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Sex and Diabetes: Climax Change
David Spero RN and Aisha Kassahoun
Aug 22, 2009

Dear Sex and Diabetes,

I am a 55-year-old woman with fairly well-controlled type 2 diabetes. I'm still interested in sex, but I haven't had an orgasm in three years. My husband and I make love anyway, but I miss orgasms. He feels bad about it too. - Unfinished

Dear Unfinished, You're not alone. In various studies, problems with orgasm have been reported by 15 to 39 percent of women with diabetes and about 10 to 20 percent of men.

Orgasm is usually defined as an intense reaction that occurs after sexual stimulation and involves contractions of the lower pelvic muscles. Because it is accompanied by the release of endorphins and oxytocin, it leads to a great feeling of relaxation and satisfaction in both men and women. Women sometimes also feel energized by orgasm.

In order for orgasm to occur, there must be blood flow to the sex organs and the stimulation of certain nerves. At the climactic point, the nerves trigger the extra genital blood to release back into the circulation, setting off the feeling of orgasm. Diabetes can interfere with orgasm both by limiting the blood flow and by damaging the nerves. Consequently, good diabetes control is the place to start improving your orgasmic function.

Psychological factors, such as stress, relationship issues, and depression, can also block orgasm. But there are many ways to reach orgasm, and you just might need to try something new. Seventy percent of women rarely orgasm from vaginal intercourse alone, but other kinds of stimulation are often very helpful.

Are orgasms necessary?

Many people believe that orgasms are the be-all and end-all of sex, but they're not. Although orgasms feel great and sometimes bring couples closer together, sex can be really good (some say better) without them. As the relationship counseling site Reuniting says, "Making love is like blowing up a balloon. Orgasm is like popping the balloon. Without orgasm, you walk around with your balloon inflated for days."

Tantric sex teaches men to have sex for hours without orgasm or ejaculation, and

Chinese medicine considers orgasms actually harmful for men above a certain age because it drains their energy. The Chinese physician Sun Su-Mo wrote, "A man may attain health and longevity if he practices an ejaculation frequency of twice monthly, or 24 times in a year. If at the same time he pays careful attention to proper diet and exercise, he will have a long and healthy life."

And that's for young healthy men. Many acupuncturists advise only one orgasm a month for men over the age of 50. If a man has health problems, they may advise avoiding ejaculation completely. They don't place such restrictions on women, though, because female orgasm is "more internal."

Paths to orgasm

In her book The Big O, sexologist Lou Paget describes ten paths to female orgasm: Stimulation of the clitoris (most common), the G-spot, the vaginal nerve centers, the urethra, the breast, the mouth, and the anal area, stimulation of other body areas (different for different women), and fantasy (no touch at all).

Men, says Paget, can orgasm from stimulation of the penis, prostate gland, anus, nipple, breast, and other body areas, or from fantasy.

We encourage you to explore some of these other areas on your own, especially the G-spot. The G-spot is a bunch of tiny glands about one to three inches inside the vaginal opening, under your pubic area in the front wall of the vagina. It feels like a sponge to touch, and you can reach it yourself. You might feel as if you need to urinate at first touch, but keep stroking it. Most women (not all) say it feels great. You can also teach your man how to do it, which might be even better.

Breathing can also help you get to orgasm. Some people tend to hold their breath as they approach orgasm (or during other intense sensations), but breath-holding can shut sensation down. Some tantric sex practitioners report that they can actually orgasm from controlled breathing alone.

Communication is important, too. You mentioned that your husband "feels bad" when you don't orgasm. Many men experience a big thrill when they help bring a woman to orgasm, and your husband may feel at fault because you're not having them. And of course, he loves you and wants to please you. It would probably be a good idea to reassure him that you don't blame him, and you can also ask him to help you explore new paths to pleasure.

It's very important to get in the right mood, relaxed and loving. Better love tends to create better orgasms. And take your time! Reduced blood flow might slow down your orgasmic process but, given enough time, you can still get there. And remember that loving is still good, with or without the big climax.

If readers have other ideas about orgasms, we would like to hear them. We look forward to reading your comments.

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David Spero RN is a nurse who has lived for 30 years with multiple sclerosis. A leading expert on self-care, he has written two books, Diabetes: Sugar-coated Crisis, and The Art of Getting Well. He has learned to maintain and even improve sex and love despite disability and illness.

Aisha Kassahoun is trained in marriage and family therapy. Aisha and David present sex and intimacy programs for people with diabetes, people with multiple sclerosis, and health professionals.

Visit David and Aisha online at davidsperorn.com or check out their coaching and counseling services. You can also read David's blog.