Erectile dysfunction and female sexual dysfunction may be a sign of undiagnosed diabetes or an indicator of a complication of diabetes.
It is therefore important that healthcare professionals are aware of the possibility of a sexual problem and are confident to ask the right questions at any given moment.
Here is a checklist designed to help you encourage your patients to talk about any sexual problems they may be experiencing.
Be aware
The person who pauses at the door of the consulting room may just have found the courage to approach the subject. You must make time to listen or the moment may be lost.
Be comfortable
Use the correct terminology when talking to your patient, but be ready to explain what you mean if you recognise that they do not understand. If you are embarrassed, they will be embarrassed too.
How to encourage a response to a difficult question
A direct question may not produce any workable reply. Possible 'lead in comments' could include:
On medication
"The doctor has started you on a tablet for your blood pressure. Were you told that it could cause you to have problems with impotence/ sexual dysfunction?”
Note for HCP: Some diuretics, beta blockers, ACE inhibitors can cause ED. It is possibly due to the reduction in pressure flowing through the arteries, but reassurance for the patient that alternatives therapies are available is usually enough. There are other groups of drugs which also cause problems eg antidepressants, tranquillizers, appetite suppressants.
On substance use
“Too much alcohol (over the recommended limit of 14 units for women and 21 units for men), can cause erectile dysfunction often referred to as ‘brewer’s droop’ or sexual dysfunction in women.”
“Smoking causes more than lung cancer, it can lead to sexual dysfunction (woman)/ impotence (man).”
Note for HCP: excessive alcohol affects the nervous system and interferes with the signals from the pituitary gland and the genitalia. It can also reduce the levels of ‘sex’ hormones in the body – testosterone and oestrogen.
Note for HCP: Smoking causes a reduction in penile blood pressure decreasing the flow of blood to the penis probably due to atherosclerosis. Nicotine can cause vasoconstriction or spasm within the penile arteries. Nicotine causes the venous chamber of the penis to dilate so losing the erection. In women this would be translated to the flow of blood to the clitoris.
On surgery/trauma to prostate, bladder, pelvis, spinal cord, penis
"Were you told after your operation/accident, you may find problems with getting or maintaining an erection/having sex? If this happens, you must come and talk to a doctor.”
Note for HCP: This may be due to temporary or permanent damage to nerves or arteries near the penis.
On stress/overwork/tiredness
“You have a very busy life/stressful job/lot of travelling. Try to make sure that you take time for yourself to relax as stress, tiredness or overwork can lead to sexual problems such as erectile dysfunction/female sexual dysfunction."
Note for HCP: Stress, anxiety, guilt, depression may follow diagnosis of diabetes and contribute to ED/FSD.
If your patient has decided to talk to you about sexual dysfunction, it is important to reassure them that help is available.
Reviewed November 2009