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                    Diabetes
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                    Preventing Diabetes Problems
                    Diabetes, Sexual, & Bladder Problems

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                Diabetes, Sexual, & Bladder ProblemsDiabetes, Sexual, & Bladder Problems
**In this section:**
Can sexual and bladder problems be symptoms of diabetes?
    When should I see a doctor about my sexual or bladder problems?
    What makes me more likely to develop sexual or bladder problems?
    What sexual problems can men with diabetes have?
    What sexual problems can women with diabetes have?
    What bladder problems can men and women with diabetes have?
    How can I prevent and treat my sexual or bladder problems?Sexual problems and bladder problems are common as people age, but diabetes can make these problems worse. You or your partner may have trouble having or enjoying sex. Or, you may leak urine or have trouble emptying your bladder normally.
Blood vessels and nerves can be damaged by the effects of high blood glucose, also called blood sugar. This damage can lead to sexual and bladder problems. Keeping your blood glucose levels in your target range is an important way to prevent damage to your blood vessels and nerves.
Work with your health care team to help prevent or treat sexual and bladder problems. These problems may be signs that you need to manage your diabetes in a different way. Remember, a healthy sex life and a healthy bladder can improve your quality of life, so take action now if you have concerns.
A couple embraces on park bench.Sexual and bladder problems may be signs that you need to manage your diabetes in a different way.Can sexual and bladder problems be symptoms of diabetes?
Yes. Changes in sexual function or bladder habits may be a sign that you have diabetes. Nerve damage caused by diabetes, also called diabetic neuropathy, can damage parts of your body—like your genitals or urinary tract. For example, men with diabetes may develop erectile dysfunction (ED) 10 to 15 years earlier than men without diabetes.1
Talk with a health care professional if you have any symptoms of diabetes, including sexual and bladder problems.
When should I see a doctor about my sexual or bladder problems?
See a health care professional for problems with sex or your bladder. These problems could be a sign that you need to manage your diabetes differently. You may find it embarrassing and difficult to talk about these things. However, remember that health care professionals are trained to speak with people about every kind of health problem. Everyone deserves to have healthy relationships and enjoy the activities they love.
What makes me more likely to develop sexual or bladder problems
You’re more likely to develop sexual or bladder problems if you have diabetes and
have high blood glucose that is not well controlled, also called high blood sugar
    have nerve damage, also called neuropathy
    have high blood pressure that is not treated
    have high cholesterol that is not treated
    are overweight or have obesity
    are not physically active
    are taking certain medicines
    drink too many alcoholic drinks
    smokeResearch also suggests that certain genes may make people more likely to develop diabetic neuropathy.2
What sexual problems can men with diabetes have?
Changes in your blood vessels, nerves, hormones, and emotional health during diabetes may make it more difficult for you to have satisfactory sex. Diabetes and its related challenges also may make it harder for you to have a child.
Erectile dysfunction
You have ED if you’re unable to get or keep an erection firm enough for satisfactory sexual intercourse. More than half of men with diabetes will get ED. Men who have diabetes are more than 3 times more likely to develop ED than men who do not have diabetes.1Good diabetes management may help prevent and treat ED caused by nerve damage and circulation problems. A doctor can help treat ED with medicine or a change in your diabetes care plan.
A health care professional talks to a man and a woman about his lab tests.Managing your diabetes may help prevent and treat ED caused by nerve damage and circulation problems.Retrograde ejaculation
Rarely, diabetes can cause retrograde ejaculation, which is when part or all of your semen goes into your bladder instead of out of your penis during ejaculation. During retrograde ejaculation, semen enters your bladder, mixes with urine, and is safely urinated out. A urine sample after ejaculation can show if you have retrograde ejaculation. Some men with retrograde ejaculation may not ejaculate at all.
Penile curvature
Men with diabetes are more likely to have Peyronie’s disease, also called penile curvature, than men who don’t have diabetes.3 Men with Peyronie’s disease have scar tissue, called a plaque, in the penis, making it curve when erect. Curves in the penis can make sexual intercourse painful or difficult. Some men with Peyronie’s disease may have ED.
Low testosterone
Men’s testosterone levels naturally lower with age. However, lower-than-normal testosterone levels may be the cause of some men’s ED, or can explain why some men often feel tired, depressed, or have a low sex drive. Men with diabetes, especially those who are older and overweight, are more likely to have low testosterone, or “low T.”
If your doctor thinks you might have low T, you will probably be asked to give a blood sample, and a health care professional will give you a physical exam. Your doctor may suggest treating your low testosterone with a prescription gel, injection, or patch.
Several studies show that, along with good diabetes management, testosterone therapy can lessen a man’s sexual problems.4 However, testosterone therapy may have serious risks and may not be safe for all men. Talk with your doctor about testosterone therapy’s side effects and whether it’s right for you.
Fertility problems
Some studies show that men with diabetes can have problems with their sperm that make it harder to conceive. Your sperm could be slow or not move well, or your sperm may not be able to fertilize a woman’s egg well.5 Working closely with your partner and a health care professional trained in fertility issues may help.
If you and your partner want to conceive a child, your doctor may treat retrograde ejaculation caused by diabetes with medicine or by changing your diabetes care plan. Or, talk with a urologist who is a fertility expert. He or she may be able to collect your sperm from your urine and then use it for artificial insemination.
What sexual problems can women with diabetes have?
Low sexual desire and response, vaginal dryness, and painful sex can be caused by nerve damage, reduced blood flow to the genitals, and hormonal changes. Other conditions can cause these problems, too, including menopause. If you notice a change in your sex life, talk with your health care team. A physical exam, which will include a pelvic exam, and blood and urine tests may help your doctor find the cause of your problems.
Low sexual desire and response
Low sexual desire and sexual response can include
being  unable to become or stay aroused
    not  having enough vaginal lubrication
    having  little to no feeling in your genitals
    being  unable to have an orgasm or rarely having oneWith diabetes, your body and mind will likely go through many changes. For example, both high and low blood glucose levels can affect how and if you become aroused. Or, you may find yourself more tired than usual or depressed and anxious, making you less interested in sex.
Your health care team can help you make changes to your diabetes care plan so that you‘re back on track. Women who keep blood glucose levels in their target range are less likely to have nerve damage, which can lead to low sexual desire and response.
Painful sex
Some women with diabetes say they have uncomfortable or painful sexual intercourse. The nerves that tell your vagina to lubricate during stimulation can become damaged by diabetes. A prescription or over-the-counter vaginal lubricant may help if you have vaginal dryness. Managing your blood glucose well over many weeks, months, and years can help prevent nerve damage.
Yeast and bladder infections
Women with diabetes are more likely to have yeast infections, because yeast organisms can grow more easily when your blood glucose levels are higher. Yeast infections can be uncomfortable or painful and prevent you from enjoying activities, including having sex.
Although some yeast infections can be treated at home, talk with a health care professional first about your symptoms. Some symptoms of yeast infections are similar to other types of infections, including sexually transmitted diseases.
Pregnancy concerns and fertility problems
If you have diabetes and plan to become pregnant, it’s important to get your blood glucose levels close to your target range before you get pregnant. High blood glucose can harm your baby during the first weeks of pregnancy, even before you know you’re pregnant.
If you have diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage your diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.
Health problems such as obesity and polycystic ovary syndrome (PCOS) that are linked to diabetes can make it harder to conceive a child. Talk with a health care professional, such as a gynecologist or a fertility specialist, if you’re having problems conceiving a child.
A health care professional speaks to a woman.If you notice a change in your sex life, talk with your health care team.What bladder problems can men and women with diabetes have?
Diabetes can cause nerve damage to your urinary tract, causing bladder problems. Overweight and obesity also can increase bladder problems, such as urinary incontinence (UI). Managing diabetes is an important part of preventing problems that can lead to excess urination.
Your health care team may be able to help you manage your blood glucose levels and help you lose weight, if needed. Doctors use blood and urine tests to diagnose bladder problems or conditions with similar symptoms. Doctors also may use urodynamic testing to see what kind of bladder problem you have.
Frequent and urgent urination
Some people with diabetes who regularly have high blood glucose levels may have to urinate too often, also called urinary frequency. Even men and women with diabetes who manage their blood glucose levels within their target range sometimes feel the sudden urge to urinate, called urgency incontinence. This can happen at night, also. Medicines may help reduce the symptoms of bladder control problems.
Trouble “going”
You may find that diabetes causes you to no longer feel when your bladder is full. Many people with diabetes report that they have trouble “going.” Over time, having a too-full bladder can cause damage to your bladder muscles that push urine out. When these muscles don’t work correctly, urine may stay in your bladder too long, also called urinary retention. Urinary retention can cause bladder infections, urine leaks, and the feeling that you always have to go.
Leaking urine
People with diabetes are more likely to have other types of UI, such as stress incontinence. Nerve damage, obesity, and bladder infections, which are linked with diabetes, are often related to bladder control problems. Leaking urine can cause you to avoid activities you once enjoyed, including sex.
If you’re overweight, losing weight can help you have fewer leaks. Avoiding weight gain may prevent UI. Studies suggest that, as your body mass index (BMI) increases, you’re more likely to leak.6 If you’re overweight or have obesity, talk with your doctor about how to lose weight.
Work with your health care team to help manage and prevent urine leaks. Bladder control problems are often treatable and are very common, even in people who don’t have diabetes. You don’t have to accept rushing to the bathroom all the time to avoid leaks.
Bladder infections
People with diabetes are more likely to have urinary tract infections, also called bladder infections, or cystitis. See a doctor right away if you have frequent, urgent urination that may be painful. Bladder infections can develop into kidney infections and can make bladder symptoms, such as leaks and urine retention, worse. Also, bladder infections can get in the way of your everyday life, including intimacy. Managing your blood glucose levels can help prevent bladder infections.
Senior couple walking along suburban street holding hands.Managing your blood glucose levels can help prevent bladder problems.How can I prevent and treat my sexual or bladder problems?
Managing your diabetes can help prevent nerve damage and other diabetes problems that can lead to sexual and bladder problems. With your health care team, you can help prevent and treat your sexual or bladder control problems by
keeping  your blood glucose, blood pressure, and cholesterol levels close to your target  numbers
    being physically active
    keeping  a healthy weight
    quitting smoking if you smoke
    getting help for any emotional or psychological  problemsSex is a physical activity, so be sure to check your blood glucose level before and after sex, especially if you take insulin. Both high blood glucose levels and low blood glucose levels can cause problems during sex.
Counseling may also be helpful when you notice changes in your sexual function or desire. These types of changes are very common as people age or adjust to health problems.
If you have a partner, he or she also may be an important member of your health care team. You may find it helpful to share your concerns and have that person join you at the doctor’s office or at counseling. Your friends and family may also be able to support you if you’re having bladder problems.
References
[1] Kouidrat Y, Pizzol D, Cosco T, et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. *Diabetic Medicine*. 2017;34(9):1185–1192.
[2] Witzel I, Jelinek HF, Khalaf K, Lee S, Khandoker AH, Alsafar H. Identifying common genetic risk factors of diabetic neuropathies. [published online May 28, 2015] *Frontiers in Endocrinology*. 2015;6:88. doi:10.3389/fendo.2015.00088.
[3] Al-Thakafi S, Al-Hathal N. Peyronie’s disease: a literature review on epidemiology, genetics, pathophysiology, diagnosis and work-up. *Translational Andrology and Urology*. 2016; 5(3):280–289.
[4] Putta S, Peluso I, Yarla NS, et al. Diabetes mellitus and male aging: pharmacotherapeutics and clinical implications. [published online August 22, 2017] *Current Pharmaceutical Design*. doi:10.2174/1381612823666170823103830.
[5] Ding G, Liu Y, Liu ME, et al. The effects of diabetes on male fertility and epigenetic regulation during spermatogenesis. [published online March 24, 2015] *Asian Journal of Andrology*. 2015;17(6):948–953.
[6] Markland AD, Richter HE, Fwu CW, Eggers P, Kusek JW. Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. *The Journal of Urology*. 2011;186(2):589–593.        Last Reviewed June 2018
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