SAN FRANCISCO — Consider the partners of diabetes patients when talking about sexual problems in diabetes, a research specialist in the field suggests.
Although only one member of a couple may have diabetes, “Partners are very often hidden patients,” said Lawrence Fisher, Ph.D., at the annual scientific sessions of the American Diabetes Association. “Diabetes [exists] in interpersonal settings. It doesn't happen in social isolation. The most powerful and emotionally charged interpersonal setting is the adult couple.” He listed six issues related to sexual intimacy that affect patients with diabetes:
Clinical depression is very common among people with diabetes, and even in patients without a formal diagnosis of depression, it's typical to find high levels of depressive affect and diabetes distress. Many of these patients are taking antidepressants, which have well-known sexual side effects. On top of that, “Being in a lousy mood is not the greatest time to have sex,” said Dr. Fisher, professor in residency at the University of California, San Francisco.
Self-blame and shame are often issues in patients with diabetes, especially those with type 2. Consciously or unconsciously, many people think, “If only I had taken care of myself better, I wouldn't be having these sexual problems.” Partners also may blame the patient with diabetes for sexual problems, further damaging the patient's self-esteem.
People with diabetes, especially with type 2, often feel socially and physically unattractive. An obese patient can have a poor body image that might inhibit him or her from initiating sexual activity. The other side of the coin is that partners may take it as a judgment about their own attractiveness when a man with diabetes is unable to achieve an erection.
Patients and partners often have specific worries about the effect of diabetes on sexual activity. Sexual intercourse can be physically demanding, and they worry about cardiovascular events and hypoglycemia. Having to plan for this, with blood testing before bed and snacks on the nightstand, for example, takes some of the spontaneity and fun out of sex. Furthermore, simply knowing that diabetes can lead to sexual failure can be a self-fulfilling prophecy.
Patients and their partners often suffer from a lack of knowledge about diabetes and its effects on sexual intimacy. And they also tend to be ignorant about the normal effects of aging on sexuality. “This creates what I like to call 'diabetes scapegoating,'” Dr. Fisher said. “Any time anything happens, it's [the fault of] diabetes. And it may not be. It may be normal functioning for people of that age.”
Cultural and personal beliefs, values, and sentiments about sexuality can often amplify the effects of diabetes. Some couples lack the language to talk about sexual difficulties. “In some cultures, even in long-standing relationships between partners, it is considered inappropriate for the partners to talk about their sexual activity,” Dr. Fisher explained.