“Sexual health is probably one of the most important factors in one’s quality of life. However, when it comes to chronic illnesses like diabetes, it probably takes a backseat,” says Dr. Niveditha Manokaran, dermatologist, venereologist and clinician in sexual & reproductive health & HIV medicine. One of the main effects of diabetes is persistent nerve damage, which can lead to diabetic neuropathy—causing pain, numbness or tingling sensations. This can furthermore result in a number of sexual dysfunctions, across genders and ages.

“In the early stages or cases of mild diabetes, proper diet and exercise are recommended to patients. When they are on medication, a healthy lifestyle becomes even more important,” suggests Hyderabad-based obstetrician and gynaecologist Dr. Anuradha Panda of Apollo Hospitals.

“Remember, you are not alone,” adds Dr. Manokaran. She urges anyone going through any of the following issues to seek help without hesitance or taboo. With proper medical guidance and open communication with your partner, you can manage and improve your diabetes symptoms as well as sexual health.

1. Erectile dysfunction: Erectile dysfunction (ED) or the inability to get/maintain an erection during sex is one of the most common problems related to diabetes, according to Dr. Manokaran. In a 2017 study published in the Indian Journal of Psychological Medicine, it was concluded that ED is an often overlooked and underestimated side effect of diabetes—which “further deteriorates the already compromised health and quality of life”.

2. Retrograde ejaculation: Dr. Manokaran reveals that retrograde ejaculation occurs when your muscles become very weak from diabetic neuropathy. The weakened muscles fail to barrier your bladder during orgasm and cause you to ejaculate little to no semen as it goes into the bladder instead of through the urethra and out of the penis.

3. Vulva-vaginal infections: Diabetic women are more common to genital infections, recurrent urinary tract infections, candidiasis etc. “Fungal infections can cause white discharge, burning, itching and pain in both genital and pelvic areas,” says Dr. Panda. This, along with fatigue (due to higher risk of cardiac diseases in diabetic females), can hinder sex drive.

4. Lower libido: Poorly managed diabetes over time can cause lower libido indifferent to genders, says the American Diabetes Association. High blood sugar, low testosterone, effects of certain medications—all can contribute to suppressed sex drive.

5. Vaginal dryness: Usually, vaginas are naturally lubricated during arousal. However, if there is nerve damage due to diabetes, it may fail to do so and cause discomfort during sex. The American Diabetes Association concludes that vaginal dryness is twice as common in women with diabetes than those without.

6. Urinary incontinence: This refers to partial or complete loss of bladder control. As per a 2009 study of adult women published in the International Urogynecology Journal and Pelvic Floor Dysfunction, "diabetes mellitus is the most important independent determinant of urinary incontinence" and increases its risk by 2.5 times.

7. Dermatological issues: Diabetes and neuropathy causes nerve damage and delays your body's natural ability to heal from sores and wounds quickly. It can cause rashes, lesions, and warts. This can affect your genitalia as well. Yeast infections like candidiasis or thrush, balanitis (inflammation of the foreskin and tip of the penis), sores and more are common with poor glycemic (blood sugar) control.

8. Effect on mental health: Healthy sexual interaction and intimacy is more than just bodily functions—your mental health plays a big part as well. According to the Centers For Disease Control And Prevention, USA, diabetic patients are at a risk for developing depression, stress and anxiety. Finding support, self-care and prioritising your needs are of utmost importance.