Shireen: Podcasting from Dallas, Texas. I am Shireen. And this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Dr. Janice Roszler is a two-time award-winning diabetes educator of the year, a licensed marriage and family therapist, board-certified sex therapist, and registered dietician nutritionist. Her columns have appeared throughout the United States, China, and Dubai. And she’s the author of five books on diabetes-related sexual complications. Welcome Dr. Rozsler. 

Dr. Roszler : Thank you for having me an absolute pleasure.

Shireen: So, Dr. Roszler, can you tell our listeners a little bit about your background and what made you focus on sex health and diabetes? And what we’ll be discussing here today? 

Dr. Roszler: Sure. I started out as a registered dietician, got into the diabetes world because that was what fascinated me the most. In contrast to other areas where no matter how hard you try to change your lifestyle, you may not improve with diabetes. If you make different lifestyle decisions, food decisions, and behavioral decisions, you can have a better quality life. I really like that. I was working with a gentleman one day in a doctor’s.

Endocrinologist office. I’d given him his diet counseling and you know, the whole thing that I was hired for. And then I went out into the waiting room and I saw this woman who I gathered was his wife sitting in the corner and she was weeping. And I immediately ran over to her and I sat down and I said, could I help you?

What’s going on? And she said, my, my husband and this diabetes, it’s ruining our marriage. And I can’t take it anymore. And I felt so helpless because all I had in my arms were nutrition guides, and I didn’t have anything that I could suggest that she read or any place for her to go or. You know, this predates websites, I guess I’ve been at it a long time, but nothing to give her.

So I immediately started to search and eventually it led to me writing my first book that I wrote with a diabetes, psychia psychologist and an endocrinologist. And so that’s how I got into the sex world for diabetes. Later at I was speaking at a CDC conference. I ran into the only other person I knew who was doing something similar.

A woman who became my co-author for all of these years, we’ve written numerous books together, spoken together, and whatever. But what we have found is that this is still a topic that few healthcare professionals ask about. It’s a topic that people with diabetes aren’t that aware of and don’t realize how diabetes can affect them and what they can do to improve things.

And so we still need to get the word out there. Just, you know, as urgently as the day that I met that woman and I guess.

Shireen: Help us understand the extent of this. So you’re absolutely right. Not a lot of people are talking about this. This is something that we came upon and we were sort of like, oh, this is interest.

Now sexual health can affect both men and women with diabetes. The most common problem that we’ve heard of is a decrease in libido, due to medication, anxiety, depression, et cetera. Can you help us understand that a little bit more for both men and women? 

Dr. Roszler: Sure. Well, first of all, let me tell you the numbers.

Approximately half of all women and men with diabetes are experiencing some type of sexual complication. That means every other person, the healthcare provider sees is having something and the range of issues is quite great. So we do know men, for instance, men with diabetes are three more likely to develop erectile dysfunction.

And they’re more likely to develop 10 to 15 years earlier than men who don’t have diabetes. They could also experience lower self-esteem because of performance or if they’ve had weight gain and you know, how they feel about connecting intimately performance anxiety, certainly with the erectile dysfunction.

Orgasm and ejaculation challenges and also lower libido lowered sexual interest. As far as women, women with diabetes have a greater risk of developing sexual complications than those who don’t have it. They may feel also less sexual desire. They may have pain during intercourse. That could be because of the diabetes slow arousal time a lack of or lessening of the level of vaginal lubrication a loss or decrease in genital sensation.

Reduce self-esteem certainly like men orgasm challenges. They also have an increased risk, especially if their blood sugar rottens tends to run high, a risk of urinary tract infections, which can lead to delays in sexual activity because you have to treat it and you’ll have to stop having sex until you finish treating it until everything goes back to a healthy level.

So those are the kind of things that we see in, in both men and women.

Shireen: And can you talk a little bit about blood sugar challenges during sex itself? The understanding you need to develop with your partner? What that could look. 

Dr. Roszler: Well, first of all, let let’s take a look at, at sex. Sex is a physical activity.

So if you view it as any form of exercise, you are likely there’s always a risk of going low. Of blood sugar dropping because you are utilizing your blood sugar stores to, to do something just as if you were running a race or if you were, you know, and certainly the level or intensity of sex varies, but but it is it’s physical activity.

So during sexual activity, A person could suddenly lose interest experience alone, where they start to, you know, whatever, if you’ve ever felt alone, doesn’t feel good. You get that kind of jittery or feeling or just incredible discomfort, fatigue, a lot of different things that can happen. So that can happen during sex.

Also, if you are, have a low interest to begin. That can be hard to maintain, you know, hard to increase during sex. Certainly, men can have erection issues. There can be difficulties with premature ejaculation, which happens, but it’s certainly, what’s more common is just erectile dysfunction where, either you can’t get an erection.

Or you can’t maintain it long enough or the erection isn’t strong enough for intercourse with a partner or you there’s something that’s a little bit less common where when you ejaculate it actually goes back into the body. So the, the nickname, the term is called shooting blanks, but because nothing comes out and that can be incredibly.

Shocking and upsetting. That doesn’t mean that you didn’t have an orgasm. It meant that because of the way the nerves are and the way the system’s functioning, it’s not moving through its proper. Paces eh, just, you know, during sex, a lot of things can happen and it’s so important to communicate that.

I think, well, two things, I, I view a bedroom because I am a sex EDU, you know, sex therapist. I view the bedroom as a playground for adults. This is, this is where this is where we play. This is our sandbox. So we want it to be fun. We don’t want it to be pressured. We don’t want it to be okay now you’ve gotta perform.

Am I ready? So what you want. Ideally is to have good communication. Say, look, I have diabetes. I’m gonna keep snacks by bed. In case I start to feel lightheaded or start to feel low, please know the symptoms that I may come up with you know, increase sweating, even though sweating can go along with more rigorous sex, but just to know your partner or at least to have some type of word that you might say, if you need to take a break, And have a partner who respects that, and then you can have a snack, you know, you could have a lot of fun with it and have strawberries.

And, you know, if you’re low, have strawberries dipped in chocolate, you know, I mean, you can go to the erotic foods but know that you may need this additional support. I, I, I do know of a story where a man was you know, I guess you’re gonna tell all your listeners that we’re gonna be, yes, we’re going there.

We’re gonna be saying some things. So this, this brought, this is not for young children. 

Shireen: Absolutely.

Dr. Roszler: But I do know of someone where the, or her male partner was performing oral sex on her in the middle. She fell asleep. She just, you know, and that. Terribly disheartening to him, but she had a, her blood sugar started dropping, she got drowsy.

And next thing you know, he, he was like, where’s hello. what am I doing? Are you even here? So to have a sense of humor, to know, you know, she described it as saying, well, we thought we were getting to the end zone in the football game, but you know, you know, fumbled the ball. So there’s, there’s all different ways, but if you could bring humor to it and safety.

Have snacks nearby you know, and, and, and lubricant if, if you possibly are experiencing vaginal discomfort or pain, because you are not having enough lubrication. One thing we see is blood sugar. If a person’s blood, if a woman’s blood sugar level’s running high. A lot of times, if you remember the old, the real traditional symptom of increased urination, when your blood sugar runs high, because your body’s trying to get rid of all of that additional sugar.

Well, that’s taking moisture out of your body. So that can promote dryness, vaginal dryness. So having a really good quality lubricant one, that’s safe for the vaginal area. Some people actually use olive oil, coconut oil, natural oils, which are also fine. But the ones that you buy are thicker. So there’s a little bit more protection against.

Chafing and rubbing, but use lubricants and, and realize in the middle, you may have to add the lubricants. So just communicating stop. I need more move or, you know, or make it part of the foreplay that you add it, but really try to come with a sense of humor, with a sense of fun, with the sense that anything can happen and see how things go.

Shireen: Absolutely. And, and, you know, there’s a I can’t miss this from what you’re saying, but there’s an emotional piece to this, right. There’s of course the physical and what the interaction looks like, but then there’s the emotional piece of this. What techniques do you have to do for partners to do emotionally?

You mentioned communicating but what else can they do to be able to help understand that it is not. , this is not about them. This is about this, this third thing that is with them in the, in the, in the bedroom, like you said. Can you tell us more about that? 

Dr. Roszler: Oh, sure. Well, I, I, you know, as you mentioned, I’m a I’m marriage and family therapist also.

So one thing I like to do is go to my narrative therapy roots, which are in narrative therapy. What we do is we name. And we do something called externalizing, which means you take it and you remove it from inside yourself and put it out there and, you know, problem. The problem is the problem.

You’re not the problem. So what happens in the bedroom, as you mentioned, sex goes with you, you can’t lock, lock it outside of the bedroom and say, stay out, you know, stay out there and I’ll be inside. It comes with you. So it’s this third being in the bedroom. And what I suggest that people do is name.

They’re diabetes because it’s an actual creature. That’s in bed with you person that’s in bed with you. And a actually there’s one, one, couple. They did this. I thought it was really fun. I don’t know if anyone, I don’t know if any of you are listening to social media right now, but there’s this whole thing going on with Jason Sudeikis former engaged.

Partner of Olivia wild. Who’s now with Harry styles. And so we’ve got kinda a three something going on. So if, if you know Jason. Whatever, if you wanted to say, you know, the person that’s inside, who’s making trouble is if you call diabetes Harry styles and say, oh, Harry, what did you come in here for?

You’re messing up our relationship. You can do that. You can give it any name that you wanted to, you can give it a color. You can give it a shape. You can call it, you know, red, Fred, whatever. But if you partner with diabetes, Male partner has an erection problem. It’s it can help prevent you from blaming him and going, oh, it’s me.

And what happened? You go. Harry go back to your performing. What did you know? You don’t belong here and blame it on diabetes because that’s the culprit. And so I like finding, you know, something celebrity or whatever you know, or someone you hate someone you don’t, you know, Or someone you dislike, you don’t have to hate it cuz diabetes really lives with you.

So it’s better to make peace with it. But you know, just something fun. You know, and just say we didn’t invite you, you know? And so you can laugh together at the fact that this has happened rather than blame each other. That’s the point. 

Shireen: I love that externalization of it to say that this is not something personal, this is not to be blamed on the, on the partner, but this is in fact something that is in the physical space with them, but we’re just trying to externalize it, trying to, you know, and like you said, make it fun along the way, because.

Diabetes is hard to begin with, so, 

Dr. Roszler: Oh, definitely. Absolutely, absolutely. Be a little fun. See what you can do.

Shireen: So let’s talk about men and then I wanna switch to women for men, the main issue around erectus function, which is caused by this lack of blood flow to the penis. You were talking about that earlier.

Can you tell us a little bit more about how to navigate that, what to expect and then how to navigate that? 

Dr. Roszler: Well, so let’s take a look at it’s it isn’t only blood flow. Blood flow is a huge piece of it because in order to have a healthy erection, a person a person needs to have healthy blood flow to the area.

Which means that their blood pressure has to be good. Their diabetes has to blood sugar has to be in a good range. So it’s not interfering with the blood flow because when your blood sugar’s higher, there’s a lot of sugar in the bloodstream. And so the blood. Is actually moving at a different pace. We wanna get it down to that region, but also neuropathy when the blood sugar level has been high for an extended period of time, it can create nerve damage.

And we need the body, the brain to be able to communicate with the penis and the nerves around that area in order to maintain an erection and in order to ejaculate properly. So if you think of when you blow up a. You pinch the end in order to hold. The air inside. If you loosen your grip on the end of the balloon, the air starts to come out.

So we have stinkers in all different areas of our body that need to close tightly. So things don’t leave once they’re in. And so what we need is the muscles to relax when it’s time to relax and that would help the blood flow. And then when the erection has already developed. We need the nerves to know, okay.

It’s time to close up and keep that blood in there in order to have the erection and then to loosen when it’s time for the erection to go away. So it’s blood flow and neuropathy, and this really goes to having a healthy A1C. We know that the higher a man’s A1C, the more likely he is to develop erection problem.

The more he improves his A1C. The more likely he is to improve his erection issues. There’s certainly damage that after a long period of time may become permanent or troublesome, but that’s usually after a long period of time where you have a lot of damage and there are also other reasons a person might not be able to have an erection, but but A1C is key.

For men, men must, please, please get your A1C in a healthy range, discuss it with your physician about what range is best for you and do everything you can, which would be making healthy food choices, being physically active taking your medication is directed monitoring your blood sugar level so you can.

Take care of everything and say this, you know, getting rest, all those good things to help keep your body in good shape. And that can be a real key for, for men. If they do try to use any type of, if they, if they lose their erection it’s really important that men with diabetes realize that only about 60% of men with diabetes can successfully use the pills.

That help with erections, the kinds that you see on, you know on the commercials, the magic pills, because they just only work in, you know, about 60% of men with diabetes. And if you’re one of the few who is in the other category, that doesn’t mean you don’t have options, you do. So other things they could try certainly are you could do peanut pumps that you can, you know, vacuum pumps that you can get on online without a prescription.

They take some practice watch the videos. Don’t just jump right in and there’s tricks for that. As well. And usually, they come with constriction rings, which after you obtain an erection, then the constriction ring will hold. You have that on the base of the penis and it holds the blood in one thing I do wanna say, cuz that there’s a surprise, people don’t usually know about is if you think when you were little, I don’t know if you did it.

I certainly did. But if you ever put a rubber band around your finger, As a little kid in class, and then you saw that your finger would kind of get cold and start to turn a little bluish. So that’s what happens to the penis because you’re cutting off. The natural blood flow. So it may become cold to the touch.

It may start to look a little grayish or bluish. Don’t be surprised. That’s just what those constriction rings do. And when you remove them, you certainly can’t leave them on forever you know, follow the directions. And then once the blood starts flowing again, your color will, will come back. So that’s a possibility for, for men.

Also, for men. We find that the Mediterranean diet for type two men with type two and I, it also help is helpful for women because it’s anti-inflammatory so it can help reduce the development of sexual complications. We’ve got some really nice research on that, and also it helps with the the level of the chemical that’s required to relax the muscle.

So blood can flow. So that’s a great diet. And if you’re on any type of diabetes meal plan, you can always add the Mediterranean choices to it. And you can just look it up or, or discuss it with your healthcare provider, dietician, whatever. That’s a possibility there’s, there’s other things for men now there’s some more Unusual not unusual, newer treatments there’s low intensity shock wave therapy that you would talk about with a urologist.

That’s becoming a little more popular also with type men with type two. It it’s common for men with type two to have low testosterone levels. and a lot of men don’t realize that it’s so E the treatment is so easy. It’s just a matter of taking testosterone supplements, either through an injection, or you can take a pill, you can take it under your tongue.

You can do a whole variety of different forms of taking it. But the good thing about that is a lot of times that will help the erection come back, because if it’s due to a hormone issue, that, you know, low testosterone can really, can really cause ed problems. Yeah. So tho that’s that’s the men stuff oh, also as VA the actual implant, the pump is is really excellent.

It is surgery. There are insurances that cover it. You want to get a urology surgeon who has experience in doing the procedure, but the good thing is that no one will know you have it. You can’t see it. It doesn’t ring bells. When you go through airport security, it doesn’t do anything, but it’s so simple and it gives a healthy.

Optimal looking erection. It’s just a matter of pressing something near the scrotum for fluid to flow in and then pressing it to release it. So you can maintain your erection as long as you wish. The, the thing about it is that you can have a natural orgasm, so it feels just like if you didn’t have the implant and and it’s a, it’s a terrific option.

Many men really, really enjoy having.

Shireen: Thank you for listening to the Yumlish podcast. Make sure to follow us on social media at Yumlish underscore on Instagram and Twitter and at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective, you can also visit our website Yumlish dot com.

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