Diabetes and its relationship with sexual dysfunction

The teacher of Department of Obstetrics and Gynecology of the Faculty of Medicine of the University of Granada (UG) Loreto Mendoza has warned that diabetes causes sexual dysfunctions in up to 50 percent of patients in the first 10 years after diagnosis, a percentage that increases as the disease progresses.

This was stated during the informative day held this Tuesday in Córdoba by the Foundation of the Spanish Diabetes Society (FSED) and the Spanish Diabetes Federation (FEDE), on the occasion of the World Diabetes Day, which is commemorated this Friday the 14th. The meeting between experts, patients and families has made it possible to put on the table some of the main areas in which diabetes impacts, but which are not usually addressed in consultation.

Among them, the sexual repercussions, which tend to be taboo among those affected. “They do not usually raise these problems in the consultation because they are embarrassed or because they do not give them the importance they deserve,” said Mendoza, who pointed out that erectile dysfunction In these people it mainly affects the excitement phase and occurs in both women and men.

Even so, she has admitted that there are some differences, since “many women give the purely physical issues of sexuality less weight than men” and, on the other hand, their self-esteem and personal image are more affected, which can favor the appearance of feelings of insecurity and, with it, behaviors of avoidance of sexual activity due to fear of intimate contact.

Furthermore, the professor has commented on the evidence about the Erectile dysfunction as an early marker in undiagnosed diabetes, especially among middle-aged men, as well as the certainty that erectile dysfunction is a marker of asymptomatic atherosclerosis in people with type 2 diabetes. At this point, the convenience of including the assessment of erectile dysfunction in cardiovascular disease risk stratification protocols has been highlighted.

Diabetes-induced sexual dysfunction has a multifactorial etiology, including metabolic, neurological, vascular, hormonal and psychological components, which must be taken into account for its correct treatment. In this sense, an adequate intervention requires that the patient comply with the prescribed diet, regularly take specific drugs for the disease and exercise regularly.

Mendoza added that treatment must correct other factors that can aggravate this dysfunction; among the most frequent, depression, high blood pressure, dyslipidemia, smoking, sedentary lifestyle, alcoholism and some drugs. Conversely, if sexual dysfunctions are adequately addressed, you will be better able to treat diabetes.

Emotional approach

Another of the topics discussed at the conference was the need to include in the clinical management of diabetes the emotional aspect, to which professionals do not usually pay attention due to the little time they have in consultation with patients. This, according to experts, prevents a global assessment of the patient and knowledge of some factors that may be influencing their clinical results.

In diabetes, for some years now, time in range (TIR) ​​has been a basic concept to understand glycemic management. The longer the time in the blood glucose range, the better for the person and the prevention of long-term complications. Starting from this fact, the psychologist Francisco Javier Hurtado has stressed that “assessing only the glycemic IRR is not enough to know if a person has quality of life on a daily basis.” For this reason, it has been suggested that in addition to monitoring the glycemic IRR, the “Emotional IRR” should also be monitored.

Among the possible emotional implications of diabetes, the psychologist has detailed that it increases the possibility of present depression, anxiety, sleep problems, distress or eating disorders. Disorders that are favored by the daily demands, constant attention, worry and/or fatigue that comes with living with a chronic condition.

For the university expert in Diabetes Education, the solution to face these problems is for the psychologist to be part of the multidisciplinary team that cares for people and families with diabetes. Given the difficulty of achieving this goal in the short term, he has proposed that doctors begin to include the psychological part in their clinical contacts with patients and their environment. “We should not focus only on clinical results, considering always including the psychological and emotional section of diabetes in educational programs,” he indicated.

Managing diabetes in the work environment

The International Diabetes Federation (IDF, for its acronym in English), on the occasion of this World Diabetes Day, has highlighted that “millions of people with diabetes face daily challenges such as stigma, discrimination and exclusion, to manage their disease in the workplace. This has a negative impact on their well-being.”

As stated in this forum by the lawyer Javier Sanhonorato Vázquez, specialist in Health Law (Madrid) and who has lived with diabetes since childhood, the work environment continues to pose obstacles in many cases for people with diabetes.

“In the 21st century, many workers with diabetes hide this condition instead of taking advantage of the facilities that the concept of occupational health offers to adapt treatment to the work day,” said Sanhonorato. At the same time, as he added, “a misreading of this concept can limit access to certain positions, shifts or even be the cause of dismissal or non-hiring.”

One of the factors that aggravate patient discrimination is the lack of regulations that meet all existing needs. “There is no Law on chronic diseases, there is no Law that responds to our needs as people with diabetes and that advocates our equality with the rights contained in the Constitution and that proposes actions based on justice and equity,” explained the lawyer.

Finally, it has demanded that the Public Powers, patient associations and medical societies act to meet these needspromote therapeutic education in Diabetes, ensure equitable access to individualized treatments, continue studying the causes that even today make diabetes a reason for exclusion in access to certain jobs and monitor compliance with existing regulations.