Approximately 15 million women in the United States have diabetes. And in many ways, women have more to manage when it comes to their diabetes and their overall health — including their vaginal health. In light of National Diabetes Month, we discuss the ways in which diabetes impacts yeast and bladder infections, plus the effects on libido and sex.
Diabetes is connected to a plethora of dilemmas, as it stems from the inability to produce glucose — AKA sugar — which can create complications that impact a woman's livelihood. For both men and women, diabetes increases the risk of heart disease. But in women, it increases those chances four times more than in men, according to the Centers for Disease Control and Prevention (CDC). Additionally, women with diabetes have increased risks of blindness, kidney disease, and depression compared to their male counterparts.
But it doesn't stop there.
"Diabetes impacts vaginal health in many ways," says Mary Jane Minkin, M.D., OBGYN, the clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine. "The major issue is that if a woman has diabetes that is not well controlled, she is spilling — literally — sugar into her urine."
Women with diabetes have an exponentially higher chance of having yeast infections and urinary tract infections due to higher blood sugar levels and poor circulation, according to the CDC.
Thrush, which is a fungal infection, also known as a yeast infection has symptoms that include itching, burning, discharge, or a foul order.
Despite common misconceptions, thrush is not a sexually transmitted infection, but it is typically passed from person to person during sex. While anyone can get thrush, yeast feeds on sugar, and since women with diabetes have sugar in their urine, they are at a much higher risk.
Many women with diabetes cannot empty their bladder all of the way due to bladder retention, which leads to bladder infections, urinary leaks, and a constant desire to "have to go." By not emptying the bladder, there is an ideal environment for bacteria to wreak havoc on the body.
"If there are any bad bacteria or yeast around, they truly thrive on that extra sugar — or in a sense — they are gobbling it up and the sugar is promoting their growth. So that is why diabetics should strive to keep their blood sugar levels as close to normal as possible, so the sugar doesn't get into their urine," Minkin tells Healthnews.
Certain medications like Dapagliflozin, Empagliflozin, and Canagliflozin, which are type 2 diabetes medications, can increase the risk of thrush.
Sugar can also enhance the growth of bacteria in the urethra, which has easy access to sugar since it sits at the opening of the vagina.
"So you are getting promotion of growth of organisms in both the bladder (which leads to urinary tract infections) and the vagina," says Minkin.
A urinary tract infection (UTI) is when the tubes — called ureters — that connect your kidneys to your bladder become infected. It's a very common, yet painful, condition with 50% to 60% of women getting a UTI in their lifetime.
A 2018 study published in Cureus found that people with type 1 or type 2 diabetes have a higher risk of infection than people who do not have the condition.
In general, Minkin says, women with diabetes have a tougher time fighting off infections. Since their immune systems aren't working at peak capacity, they are at risk of other complications like foot infections or infections after surgery.
Another way in which diabetes can impact the vagina is vaginal dryness. High blood sugar leads to damaged blood vessels in the vagina which results in less natural lubrication. The outcome? Painful, unpleasant intercourse.
Minkin says that vaginal dryness can lead to more infections, like UTIs, too.
"I've had a difficult time achieving orgasm," says 47-year-old Amanda Adamson* from Louisville, Kentucky, to Healthnews. "I think it's all connected to my diabetes, but I'm having trouble finding answers because I'm also getting older and it's easy to brush off as menopause."
People with type 2 diabetes are, on average, over the age of 45 years old but in some cases teens and children develop it at a younger age.
For some women, Adamson included, having any sex at all sounds less than desirable. A 2013 study published in the Journal of Natural Science, Biology, and Medicine looked at 500 women with diabetes and found that 81% of the participants had low sexual desire and 47% had issues with reaching an orgasm. The reasons for this may be nerve damage, reduced blood flow, medications, or hormonal changes.
Adamson says her marriage of 15 years is suffering not only because of her type 2 diabetes diagnosis, which she received one year ago but also due to her complete lack of desire for sex. "I don't want to initiate, and I'm not interested when he initiates. If I don't experience an orgasm, it's hard for me to want to have sex. So, where do I go from here?" she says.
Approximately 90% of people with type 2 diabetes are overweight or obese, according to the CDC. Adamson, a stay-at-home mom, is candid about her weight gain and says much of her health issues are connected to her extra body weight. "I'm worried about future health concerns. I'm obese, I know I weigh too much and now I'm suffering the consequences. All of that worry is turning into constant anxiety and stress and all of that stress and anxiety is making me want sex less and less."
While they are different, vaginal concerns are present in people who have type 1 and type 2 diabetes.
So, what are the specific variations in the two diseases?
- Type 1 diabetes is when the pancreas — which maintains healthy blood sugar levels — does not make insulin. This type of diabetes is an autoimmune disease that can stem from certain genes, viruses, foods, or chemicals.
- Type 2 diabetes is when the pancreas makes less insulin but the body becomes resistant to it. This type of diabetes is not an autoimmune disorder like type 1 diabetes and occurs due to body fat or genes.
How can you prevent vaginal issues when you have diabetes?
"We always have bacteria in our vaginas — but there are good bacteria and bad bacteria and yeast," says Minkin. "The good bacteria known as lactobacilli make acid— sounds strange, but acid in the vagina is good — and helps keep bad bacteria and yeast away."
The main method in keeping any infections away is to maintain your blood sugar levels as close as you can to your target range. To avoid thrush, keep your blood sugar in your target range, don't use perfume or shower gels near your vagina, and wear loose underwear.
Advice for UTIS is similar and includes drinking water, wearing cotton underwear, and urinating as often as you can instead of waiting for a full bladder.
For lubrication problems, there are several products for women to use to increase natural lubrication. Painful sex with no lubrication can lead to small tearing as well as less desire to have intercourse.
Adamson says, "I plan on seeking help for my orgasm issues and my low libido. It's only been a year since my diagnosis, so I feel like I'm just now getting my diabetes under control and understanding what my diagnosis means. It's been a lot to process."
For diabetic women going through menopause, visit a doctor who can prescribe estrogen medication, which may help with less lubrication and lower libido.
Minkin suggests over-the-counter vaginal moisturizers for women who need more lubrication and probiotics for women looking to avoid future infections.
Overall, some of these conditions may make you feel embarrassed. But with one in nine American women having diabetes, you are not alone. Seeking professional help and figuring out a solution to control blood sugar and combat vaginal issues can only enhance your life and your future.
Several of these conditions can be prevented. And during this years National Diabetes Month, being aware of the risks is the first step.