Three of the most important topics in relation to teenagers are illicit drugs, alcohol, and sex. Clearly diabetes has implications on all three. I want to be proactive in these blogs and address these sensitive topics. Ginger and I already discussed Alcohol and Diabetes. (Diabetes and Alcohol: Part I - If You Choose to Drink) The next very relevant concern for all teens is sex, birth control, and protection from sexually transmitted diseases.
Diabetes complicates the issue of sex in very significant ways. First let's discuss important facts that concern all teens, regardless of diabetes. I do not want to discuss the morality of sexual behavior. My goal is to be open and honest and discuss what is actually occurring in your world and not hide from reality. Therefore, it is very important for teens to protect themselves from unwanted pregnancy by use of appropriate birth control and barrier protection to avoid STDs. My suggestion for all girls who are planning to become sexually active is to be proactive, and visit a gynecologist who can discuss these issues. I also suggest that young women should have their first visit with a gynecologist before starting college.
How does diabetes affect sexuality and sexual behavior? It is different for everyone. Some feel less attractive because they have to check blood sugars or wear a pump. Others have no issues. It is important to remember that you are a person who happens to have diabetes and that you are still you. The same precautions as described above (avoidance of pregnancy and protection from STDs) apply to you. However, for women with diabetes, if you choose oral contraception, it is important to choose the appropriate combination of hormones to minimize the possibility of blood sugar related issues. A visit with your gynecologist is essential. Many gynecologists will recommend the lowest hormonal doses possible to alleviate blood sugar variability. This concern may require an open and honest discussion with your family, which I highly recommend to prevent surprises and ensure appropriate medical care (including insurance issues). As always, barrier protection (condoms) is necessary, regardless of whether you use oral contraceptives, to prevent sexually transmitted diseases.
Another important factor to consider is that sexual activity is a form of exercise and you must be careful that you do not go LOW. Rapid acting carbohydrate should be available at all times (along with a blood glucose meter, etc.) If one of my teen patients is on an insulin pump, he or she will often ask if they should remove the pump during sexual activity. This decision is entirely up to you. Keep in mind that very long tubing is available to keep the pump off your body or you can remove the pump, as you would normally do if you took a shower or went swimming.
Many of my male patients are concerned about impotence. Unfortunately, this complication of diabetes may occur due to autonomic neuropathy (compromised functioning of tiny nerves) and may occur after long-standing (and often poorly controlled diabetes). Impotence secondary to diabetes alone is very rare at your age. However, other factors may be in play, including your emotions. I encourage men to control their diabetes as best as possible to prevent this complication.