Since diabetes can result in more frequent infections of all types, vaginitis is a particular problem for sexual functioning. Both partners may experience pain in intercourse related to this and other tissue infection. About one third of women with diabetes have problems with orgasmic contractions, probably related to the same neurological and vascular damage as in the male. Erection of the clitoris would also be expected to be affected. Diabetic women should check for recurrent mild urethral infections, cystitis, and vaginal abscesses, these are all treatable, so there is no reason to continue to have pain in intercourse. If you notice a decrease in natural lubrication (maybe due to microcirculation problems), check with your doctor. Again, do not assume that sexual problems are always related to your disease. If there is a lubrication problem, lubricants can be prescribed or recommended.

As with men, all areas of the sexual-response system remain intact for diabetic women. Interest, arousal, psychasms, and other dimensions do not have to be impaired if open communication and degenitalized approaches are considered and practiced.

Diabetes is like any other disease in that it is helped by positive emotions and intimacy, and hindered by fear and helplessness. Even if your diabetes gets worse, remember, you do not cause it to get worse. Even with your best efforts, diseases run different courses. None of these courses preclude intimacy. Every couple I treated in which one or both partners were diagnosed as diabetic were able at five-year follow-up to experience a mutually pleasing sexual life, even when the diabetes itself might have worsened. There were eighty-seven diabetic men in the sample and forty-seven diabetic women. While initially thirty of the men were considering implants, none of them went ahead with that procedure following counseling.

If severe genital problems have resulted from diabetes, there are still several things that ean be done to enjoy sex. You read about some of these in Chapter Eight. One of the oldest medical jokes relates to a man whose arm hurts every time he tries to raise it. He tells the doctors about his problem and the medical advise is, “If it hurts when you do that, then don’t do that.” I would add, “If it hurts, check out why, if it can’t be helped, try something else.”

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