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Few studies have looked closely at female sexuality and diabetes. What are the special issues that arise? In this interview, Eileen Walko, MD, and Daryn Stier, MSW, LCSW, poignantly discuss what all women with diabetes should know.
DIABETES HEALTH: What type of medical experiences are common among women with diabetes?
Dr. Walko: Women with diabetes, as with all people with diabetes, must be concerned with eye and kidney disease, along with keeping good sugar control. But women with diabetes have special issues that men with diabetes do not necessarily have to worry about. In particular, vaginal or yeast infections tend to be common. This happens because yeast can live in the sugar that diabetic women produce in their urine. This can be very difficult for women, because they must periodically return to their doctor to determine the cause of the itchiness and redness.
DIABETES HEALTH: Do diabetic women get more yeast infections than non-diabetic women?
Dr. Walko: Some studies say yes.
DIABETES HEALTH: What sort of remedies are there to cure some vaginal infections?
Dr. Walko: Fortunately, there are some over-the-counter products that are very effective. In addition, some argue that home remedies, such as applying yoghurt, also work well. Unfortunately, this technique can also be a little messy.
DIABETES HEALTH: Are there differences in a woman's sexual response based on whether she has diabetes or not?
Daryn Stier: Many women with diabetes have reported that they are often tired and not in the mood for sex. They say that this is due to their fluctuating blood sugar levels. But more importantly, women with diabetes must tackle the issue of low self-esteem, and the difficulty of accepting diabetes as a normal part of life. For example, if a woman develops a black and blue mark due to repeated injections, she might hesitate getting involved with someone, for fear of having to explain the reason for the bruise. For Type 2 diabetics, the issue is often obesity, and its effect on self-esteem. These experiences can often make it difficult for a woman to share her body with another individual. In addition, it may be very difficult to even share the fact that she has diabetes.
DIABETES HEALTH: What psychological issues arise when a woman finally chooses to tell a partner she has diabetes?
Daryn Stier: Well, women with diabetes must constantly struggle with the false belief that she is somehow defective because of her diabetes. This is even more a reality today, when advertising companies have so much power in defining the meaning of beauty.
DIABETES HEALTH: What is a common medical problem associated with women who have diabetes?
Dr. Walko: One problem is obesity. Many women who take insulin have a very difficult time controlling their weight. Often, insulin itself is the culprit. This can be frustrating, especially when your doctor says you have to lose weight, and the insulin actually works to the opposite effect.
DIABETES HEALTH: Should a woman with diabetes be thinking differently about contraception than a person without diabetes?
Dr. Walko: There is new research that says that diabetic woman can in fact use low-dose estrogen birth control pills. However, if a woman has been told by her doctor that these pills would complicate any existing conditions, then they should think about using other forms of birth control.
DIABETES HEALTH: Why does pre-menstrual syndrome affect blood sugars?
Daryn Stier: No one is sure why different points of your menstrual cycle affect blood sugar readings. This happens in diabetic as well non diabetic women. We know that there is generally a higher blood sugar reading prior to, and during, a woman's period, and that this can change insulin needs and sugar control. For emotional reasons, it is important for diabetic woman to realize that readings during menstrual cycles may be a little off. Accepting this fact will make it a lot easier to live with your diabetes.
DIABETES HEALTH: How does diabetes affect a woman's sex life?
Dr. Walko: Four unscientific studies have examined this question, with mixed results. One study showed that some women had problems with vaginal lubrication, pain, and difficulty in obtaining orgasm. However, the study showed that there was no distinction between the experiences of Type I diabetics and non-diabetics. However, Type 2 diabetics were shown to experience much more dissatisfaction.
DIABETES HEALTH: Dr. Walko, do you have any final thoughts you would like to share with our listeners?
Dr. Walko: Honesty with yourself is the most important thing. Women with diabetes should be honest about what they are eating, and the type and quantity of insulin being administered. In addition, it is very important to feel as comfortable as possible with your diabetes.
DIABETES HEALTH: Daryn, is there anything you would like to add?
Daryn Stier: Think of diabetes as a gift. This gift allows us to be honest and straightforward with the people in our lives.
(Editor's note: Dr. Walko was warned by some doctors and medical staff not to mention that she had diabetes on her medical school application because they were afraid it would cause a backlash, and that people would think she would be unable to finish the course work. In fact, she has had only one sick day in four years.)
Eileen Walko and Daryn Stier were interviewed for Diabetes on the Dial, a weekly radio show broadcast live in the San Francisco Bay Area. If you would like to order a cassette copy of the entire one hour interview, turn to page 16.
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.