Isnin, 11 November 2013

The Star Online: Lifestyle: Health

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The Star Online: Lifestyle: Health

You've lost that loving feeling


Few diabetics realise that high glucose levels can have a detrimental effect on their love life.

IT'S hard to imagine that one little compound, consisting of only three elements, can wreck such havoc upon the human body.

Glucose, which is formed from the elements of carbon, hydrogen and oxygen, is the fuel upon which our body runs.

However, getting it to where it is needed is a three-step process.

As our bodies cannot produce glucose, we need to obtain it from our food, which needs to be eaten, digested and absorbed into the bloodstream.

Our bloodstream – the transportation network of the body – will then disperse it to all the body's cells.

The glucose is then absorbed into our cells, and utilised for energy.


Dr Ismail shares that male diabetics suffering from sexual dysfunction often fail to achieve a quality erection.

The hormone insulin is a key player in this final step. It regulates the entry of glucose into our cells, and signals the liver to convert excess glucose into glycogen for storage when the body's energy levels are sufficient.

When there is a problem with insulin – either through the lack of it or resistance to its actions, as in diabetes mellitus – glucose levels in the bloodstream remain high.

All this glucose floating aimlessly around in the blood eventually causes damage to the blood vessels of the body, which results in multiple medical conditions.

While the more serious complications like coronary artery disease leading to heart attacks, stroke, nephropathy (kidney damage) leading to kidney failure, retinopathy (damage to the eye) leading to blindness, and peripheral neuropathy (nerve damage) leading to amputation, are commonly known, there is one complication of diabetes that is not as widely recognised or discussed, either by doctors or patients themselves.

While this condition may not be as life-threatening as some of the other chronic diabetic complications, it certainly has a big impact emotionally, mentally, and on the general quality of life, of those who suffer from it.

Sexual dysfunction

Good blood flow and proper nerve sensitivity are key physical factors in sexual health. And in diabetics, these two areas can be easily compromised when glucose levels are not controlled properly.

In fact, consultant clinical andrologist Dr Mohd Ismail Mohd Tambi says that some male pre-diabetics – those whose blood glucose levels are almost high enough to be classified as diabetic – do experience problems like being unable to maintain an erection or rapid ejaculation, especially after eating a bit too much and causing their glucose levels to spike upwards.

But then, when their glucose level normalises, normal penile function returns, and they do not associate their previous problems with the high blood glucose levels caused by overeating.

"The sad part is that sexual dysfunction due to diabetes is very much underdiagnosed," says Dr Ismail.

"For every three or four clients who come (to see me), at least one will admit to having diabetes upon further enquiry."

In general, he explains that male diabetics tend to have the following sexual problems: being unable to generate a quality erection, ie one hard enough for penetration; being unable to maintain an erection; and having less control, resulting in, for example, rapid or premature ejaculation.

Dr Ismail also notes that while younger male diabetics in their teens or 20s might still be able to have and maintain an erection, they often experience retrograde ejaculation.

In this condition, semen enters into the bladder, rather than being expelled through the penis during orgasm.

"When they make love, they don't see anything coming out in front. They might have a mental orgasm or climax, but nothing physical happens," he explains, adding that such patients will have cloudy urine as their semen will be mixed in with their urine.


The penis is a vascular and sensitive organ, making it an easy target for diabetic complications, which are caused by problems of circulation and nerves. – RAYMOND OOI/The Star

Diabetic peripheral neuropathy can also involve the penis.

Just like the better-known glove-and-stocking distribution of sensory loss on the hands and feet, diabetic neuropathy can cause the tip of the penis to be either overly-sensitive or numb.

In addition, Dr Ismail says that diabetes has been linked to low testosterone levels, resulting in lower sex drive, less energy and the inability to maintain an erection.

Women face it too

Female diabetics also suffer from similar sexual problems, just "translated" to the different genital organs.

"Women face the same scenario – they are less easily aroused or excited, there is less or no blood flow to the genitals, loss of sensation, and they feel quite dry.

"So, if love-making is attempted, they will feel quite sore," Dr Ismail says.

Like in men, lower levels of testosterone will make them tire more easily and decrease their sex drive.

Female diabetics are also more prone to developing the yeast infection known as thrush, due to their increased blood glucose levels, which promotes this infection, as well as their compromised immune system.

This infection is caused mainly by Candida albicans, which thrives in warm, moist areas of the body, like the vagina.

The most common symptoms of this infection are white vaginal discharge, soreness and itchiness around the vagina and vulva, and discomfort or pain during intercourse or urination.

However, Dr Ismail notes that most Malaysian women tend to view sex as more to please their partners and to procreate, rather than primarily for their own pleasure.

Sex, for women, he adds, is also more emotional and mental. "They need to feel confident, secure, and in the mood to make love. They must feel able to open up and relate to their partners," he says.

As such, female diabetics might be less prone to complain of the physical symptoms of sexual dysfunction.

Control the sugar

Treatment-wise, the first and most important steps involve controlling the patient's blood glucose levels via dietary changes, exercise and/or diabetic medication.

Dr Ismail laments that many male diabetics discard their diabetic drugs in favour of alternative therapies like herbs, because they believe that the medication will cause them to have erectile dysfunction.

"This is totally wrong! Diabetic medication does not have any effect on the penis at all," he says.

The misunderstanding, he believes, arises from the fact that diabetic patients often also have other health issues like high cholesterol levels or high blood pressure. The drugs used to treat these two conditions may result in erectile dysfunction.

There are also specific treatments to help men develop and maintain a quality erection, prevent rapid ejaculation, treat the infertility that arises from retrograde ejaculation, and increase testosterone levels.

However, Dr Ismail notes that there are no specific treatments for women with similar sexual complications.

He also observes: "To be honest, once patients get erectile dysfunction, they tend to depend on the drugs.

"At certain times, they can get normal erections on their own, but this is only on and off. They usually need to be on the drugs regularly."

He stresses that diabetics need to control their blood glucose levels first and foremost, before thinking about other treatments for their sexual problems.

"If you are pre-diabetic and control your diet and exercise, your problems will get better. Don't just keep quiet and go into denial mode.

"The same goes for women. Go and see your family physician, talk to them, and if necessary, they can refer you to a specialist."

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