual Disorders

The classic chronic complications of poorly controlled or long-standing diabetes, such as retinopathy, nephropathy, or cardiovascular complications, are well known. However, sexual dysfunction is a much less studied complication associated with diabetes. It can affect both men and women, and its prevalence is not negligible: it is thought that up to one-third of patients with diabetes may have problems in the sexual sphere. Erectile dysfunction is the most common dysfunction in men, and metabolical, vascular, and neurological causes are involved. Several treatments can be offered to patients: phosphodiesterase type 5 inhibitors, intracavernous injection of drugs, vacuum systems, surgical treatments, etc. Men with diabetes may also have other sexual disorders such as retrograde ejaculation or low sexual desire. On the other hand, female sexual dysfunction is characterized by low sex desire, vaginal lubrication disorders, anorgasmia, and dyspareunia. Moreover, sexual dysfunction (especially erectile dysfunction in men and vaginal lubrication disorders in women) can represent an early marker of cardiovascular disease in people with diabetes, as they may indicate presence of angiopathy. This highlights the importance of early diagnosis of sexual complications in people with diabetes. Although biological, psychological, and social factors are involved in the expression of sexuality in both sexes, the literature has mainly focused on the biological aspects in men, and the psychological and social ones in women. In fact, sexual dysfunction in women with diabetes has been poorly studied. Thus, sexual health must be included as part of diabetes follow-up in our clinical practice, regardless of gender.