Some estimates suggest that just over 10 percent of all Americans have diabetes, a blanket term for several diseases that affect how bodies produce or react to insulin, a hormone created by the pancreas that regulates the amount of sugar in the blood. Even though diabetes is one of the most common chronic health conditions in the world, a surprising number of its potential effects on people’s lives are often neglected in medical research and discussions with health care providers—especially as those effects relate to sex.
The sexual issues associated with diabetes aren’t rare or insignificant. In fact, many of the core symptoms of diabetes can have a huge impact on people’s sex lives. Excessive blood sugar levels (hyperglycemia), linked to un- or under-treated diabetes can cause brain fog, fatigue, extreme thirst, blurred vision, nausea, and shortness of breath. Excessively low blood sugar (hypoglycemia), linked to glitches in diabetes treatment, can lead to confusion, fatigue, vision issues, anxiety, shakes, sweats, and, in extreme cases, seizures. Either can make it incredibly hard to feel turned on, let alone engage in sex.
More directly, many diabetics report issues with libido, arousal, sensation, orgasm, frequent yeast and urinary tract infections (UTIs), and bladder issues like incontinence. People with penises may experience retrograde ejaculation, where semen shoots up into the bladder, and are also at elevated risk of developing Peyronie’s disease, which causes an extreme, painful curvature in their penises. Those who use wearable continuous insulin pumps or blood sugar monitoring devices have to be conscious of these tools when grappling with partners or moving into positions, if they keep them hooked in and on during sex. Though effective management can rein in most sexual complications, some may persist.
The lack of attention paid to these issues, even within medical care and research contexts, is a huge problem, given how difficult it can be for people to independently figure out what to do about effects that don’t disappear with basic diabetes management. For instance: Persistent low libido may reflect anxiety, depression, and self-image issues linked to living with diabetes. Or it could stem from long-term blood flow and enervation damage. Or it could be a side effect of diabetes medication. Each cause may require a different intervention.
Diabetes advocacy, education, and support groups have attempted to address this gap by publishing and disseminating rundowns on diabetes’ potential sexual effects. These guides often give remarkably fine-grained advice for how to feel out the source of, cope with, or fully tackle each individual issue. But accounts of couples navigating sex and diabetes are still few and far between. VICE recently spoke to Laura Bull, a Type 1 diabetic, and her partner, James Harrod, about how they deal with diabetes and sex.
Laura Bull: I got diagnosed with diabetes five years ago. I was having recurring UTIs that I couldn’t get rid of, so my doctor tested my blood sugar. It was about four times higher than average, so they put me on insulin injections.
I realized I’d experienced other diabetes symptoms and just written them off: Carbohydrates made me sleepy, so I stopped eating them. I lost a lot of weight, but I thought it was because of this new diet. I drank seven liters of water at work, but I thought it was just because of the UTIs. All of that had become normal to me, but, in hindsight, I was not doing well.
James Harrod: We got together two months after you got diagnosed. Diabetes actually came up in our initial Tinder conversation. I like to bake, so I was like, “I’ll bake you a cake sometime.” Laura said, “I have diabetes, so I can’t eat it.”
Laura: At that point, I still thought having diabetes meant I couldn’t eat something like cake. (It doesn’t.) I’ve always been really open about what’s going on with my health, although a lot of people try to hide their diabetes, especially when dating.
Our second date was only the second time I’d gone out to eat after I started this course on how to adjust your insulin dose so you can eat what you want, which mainly teaches you how to count the grams of carbohydrates in whatever you’re eating. We got this massive pizza.
James: It was a really good pizza…
Laura: I thought, I have no idea how much insulin to inject for this. Then James was just like, “It’s 120 grams of carbs,” because he counted macronutrients as part of his gym routine. As we kept dating, he’d calculate the carbs and the insulin dosage for meals we’d cook together without me ever asking. From the beginning, he very much shared in the management of my diabetes. He’s done as much as he can to make my life as easy as possible.
James: As the partner of someone who’s diabetic—or who has any disability or chronic health condition—you have to ask questions and do your homework. It’s a big burden to put on one person to manage everything to do with a disability in a relationship. I know that I can’t be your pancreas…
Laura: [Laughs] You’ve tried, though.
James: But I do what I can. Honestly, stuff like that also makes my life easier. When we weren’t living together yet, if we hung out for an afternoon or an evening, it was always more enjoyable for both of us if you weren’t having sugar highs or lows. Early on in our relationship, we would be having sex, or about to have sex, and you would sometimes get very low or very high, which would force us to stop.
Laura: I was also really worried about getting UTIs from sex early on because of the recurrent infections that led to my diagnosis. A few months into our relationship, I experienced more dryness and pain, and sex ended in a UTI for me more often than not. At one point, we were going six weeks to two months between having sex as I recovered from my UTIs.
James: We never had a big conversation about any of this. It was more organic. We’d say, “OK, we had sex and now you have a UTI, what can we do to make sure that doesn’t happen next time?” Or, “You had a sugar low during sex. Next time we can try making sure there are sweets on the nightstand so you can get your blood sugar up.”
Laura: We’re physically active; before the pandemic, we went to the gym together. Our communication after sex is similar to what we have around any other form of physical activity. I’ve always felt comfortable saying whatever I need to James. Like, “We need to stop now. I need some sweets.”
Usually, by the point I need sugar, I’m in no mood to continue having sex; I get shaky, can’t focus properly, and start slurring my words and saying lots of weird stuff. We just stop everything at that point indefinitely.
James: As your diabetes management improved, it seems like it’s helped you avoid highs, lows, and UTIs. We also changed our diet to eat healthier and drink more water.
Laura: The UTIs were hard to troubleshoot, though. I developed rituals like washing myself off immediately after sex.
James: That can have a slight effect on our intimacy, because if Laura goes to the bathroom right after sex every time, we can’t really cuddle. We usually have sex at night, so by the time she finishes up and comes back, I’ve usually fallen asleep. [Both laugh]
Laura: I also take antibiotics and cranberry tablets for a couple of days after we have sex. I can’t eat anything too sugary right after sex, either, or that can sometimes risk an infection. And we’ve got all kinds of lubricants to counteract dryness that we can easily reach out and grab.
James: Sometimes, diabetes still limits when we can have sex. Like, if you do have a day with a lot of highs and lows, I’m probably not going to initiate anything because I don’t want to add more variables to an already difficult calculation for condition management.
Laura: I’m usually ready for bed by, like, 9 p.m. because of all the extra thought I have to put into planning and managing my diabetes. On bad days, I’ll pass out at 7. Sometimes there just isn’t any opportunity after work for us to actually have sex.
James: There have also been days when you didn’t want to try to have sex because you were concerned about how the activity would affect your blood sugar, and the risk of triggering a low.
Laura: About a year and a half after my diagnosis, I switched from insulin injections to wearing an insulin pump. That really helped with maintaining my blood sugar consistently. And I’m pretty body-confident, so I never felt self-conscious about wearing it. But you do have to be aware of the tubing between the device and the needle going into your body. You don’t want it to get hit accidentally and jab the needle deeper inside of you, or to get tangled up in the tubing.
James: Your continuous glucose monitor actually caused more issues like that than the pump.
Laura: [Laughs] Yeah, I don’t think you actually know which side that’s on.
James: Well, you change it every week!
Laura: That is true. You have to avoid that accidentally ripping that thing off, as well.
James: With the pump, if we’re having sex and realize it’s come unplugged, then we stop and figure out when that happened and how much insulin you missed. It’s easy to roll over and unplug it, or to accidentally hook a thumb in the tubing while you’re trying to grab your partner. I’m sorry I can be so clumsy with that.
Laura: [Laughs] I mean, I’m clumsy too, so…
James: Your band has probably been the saving grace for our sex life in that respect.
Laura: I have this little band I can tuck my pump into. Mine is quite small and light, so it’s easy to keep it secure under there. I can unclip it during sex if my sugar levels are doing well.
James: Even when we can’t have penetrative sex, whether because of diabetes or anything else, we can always find alternative solutions. Like, oral sex doesn’t seem to cause as many issues.
Laura: We default to oral if we want to be intimate, but don’t think we can handle the possible consequences of a full penetrative sex session for whatever reason.
James: Or we find other non-sexual things to do together, like cooking or watching a movie. Just having a date night makes us feel romantic and special.
Laura: We get on so well with each other. We’re really good teammates. We’ve always loved each other so much. Our connection is never in doubt, even when we can’t have as much physical intimacy. And you know what? Being together for like a year straight with the lockdown has only improved how we talk about this. Our sex life has been a saga, but we can always find ways of working through these issues.