Diabetes and Painful Sex

As anyone living with diabetes knows, it majorly impacts your daily life and your mental and physical health. You have to change the way you eat, the way you exercise, and so many regular habits—often while dealing with symptoms like fatigue, mood swings, and chronic pain. 

But did you know diabetes can also have a major impact on your sex life? Many people who live with the disease experience sexual issues, including pain during sex. If you didn’t even know these problems could be related to diabetes, you’re not alone! The link between diabetes and sexual function isn’t talked about nearly enough.

Let us fill you in on the info you’ve been missing. 

Unsurprisingly, most of the research into diabetes and problems with sex is about how it affects penises. Don’t get us wrong, guys (and other folks with penises). We’re glad you can find lots of info! We just wish the ladies (and other folks with vaginas) could find the same amount. 

Now that we’ve gotten that out of the way, let’s go over how diabetes can lead to painful sex for people with penises. 

Unfortunately, there’s not a lot of research about diabetic men and penis-owners who experience pain during sex. Most of the research on diabetes and sex focuses on erectile dysfunction. 

But there is some research linking diabetes to problems with ejaculation, which can cause pain during orgasm. According to a review published in the medical journal Andrology, between 35%–50% of diabetic men have issues ejaculating such as:

• premature ejaculation

• incomplete ejaculation

• retrograde ejaculation (the sperm goes backwards into the bladder instead of out of the penis)

• dry orgasms (orgasms without any ejaculation)

• painful ejaculation 

Right now, there’s just not enough information to explain the link between ejaculation problems and diabetes. But experts do have some theories. 

The most widely-accepted one is that diabetic neuropathy (damage to nerves throughout the body caused by diabetes) makes the nerves in and around the prostate, testicles, and penis react differently to sexual stimulation. This could show up as less sensitivity in the penis, which creates issues with getting and maintaining erections, problems with the muscle contractions involved in orgasm and ejaculation, and pain during ejaculation. 

Having high blood sugar can cause damage to blood vessels throughout the body, resulting in less blood flow to the penis. So, many experts also support the theory that reduced blood flow to the penis can lead to ejaculation issues, including pain during ejaculation. 

According to a review published in Andrology, there is research that suggests diabetes may contribute to the development of a condition called Peyronie's disease. This is a connective tissue disorder that causes scar tissue to build up in and on the penis. This buildup of scar tissue can cause penile pain all on its own, and it can create painful swelling (not the good kind!) in the penis. Obviously, this would make sexual activity of any kind painful. 

Research shows that between 4 and 20% of men with diabetes also have Peyronie's disease, and among men with Peyronie's disease, between 13% and 50% have diabetes. So, there is evidence that Peyronie's disease is more common in people with diabetes! There isn’t much research explaining why, but researchers think that the damage to the blood vessels and nerves diabetes causes could be to blame. 

Though there’s still much more research on how diabetes impacts sex for men and penis-owners, research into sexual problems in diabetic women and vagina-owners has increased quite a bit in the past few years. Yay! Well, maybe not yay exactly – that research has revealed that diabetic women (and other people with vulvas) struggle with a wider range of sex-related issues than diabetic men. 

According to a review of the current research published in the medical journal Diabetology, diabetic women are twice as likely to have problems with sex than non-diabetic women, and they encounter issues during every stage of the sexual response cycle, from arousal to orgasm. Many of these issues can make sex painful. 

Anyone with a vagina knows that sex can be really painful when they’re not wet enough. See, when people with vaginas get aroused, there’s increased blood flow to the genitals and, usually, the vagina becomes wet. Though this doesn’t happen for everyone, including some diabetic people. Diabetes interrupts this arousal cycle in multiple ways, which often makes it difficult to get wet. 

As Dr. Sasha Davenport, a board-certified OBGYN who specializes in pelvic pain, explained, “When someone has high blood sugars, over time it ends up affecting their blood vessels… [and] the blood flow to different organs… So, it affects the blood flow to the vagina, which in turn can affect lubrication.”

Diabetes can affect arousal and lubrication in several ways, including:

• Reduced vaginal lubrication and dryness
• Decreased blood flow to the genitals
• Reduced genital sensitivity
• Difficulty becoming aroused
• Pain during penetration

Research has shown that damage to the nerves in the entire pelvic region caused by diabetes (diabetic neuropathy) can change how these nerves interpret physical sensation and respond to sexual stimulation. In some cases, the nerves in the genitals can interpret pleasurable sensations as painful instead (this is called allodynia). 

When this happens, even the lightest touch on the clitoris, labia, and/or vaginal opening can cause extreme pain, and penetration can be excruciating or even impossible.

When sex is painful on the regular, the body starts to respond to sexual stimulation differently. Because the body instinctively knows that those sexy feelings often lead to pain, it starts to interpret arousal as a precursor to pain. To prepare itself for the pain, the body involuntarily tenses muscles all around the pelvic region, even all the way up into the back and down the legs. 

Dr. Davenport explained, “The body protects itself. So, whether the pain is external or internal, what eventually ends up happening is those muscles are contracting… and then those muscles get painful. And so there's this domino cascade effect that happens.”

When those muscles stay tense for a long time, they begin to hurt, causing even more pelvic pain. In extreme cases, even fear and anxiety of having painful sex can trigger the muscles to tense up and stay tense. Eventually, the muscles can forget how to relax, leading to chronic pelvic, back, and leg pain even when nothing sexy is happening.

As you’ve definitely figured out by now, some of the ways diabetes impacts sexual function is anatomy-specific. However, there are ways that diabetes can make sex painful regardless of what’s in your pants. 

Diabetes can contribute to painful sex by:

• Damaging nerves involved in sexual sensation (diabetic neuropathy)
• Reducing blood flow to the genitals
• Increasing the risk of recurring UTIs and yeast infections
• Causing chronic inflammation that changes how the body processes pain
• Triggering pelvic floor muscle tension after repeated painful experiences

According to a review published in Medicina, diabetic people are more likely to get persistent and recurring urinary tract infections. Diabetic vulva-owners are also more likely to have recurrent yeast, bacterial, and fungal infections in the genital area. 

According to Dr. Davenport, this happens because diabetes wreaks havoc on the immune system. “As blood flow changes… the same defense mechanisms we [usually] have are not there. The other thing is when you have chronically high blood sugars, your immune system is suppressed and it's not functioning in the same way. And so that's something else that not only predisposes to UTIs, but overall can predispose to a lot of things.”

She continued, explaining that these recurring infections cause a lot of swelling in the genitals and pelvic area, which can make any kind of touch or penetration painful. 

Speaking of inflammation, there’s lots of research out there now about the negative ways chronic, systemic inflammation affects the body — and high blood sugar, damage to the blood vessels, and diabetic neuropathy can all cause chronic, systemic inflammation. On top of that, frequent genitourinary infections also trigger swelling, and leave a lasting impact on the body even after they’re treated. 

To make matters worse, inflammation actually changes the way we respond to pain. Dr. Davenport says,“With chronic inflammation, things can sort of become discombobulated. Once those inflammatory markers are increased, the way your body transmits pain is different, and the way your body interprets certain things is different.”

People with diabetes often experience pain in many ways, from multiple sources, all of which can literally change the way their bodies process pain. So, it’s no wonder so many people with diabetes experience pain during sex! 

If you’re one of those people, there’s some good news: there are treatments that can help you enjoy sex again! The majority of the research on diabetes and sexual dysfunction has shown that sexual issues get better when you make lifestyle changes to manage high blood sugar. In addition to managing your diabetes, treatments for chronic pelvic pain like pelvic floor physical therapy and sexual wellness devices like Kiwi and Ohnut can also help.

You do have to live with diabetes, but you don’t have to live with painful sex forever!