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by Aryadasa Ratnasinghe

"Hermonal influences on human sexuality begin at the moment of conception and continues throughout life. Among the disturbances of endocrine function that adversely affect sexual response in the male, the most insidious is diabetes, and it is equal, if not greater, than other endocrine disorders combined".

Dr. Bernard Shagan

There are two principal types of diabetes. In Type 1 (formerly known as insulin dependent), the pancreas fails to produce sufficient quantities of insulin which is essential for survival. Type 2 diabetes (formerly known as non-insulin dependent) is the result of the body's inability to respond properly to the action of insulin produced by the pancreas. The former develops among the younger generation, and the latter is acquired due to hereditary reasons. The symptoms of diabetes may be pronounced, subdued or even absent.

Insulin

Insulin is necessary to control sugar metabolism in the body. In a diabetic patient, the blood-sugar level rises above normal values (the range being 70 - 100 mg/dl), and spills over into the urine causing the onset of diabetes. Insulin is a protein secreted in response to increases in the blood-glucose concentration, after a meal, and its main function is to lowdown blood-sugar and promote its conversion into glycogen and fat.

Hormones are internal secretions which exercise a specific physiological action. They are chemical messengers synthesised and secreted in small amounts by the endocrine glands that pour secretions into the blood. They are chemically classified into amines (noradrenaline and thyroxine), peptises (oxytocin), proteins (insulin) and steroids (aldosterone and testosterone). Hormones play extremely vital roles in sexual function and behaviour, and have a dramatic effect leading to impotency.

Pancreas

The pancreas which secretes insulin is known as the 'sweet-bread'. It is a large gland, 12 to 15 cm. long, discharging into the duodenum and containing islands of endocrine gland tissue or the Isles of Langerhans. Diabetes was once considered a model for the aged and changes in lifestyles given to the intake of high calorie-refined foods and sweet products, and no exercise, sometimes leading to abnormal weight gain or being obese, have been cited as instances favourable to the onset of diabetes.

Unfortunately, today, even children suffer from this horrible disease, which is debilitating, degenerating and leading to complications of the metabolism process within the body. Recently compiled data by the World Health Organisation (WHO) reveals that approximately 150 million people, throughout the world, have diabetes. Sri Lanka is a good example of the lifestyle changes that show a marked increase in the prevalence of diabetes mostly among the urban than the rural population. There are about 1 million people in the country who are diabetics.

Complications

Diabetes may develop, as its concomitant, peripheral arterial disease, arteriosclerotic heart disease, premature loss of limb, paralysis, diabetic retinopathy leading to blindness, renal failure etc. Diabetic neuropathy is, probably, the most common complication of diabetes. It can lead to sensory loss, damage to the limbs and is also a major cause of impotence among men. The mainstay of non-pharmaco-logical diabetes treatment is diet and physical exercise. Changes in sexual dysfunction may also be one of the sequelae of diabetes, e.g., impotence in men, frigidity in women and loss of libido in both. The incidence of impotence in males is difficult to evaluate because they do not want to divulge it to others over their erotic failures.

On the other hand, medical research studies regarding diabetes on sexuality have mostly been directed towards the male who are the active partners during intercourse. In the female, it may cause orgasmic dysfunction and, when achieving pregnancy, bear larger babies than normal size, unlike in non-diabetic women. This position, invariably, returns to normal after childbirth.

Association

The close association between diabetes and impotence was first recognised in 1798, but in the past 30 years or so, it has received increased attention by the WHO and other international health organisations and family planning associations including sex-guidance clinics. The Diabetes Association of Sri Lanka has come forward to give support to diabetic patients and those who suffer from impotence.

According to medical opinion, the precise etiology of diabetic impotence is still not clear, but it has been postulated that four conditions are possible, viz: (1) The type of diabetic neuropathy, (2) Vascular changes, arteriosclerotic changes in the penile blood vessels that impair pooling and trapping of blood in the corpora of the penis. (3) A disruption of bio-chemical or hormonal balance and (4) Psychogenic factors. It is also possible that two or three of these conditions may exist together.

Neuropathies

There are several diabetic neuropathies rather than one single entity. The scope of the involvement includes every system. "Peripheral neuropathy and visceral neuropathy as well as direct autonomic neuropathy may occur in diabetic patients leading to impotence". Vascular insufficiency has been implicated but not confirmed as a cause of impotence.

Endarteritis affecting the vascular mechanism of erection has been suggested as a cause of impotence. Sometimes, psychologically, fear or failure, with accompanying decrease in erectile strength, may operate to cause impotence, even though pathophysiologic problems are not extensive. Most diabetics fear that they may not be able to achieve a successful coitus in view of the disease, when their wives feel that their husbands have lost their masculinity.

Fatally fourth

According to the WHO, diabetes is the fourth main cause of death in most developed countries, depending on the food they eat and due to easy lifestyles with no exercise. According to medical opinion, people with diabetes are most likely to develop cardiovascular disease than people without diabetes.

Scientists of the world have realised that Type 2 diabetes, which is spreading in epidemic proportions, has no single cause, but the potential areas are genetics, foetal origins, lifestyles and most the stress. There is conclusive evidence that good control of blood glucose could be significantly and substantially reduced to prevent the risk of developing complications and slow their progression in all types of diabetes. The management of hypertension (high-blood pressure) and raised blood lipids (fats) is equally important for the control of diabetes.

Control

Diabetes is, today, a serious and costly disease which is raising its ugly head and becoming increasingly common, mostly in developing countries, like Sri Lanka, and chiefly among the middle-class families who are prone to rich foods and different patterns of living conditions. Diabetes cannot be cured but can be controlled to lead a normal life with selected diet.

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Copyright 2001 The Associated Newspapers of Ceylon Ltd.
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