In Type 1 Diabetes, Urologic Issues and Sexual Troubles Often Coexist

With Hunter Wessells, MD, and Tomas Griebling, MD, MPH, FACS, FGSA AGSF

While doctors and researchers have long known that having type 1 diabetes increases the tendency to have urinary and sexual problems, information on how common and why has been lacking.

A survey asking women and men with type 1 diabetes presents about these issues offers a clearer understanding of the impact of these critical life factors;1 the study appears in the journal, Diabetes Care.

 

Older couple on beachComplaints of bladder problems and sexual issues commonly occur with type 1 diabetes, and are treatable. Photo: Unsplash, Esther Wiegardt

Managing Diabetes Goes Beyond Blood Sugar Control

The majority of men and women reported having experienced at least one complication.  While some, though a minority of those polled, admitted to having multiple problems. Among women, for example, 2% responded that they had four such issues, and in men, 3% said they struggled with four issues.1

While there has been research looking at these issues—sexual and urinary—separately, ''no one has been able to measure all of these related issues at the same time in the same patient," says study leader Hunter Wessells, MD, professor and chair of urology at the  University of Washington School of Medicine, Seattle. 

The researchers looked into a range of conditions, including urinary incontinence, lower urinary tract symptoms, urinary tract infection, female sexual dysfunction, erectile dysfunction, low male sexual desire, and orgasmic dysfunction.

In Type 1 Diabetes: Complaints of Both Sexual Dysfunction and Bladder Issues Are Common

The men and women who participated in the survey had been enrolled in two studies; overall, 508 women and 551 men completed surveys both times. The Diabetes Control and Complications Trial (DCCT) was conducted in 2001, and the follow-up study, Epidemiology of Diabetes Interventions and Complications (EDIC) was initiated in 2010 with results published a year later.2

Here is the scorecard:

Of the sexually active women who completed the EDIC survey, 65% reported at least one complication, while 35% had no complications. Of those who reported a problem with bladder or sexual relations, 39% indicated having one issue, 19% reported two concerns, 5% had three problems, and 2% responded as having four related concerns.1

Of the sexually active men who participated in the second survey, 69% of them indicated at least one problem, while 31% reported no bladder problems or concerns with sexual activity.1 Of those who reported complications, 36% had one, 22% two, 9% three and less than 3% had four.

Sexual dysfunction was the most commonly reported issue, mentioned by 42% of women and 45% of men. Forty percent of the men indicated having low sexual desire while urinary incontinence was reported by 31% of women.1

Did the complaints disappear over the decade-long interval between surveys? Not typically, according to Dr. Wessells and his team. Improvement in initial concerns ranged from 4 to 12% of those surveyed.1

The Diabetes Control and Complications Trial is a randomized study, launched by the National Institute of Diabetes and Digestive and Kidney Diseases, that was initiated to evaluate the relationship between blood glucose control and the development, progression, and treatment of early vascular complications in people who require insulin to manage their diabetes.2

Will these Findings Inform Diabetes Care in the Future?

The frequency of urinary and sex-related complications are so much higher in people with type 1 diabetes then is seen in the general population, Dr. Wessells tells EndocrineWeb. And, he points out, while the general population does tend to have similar complaints as they age, those with diabetes tend to develop the complications at a much younger age, and for a lot longer.1

What causes these quality-of-life issues to occur earlier in people with diabetes? Issues of bladder control and sexual function are affected by both vascular and nerve activity, he says. Diabetes often has a negative effect on both the nerves and blood vessels, which will naturally raise the risk that these complications will develop. Also, nerves affect the bladder, urethra, and the sexual organs, he says, and on top of that, sexual organs depend on a good blood supply.

The effects of diabetes, particularly when it is not well-controlled, will worsen these symptoms because it affects both nerve health and blood supply, kind of a double whammy for sexual complaints, he says.

While the remission rate for complaints was low, some people did remit, Dr. Wessells says. That is a good area for future research, to figure out why the group that had remissions did so.

While he can't say at this point if there are specific factors that would assure a reduction in symptoms, he speculates that aiming for good control of blood pressure, blood sugar, and body weight, and not smoking are all likely to play a role. "Since these factors [which possibly are driving the complications] are modifiable," he says.

Do Similar Patterns Occur in Type 2 Diabetes?

While the researchers did not study individuals with type 2 diabetes, Dr. Wessells suspects that the same physiological factors are likely to drive complications related to sexual pleasure and urinary problems in anyone who has type 2 diabetes. Again, the issues are most likely to present in people whose diabetes is not well managed.

Until more research can better inform changes in patient care, Dr. Wessells urges anyone with diabetes to speak up sooner about these complications and to seek help because relief is available. More importantly, the earlier you get treatment, the better your chances of feeling better, and possibly even reversing the symptoms, he says.

Mention Sexual or Urological Concerns to Your Doctor, Help is Available

The findings do not surprise urologist Tomas Griebling, MD, MPH, FACS, the John P. Wolf 33 Degree Masonic Distinguished Professor of Urology at the University of Kansas in Lawrence. Based on his clinical experience, he speculates that "some of the conclusions will apply equally to type 2 diabetes, too."

One surprising finding, he says, is the high rate of female sexual dysfunction. "It really stands out; we've had data about this complaint in men," he says, but this study highlights this problem as a women's issue, too.

"Better glycemic control may prevent you from developing some of these complications, and [if you already struggle with urinary problems or sexual dysfunction], it may mean you may have better outcomes," Dr. Griebling tells EndocrineWeb.

In general, he says, one issue that arises in many of his patients with urological problems is delaying trips to the bathroom. "There is a myth that you can hold urine for a long time and somehow that is a good thing but our bodies are not designed to do that." It’s much better, he says, to void regularly and completely. Simply put, as soon as you feel the sensation, Go!

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