Sexual and Urologic Problems of Diabetes

Sexual and Urologic
Problems of Diabetes
National Diabetes Information Clearinghouse
Troublesome bladder symptoms and changes
flow resulting from damage to blood vessels
in sexual function are common health
can also contribute to sexual dysfunction.
problems as people age. Having diabetes
can mean early onset and increased sever­
What sexual problems can
U.S. Department
ity of these problems. Sexual and urologic
of Health and
complications of diabetes occur because
occur in men with diabetes?
Human Services
of the damage diabetes can cause to blood
Erectile Dysfunction
vessels and nerves. Men may have difficulty
NATIONAL
Erectile dysfunction is a consistent inability
INSTITUTES
with erections or ejaculation. Women may
to have an erection firm enough for sexual
OF HEALTH
have problems with sexual response and
vaginal lubrication. Urinary tract infections
intercourse. The condition includes the total
and bladder problems occur more often in
inability to have an erection and the inability
people with diabetes. People who keep their
to sustain an erection.
diabetes under control can lower their risk of
Estimates of the prevalence of erectile dys­
the early onset of these sexual and urologic
function in men with diabetes vary widely,
problems.
ranging from 20 to 75 percent. Men who
have diabetes are two to three times more
Diabetes and Sexual
likely to have erectile dysfunction than men
Problems
who do not have diabetes. Among men with
erectile dysfunction, those with diabetes may
Both men and women with diabetes can
experience the problem as much as 10 to
develop sexual problems because of damage
15 years earlier than men without diabetes.
to nerves and small blood vessels. When a
Research suggests that erectile dysfunction
person wants to lift an arm or take a step, the
may be an early marker of diabetes, particu­
brain sends nerve signals to the appropriate
larly in men ages 45 and younger.
muscles. Nerve signals also control internal
organs like the heart and bladder, but people
In addition to diabetes, other major causes
do not have the same kind of conscious
of erectile dysfunction include high blood
control over them as they do over their arms
pressure, kidney disease, alcohol abuse, and
and legs. The nerves that control internal
blood vessel disease. Erectile dysfunction
organs are called autonomic nerves, which
may also occur because of the side effects of
signal the body to digest food and circulate
medications, psychological factors, smoking,
blood without a person having to think about
and hormonal deficiencies.
it. The body’s response to sexual stimuli is
Men who experience erectile dysfunction
also involuntary, governed by autonomic
should consider talking with a health care
nerve signals that increase blood flow to the
provider. The health care provider may ask
genitals and cause smooth muscle tissue to
about the patient’s medical history, the type
relax. Damage to these autonomic nerves
and frequency of sexual problems, medica­
can hinder normal function. Reduced blood
tions, smoking and drinking habits, and other

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health conditions. A physical exam and
laboratory tests may help pinpoint causes
For additional information about erectile
of sexual problems. The health care pro­
dysfunction, see the fact sheet Erectile
vider will check blood glucose control and
Dysfunction, available from the National
hormone levels and may ask the patient to
Kidney and Urologic Diseases Informa­
do a test at home that checks for erections
tion Clearinghouse at 1–800–891–5390.
that occur during sleep. The health care
This fact sheet is also available online at
provider may also ask whether the patient
www.kidney.niddk.nih.gov.
is depressed or has recently experienced
upsetting changes in his life.
Treatments for erectile dysfunction caused
Retrograde ejaculation caused by diabetes or
by nerve damage, also called neuropathy,
surgery may be helped with a medication that
vary widely and range from oral pills, a
strengthens the muscle tone of the sphincter
vacuum pump, pellets placed in the urethra,
in the bladder. A urologist experienced in
and shots directly into the penis, to surgery.
infertility treatments may assist with tech­
All of these methods have advantages and
niques to promote fertility, such as collect­
disadvantages. Psychological counseling to
ing sperm from the urine and then using the
reduce anxiety or address other issues may
sperm for artificial insemination.
be necessary. Surgery to implant a device to
aid in erection or to repair arteries is usually
What sexual problems
used as a treatment after all others fail.
can occur in women with
Retrograde Ejaculation
diabetes?
Retrograde ejaculation is a condition in
Many women with diabetes experience
which part or all of a man’s semen goes
sexual problems. Although research about
into the bladder instead of out the tip of
sexual problems in women with diabetes
the penis during ejaculation. Retrograde
is limited, one study found 27 percent of
ejaculation occurs when internal muscles,
women with type 1 diabetes experienced
called sphincters, do not function normally.
sexual dysfunction. Another study found
A sphincter automatically opens or closes a
18 percent of women with type 1 diabetes
passage in the body. With retrograde ejacu­
and 42 percent of women with type 2 diabe­
lation, semen enters the bladder, mixes with
tes experienced sexual dysfunction.
urine, and leaves the body during urina­
tion without harming the bladder. A man
Sexual problems may include
experiencing retrograde ejaculation may
•
notice that little semen is discharged during
decreased vaginal lubrication, resulting
in vaginal dryness
ejaculation or may become aware of the
condition if fertility problems arise. Analy­
• uncomfortable or painful sexual
sis of a urine sample after ejaculation will
intercourse
reveal the presence of semen.
Poor blood glucose control and the result­
• decreased or no desire for sexual
ing nerve damage can cause retrograde
activity
ejaculation. Other causes include prostate
• decreased or absent sexual response
surgery and some medications.
2 Sexual and Urologic Problems of Diabetes

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Decreased or absent sexual response can
Diabetes and Urologic
include the inability to become or remain
Problems
aroused, reduced or no sensation in the
genital area, and the constant or occasional
Urologic problems that affect men and
inability to reach orgasm.
women with diabetes include bladder prob­
lems and urinary tract infections.
Causes of sexual problems in women with
diabetes include nerve damage, reduced
blood flow to genital and vaginal tissues,
and hormonal changes. Other possible
causes include some medications, alcohol
Kidneys
abuse, smoking, psychological problems
such as anxiety or depression, gynecologic
infections, other diseases, and conditions
relating to pregnancy or menopause.
Ureters
Women who experience sexual problems or
notice a change in sexual response should
consider talking with a health care provider.
The health care provider will ask about
the patient’s medical history, any gyneco­
logic conditions or infections, the type and
frequency of sexual problems, medications,
Bladder
smoking and drinking habits, and other
health conditions. The health care pro­
Urethra
vider may ask whether the patient might be
pregnant or has reached menopause and
The urinary tract.
whether she is depressed or has recently
experienced upsetting changes in her life.
A physical exam and laboratory tests may
Bladder Problems
also help pinpoint causes of sexual prob­
Many events or conditions can damage
lems. The health care provider will also
nerves that control bladder function, includ­
talk with the patient about blood glucose
ing diabetes and other diseases, injuries,
control.
and infections. More than half of men and
Prescription or over-the-counter vaginal
women with diabetes have bladder dysfunc­
lubricants may be useful for women expe­
tion because of damage to nerves that con­
riencing vaginal dryness. Techniques to
trol bladder function. Bladder dysfunction
treat decreased sexual response include
can have a profound effect on a person’s
changes in position and stimulation during
quality of life. Common bladder problems
sexual relations. Psychological counseling
in men and women with diabetes include
may be helpful. Kegel exercises that help
the following:
strengthen the pelvic muscles may improve
• Overactive bladder. Damaged nerves
sexual response. Studies of drug treatments
may send signals to the bladder at the
are under way.
wrong time, causing its muscles to
3 Sexual and Urologic Problems of Diabetes

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squeeze without warning. The symp­
Diagnosis of bladder problems may involve
toms of overactive bladder include
checking both bladder function and the
appearance of the bladder’s interior. Tests
– urinary frequency—urination eight
may include x rays, urodynamic testing to
or more times a day or two or more
evaluate bladder function, and cystoscopy, a
times a night
test that uses a device called a cystoscope to
– urinary urgency—the sudden, strong
view the inside of the bladder.
need to urinate immediately
Treatment of bladder problems due to
– urge incontinence—leakage of urine
nerve damage depends on the specific prob­
that follows a sudden, strong urge to
lem. If the main problem is urine reten­
urinate
tion, treatment may involve medication to
•
promote better bladder emptying and a
Poor control of sphincter muscles.
Sphincter muscles surround the
practice called timed voiding—urinating
on a schedule—to promote more efficient
urethra—the tube that carries urine
urination. Sometimes people need to peri­
from the bladder to the outside of
odically insert a thin tube called a catheter
the body—and keep it closed to hold
through the urethra into the bladder to
urine in the bladder. If the nerves to
drain the urine. Learning how to tell when
the sphincter muscles are damaged,
the bladder is full and how to massage the
the muscles may become loose and
lower abdomen to fully empty the bladder
allow leakage or stay tight when a
can help as well. If urinary leakage is the
person is trying to release urine.
main problem, medications, strengthening
muscles with Kegel exercises, or surgery can
• Urine retention. For some people,
help. Treatment for the urinary urgency
nerve damage keeps their bladder
and frequency of overactive bladder may
muscles from getting the message that
involve medications, timed voiding, Kegel
it is time to urinate or makes the mus­
exercises, and surgery in some cases.
cles too weak to completely empty
Urinary Tract Infections
the bladder. If the bladder becomes
too full, urine may back up and the
Infections can occur when bacteria, usually
increasing pressure may damage the
from the digestive system, reach the urinary
kidneys. If urine remains in the body
tract. If bacteria are growing in the ure­
thra, the infection is called urethritis. The
too long, an infection can develop
bacteria may travel up the urinary tract and
in the kidneys or bladder. Urine
cause a bladder infection, called cystitis.
retention may also lead to overflow
An untreated infection may go farther into
incontinence—leakage of urine when
the body and cause pyelonephritis, a kidney
the bladder is full and does not empty
infection. Some people have chronic or
properly.
4 Sexual and Urologic Problems of Diabetes

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recurrent urinary tract infections. Symptoms
of urinary tract infections can include
The following publications, available
• a frequent urge to urinate
from the National Kidney and Urologic
Diseases Information Clearinghouse
• pain or burning in the bladder or
at www.kidney.niddk.nih.gov or by call­
urethra during urination
ing 1–800–891–5390, provide additional
information about urologic problems:
• cloudy or reddish urine
• Bladder Control for Women
• in women, pressure above the pubic
bone
• Cystoscopy and Ureteroscopy
•
•
in men, a feeling of fullness in the
Imaging of the Urinary Tract
rectum
• Nerve Disease and Bladder Control
If the infection is in the kidneys, a person
•
may have nausea, feel pain in the back or
Pyelonephritis (Kidney Infection)
side, and have a fever. Frequent urination
in Adults
can be a sign of high blood glucose, so results
• Urinary Incontinence in Men
from recent blood glucose monitoring should
be evaluated.
• Urinary Tract Infections in Adults
The health care provider will ask for a urine
• Urodynamic Testing
sample, which will be analyzed for bacteria
and pus. Additional tests may be done if the
• What I need to know about Urinary
patient has frequent urinary tract infections.
Tract Infections
An ultrasound exam provides images from
the echo patterns of sound waves bounced
• Your Kidneys and How They Work
back from internal organs. An intravenous
pyelogram uses a special dye to enhance
• Your Urinary System and How It
x-ray images of the urinary tract. Cystoscopy
Works
might be performed.
Early diagnosis and treatment are important
to prevent more serious infections. To clear
up a urinary tract infection, the health care
provider will probably prescribe antibiotic
treatment based on the type of bacteria in
the urine. Kidney infections are more seri­
ous and may require several weeks of antibi­
otic treatment. Drinking plenty of fluids will
help prevent another infection.
5 Sexual and Urologic Problems of Diabetes

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Who is at risk for developing
sexual and urologic
For additional information about pre­
problems of diabetes?
venting diabetes complications, see
the Prevent Diabetes Problems Series,
Risk factors are conditions that increase the
available from the National Diabetes
chances of getting a particular disease. The
Information Clearinghouse at 1–800–
more risk factors people have, the greater
860–8747. The series is also available at
their chances of developing that disease or
www.diabetes.niddk.nih.gov/dm/pubs/
condition. Diabetic neuropathy and related
complications.
sexual and urologic problems appear to be
more common in people who
• have poor blood glucose control
Points to Remember
• have high levels of blood cholesterol
The nerve damage of diabetes may cause
•
sexual or urologic problems.
have high blood pressure
•
• Sexual problems in men with diabetes
are overweight
include
• are older than 40
– erectile dysfunction
•
– retrograde ejaculation
smoke
•
• Sexual problems in women with
are physically inactive
diabetes include
Can diabetes-related sexual
– decreased vaginal lubrication and
uncomfortable or painful intercourse
and urologic problems be
– decreased or no sexual desire
prevented?
– decreased or absent sexual response
People with diabetes can lower their risk of
sexual and urologic problems by keeping
• Urologic problems in men and women
their blood glucose, blood pressure, and
with diabetes include
cholesterol levels close to the target numbers
– bladder problems related to nerve
their health care provider recommends.
damage, such as overactive bladder,
Being physically active and maintaining a
poor control of sphincter muscles,
healthy weight can also help prevent the
and urine retention
long-term complications of diabetes. For
– urinary tract infections
those who smoke, quitting will lower the risk
of developing sexual and urologic problems
• Controlling diabetes through diet,
due to nerve damage and also lower the
physical activity, and medications as
risk for other health problems related to
needed can help prevent sexual and
diabetes, including heart attack, stroke, and
urologic problems.
kidney disease.
• Treatment is available for sexual and
urologic problems.
6 Sexual and Urologic Problems of Diabetes

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Hope through Research
Participants in clinical trials can play a
The National Institute of Diabetes and
more active role in their own health care,
Digestive and Kidney Diseases (NIDDK)
gain access to new research treatments
was established by Congress in 1950 as one of
before they are widely available, and help
the National Institutes of Health of the U.S.
others by contributing to medical research.
Department of Health and Human Services.
For information about current studies, visit
The NIDDK conducts and supports research
www.ClinicalTrials.gov.
on diabetes, glucose metabolism, and related
conditions. NIDDK-supported research
For More Information
on the sexual and urologic complications of
American Diabetes Association
diabetes includes research conducted as part
1701 North Beauregard Street
of the Epidemiology of Diabetes Interven­
Alexandria, VA 22311
tions and Complications (EDIC) study. The
Phone: 1–800–DIABETES (342–2383)
EDIC is an observational follow-up study
Email: AskADA@diabetes.org
of people who originally participated in the
Internet: www.diabetes.org
Diabetes Control and Complications Trial
(DCCT). The DCCT showed that intensive
American Urological Association Foundation
blood glucose control can reduce the risk of
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complications of type 1 diabetes. EDIC study
Linthicum, MD 21090
results suggest that tight glucose control can
Phone: 1–866–RING–AUA (746–4282)
delay the onset of erectile dysfunction in men
or 410–689–3700
with type 1 diabetes.
Fax: 410–689–3800
Email: patienteducation@auafoundation.org
A recent study focused on urinary inconti­
Internet: www.auafoundation.org
nence in women at high risk for developing
www.UrologyHealth.org
type 2 diabetes who participated in the
NIDDK-sponsored Diabetes Prevention Pro­
Juvenile Diabetes Research Foundation
gram (DPP). The women had pre-diabetes,
International
a condition in which blood glucose levels are
120 Wall Street
higher than normal but not high enough for
New York, NY 10005–4001
a diagnosis of diabetes. Women who were in
Phone: 1–800–533–CURE (2873)
the DPP group that used a lifestyle change
Fax: 212–785–9595
approach to diabetes prevention and lost
Email: info@jdrf.org
5 to 7 percent of their weight through dietary
Internet: www.jdrf.org
changes and increased physical activity were
National Diabetes Education Program
compared with those in other DPP groups
1 Diabetes Way
who received standard education and main­
Bethesda, MD 20814–9692
tained a stable weight. The women in the
lifestyle intervention group had fewer prob­
Phone: 1–888–693–NDEP (6337)
lems with urinary incontinence than women in
TTY: 1–866–569–1162
the other groups. This finding adds to other
Fax: 703–738–4929
results of the DPP study that indicate the
Email: ndep@mail.nih.gov
value of lifestyle changes for preventing or
Internet: www.ndep.nih.gov
delaying the development of type 2 diabetes.
7 Sexual and Urologic Problems of Diabetes

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National Kidney and Urologic Diseases
National Diabetes
Information Clearinghouse
3 Information Way
Information Clearinghouse
Bethesda, MD 20892–3580
1 Information Way
Phone: 1–800–891–5390
Bethesda, MD 20892–3560
TTY: 1–866–569–1162
Phone: 1–800–860–8747
Fax: 703–738–4929
TTY: 1–866–569–1162
Email: nkudic@info.niddk.nih.gov
Fax: 703– 738–4929
Internet: www.kidney.niddk.nih.gov
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov
The National Diabetes Information Clear-
You may also find additional information about this
inghouse (NDIC) is a service of the National
topic by visiting MedlinePlus at www.medlineplus.gov.
Institute of Diabetes and Digestive and Kidney
This publication may contain information about med-
Diseases (NIDDK). The NIDDK is part of
ications. When prepared, this publication included
the National Institutes of Health of the U.S.
the most current information available. For updates
or for questions about any medications, contact
Department of Health and Human Services.
the U.S. Food and Drug Administration toll-free at
Established in 1978, the Clearinghouse provides
1–888–INFO–FDA (463–6332) or visit www.fda.gov.
information about diabetes to people with diabe-
Consult your doctor for more information.
tes and their families, health care professionals,
and the public. The NDIC answers inquiries,
develops and distributes publications, and works
closely with professional and patient organiza-
The U.S. Government does not endorse or favor any
specific commercial product or company. Trade,
tions and Government agencies to coordinate
proprietary, or company names appearing in this
resources about diabetes.
document are used only because they are considered
necessary in the context of the information provided.
Publications produced by the Clearinghouse are
If a product is not mentioned, the omission does not
carefully reviewed by both NIDDK scientists and
mean or imply that the product is unsatisfactory.
outside experts. This publication was originally
reviewed by Jeanette S. Brown, M.D., Women’s
Continence Center, University of California at
San Francisco; Kevin T. McVary, M.D., Depart-
ment of Urology, Northwestern University; and
Hunter Wessells, M.D., Department of Urology,
University of Washington.
This publication is not copyrighted. The Clearing-
house encourages users of this fact sheet to duplicate
and distribute as many copies as desired.
This fact sheet is also available at
www.diabetes.niddk.nih.gov.
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 09–5135
December 2008

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