Nearly 1 in 10 Americans have diabetes, and the vast majority of them have Type 2 diabetes (T2D). If you or someone you know has T2D, you have likely already heard of the complications that accompany this chronic disease, including kidney failure, heart problems, obesity, and even polycystic ovary syndrome (PCOS). But did you know that Type 2 diabetes may also be tied to problems with your sex life?
Type 2 diabetes recap
T2D occurs when your body cannot respond normally to insulin. After you eat food containing carbohydrates (sugars), your pancreas releases insulin to allow the sugar in your blood to move into the cells to use as energy. However, people with T2D are resistant to insulin’s normal effects in the body. This is called insulin resistance. Initially, the body makes more and more insulin to keep up with rising blood sugar. Later on, the pancreas “fatigues” an insulin production slows down, resulting in higher blood sugars. It is this downstream effect that is recognized clinically as diabetes, diagnosed by labs such as an HgbA1c or elevated blood glucose. (Of note, elevated insulin levels may be damaging the body years before diabetes is diagnosed).
In contrast to Type 1 diabetes, an autoimmune disorder in which the body attacks pancreatic cells so they cannot produce insulin, T2D develops over time due to a combination of lifestyle factors and genetics.
T2D complications contribute to infertility and sexual dysfunction
Diabetes causes neuromuscular, vascular (blood vessel), and psychological changes that can contribute to infertility and/or sexual dysfunction by affecting vaginal lubrication, desire, arousal, and orgasm.
Specifically, diabetes complications can decrease blood flow to the genitals, the length and diameter of the clitoris, vaginal lubrication, and the vagina’s ability to relax [1,2]. Diabetes complications can also damage the nerve cells that line the vagina [2]. Vaginal or yeast infections, which are more common in women with T2D, can also impact sexual function [3].
Women with diabetes (both T1D and T2D) have an increased risk of depression and anxiety, but the but the medications they take for their mental health (antidepressants) often cause a decreased interest in sex or ability to orgasm [4].
Hormone imbalances and PCOS
In general, the sex hormone estrogen protects against Type 2 diabetes because healthy estrogen levels improve insulin sensitivity, which decreases insulin resistance [4]. But excess insulin in the bloodstream can stimulate the ovaries to produce excess sex hormones—especially androgens, a key feature of polycystic ovary syndrome (PCOS). Excess insulin also leads to weight gain. In turn, excess adipose tissue creates abnormally high levels of estrogens, which may contribute to mood swings, more weight gain, fibroids or even endometrial cancer. It’s all about balance.
The spectrum of insulin profiles in individuals with diabetes is diverse and complex. In general, by the time someone has developed T2D, they have had excess insulin in the bloodstream for years. Once the pancreas can no longer keep up with the rising insulin resistance, individuals may require injecting insulin to control blood sugar. Using insulin to control hyperglycemia can lower microvascular complications (such as kidney or eye damage) but it does not lower macrovascular complications such as heart disease or stroke.
Importantly, physicians no longer predominantly use insulin to treat T2D (for most patients) because there are now many excellent medications that improve insulin sensitivity. As we noted above, high insulin levels lead to excess androgen production in the case of PCOS. Using medications that are also used to improve insulin sensitivity in patients with T2D is an effective treatment for PCOS.
The tie-in between PCOS and low libido
Women with obesity and/or PCOS are known to report a high rate of sexual dysfunction and are also at higher risk of developing T2D [1, 6, 7]. PCOS complications include acne, infertility, anxiety, and low self-esteem. All of these can contribute to a woman’s sexual satisfaction.
How prevalent is sexual dysfunction in women with T2D?
While systematic reviews and meta-analyses aren’t set up to establish cause-and-effect, they are good for identifying general themes or factors in large or particular groups of people. Many such studies confirm that rates of sexual dysfunction are indeed high in women with T2D.
For example, a 2019 systematic review and meta-analysis reviewed 25 scientific studies to define risk factors for and indicators of female sexual dysfunction in women with T2D. They defined sexual dysfunction as “a person’s inability to engage in the desired sexual intercourse.” This dysfunction can be due to a variety of symptoms with either biological or psychological origin [8]. The researchers found that up to 68% of women with T2D experienced some form of sexual dysfunction.
Additionally, a 2023 systematic review and meta-analysis examined the prevalence of sexual dysfunction in women with metabolic syndrome, to which T2D is a major contributor. A review of nine studies found that nearly 40% of women with a metabolic syndrome also experienced sexual dysfunction [1].
Type 2 diabetes can impact your sex life, but there is hope
The complications of Type 2 diabetes can certainly affect your sex life. If you or someone you know have T2D and experience sexual dysfunction, there is help. Physical activity reduces the risk of diabetes and can improve common symptoms, including reducing obesity. Sexual dysfunction was reported by 67% of women who lived a sedentary lifestyle compared to 56.7% of women with regular activity [8].
A healthy diet can also reduce complications as well as help manage blood sugar in women with T2D. A “Mediterranean Diet” focused on whole grains, fruits and vegetables, lean proteins, and healthy fats has been reported to improve sexual health in women [1], although a low-carb diet might be even more effective. Mindfulness-based cognitive behavioral therapy may also be helpful for women with T2D experiencing anxiety and/or depression [9].
Improve your blood sugar control, improve your sex life?
Poor blood sugar control aggravates all diabetes complications, including those that lead to sexual dysfunction. Measures to improve blood sugar control may indirectly reduce sexual dysfunction. Hormonal birth control can complicate blood sugar control in women with diabetes, so if you’re using it for family planning, consider switching to a fertility awareness method. Since insulin resistance is a common cause of PCOS, if you are on birth control for symptoms of PCOS or another reproductive issue, consider that oral contraceptives can worsen insulin resistance [10]. Healthcare professionals trained in restorative reproductive medicine can help you identify and treat root causes instead of Band-Aiding over your symptoms.
Using a fertility awareness method to chart your menstrual cycles may also help you proactively identify (or rule out) hormonal causes for sexual dysfunction. And since your blood sugar can fluctuate depending on where you are in your cycle, your charting might help you identify when you’re likely to need more or less insulin to maintain normal levels. Lastly, knowing where you are in your cycle may help you respond mindfully to pre-period sugar cravings.
