Women’s Health and Diabetes

Tuesday, 4 September 2018

We get matter of fact with Director of Diabetes Services at St Vincent’s Hospital, Professor Lesley Campbell.

Thrush (also known as monilia, candida and yeast infection)

What you need to know:

It is a common fungal infection caused by an overgrowth of candida albicans yeast, likely to occur following antibiotic therapy and when your immune system is low. According to the Melbourne Sexual Health Centre 75 per cent of women will develop vaginal thrush in their lifetime. Symptoms include itching, a thick white discharge and a burning or stinging sensation while urinating and during sexual intercourse.

Diabetes & thrush:

Professor Campbell says all women with diabetes are at greater risk because monilia thrives in a sugary environment. American researchers found a greater incidence among women with elevated HbA1c and women with type 1 diabetes.

What can help?

  • Evidence supports maintaining blood glucose levels and HbA1c within target range.
  • Turkish researchers found daily walking significantly decreased the risk of thrush.
  • Professor Campbell recommends treatment as quickly as possible. Speak to your pharmacist about over-the-counter options.
  • If unsure whether your symptoms are due to thrush visit your
  • When washing use non-scented sorbolene and avoid soaps, antiseptics and douches.
  • Wiping from front to back with unscented toilet paper can prevent the transfer of candida albicans to the genital area.
  • Following antibiotic therapy, evidence supports the use of probiotics to help restore the protective bacteria in your gut. You will find these in yoghurt and probiotic drinks and in tablet or powder form at your
  • The ‘Candida’ diet which advocates the avoidance of yeast, sugar and dairy is not supported by the evidence.

Urinary Tract Infection (also known as UTI or cystitis)

What you need to know:

It is a common bacterial infection caused by escherichia coli and can affect the urethra, bladder or kidneys. Kidney Health Australia report one in two women and one in 20 men will get a UTI in their lifetime.

Our anatomy, namely the short length of the female urethra, is why more women are affected than men.

Symptoms include an urge to urinate more frequently and urgently, even if only a few drops, and a burning sensation.

Diabetes & UTI:

UTIs occur more frequently and with greater severity among people living with type 1, type 2 and gestational diabetes. Research also suggests they are more likely if you have an elevated HbA1c, high blood pressure, or diabetes-related complications including nephropathy and incomplete bladder emptying due to autonomic neuropathy. Professor Campbell warns it is important to discuss your symptoms with your GP. “A lot of women with diabetes who experience these urinary symptoms are not infected,” she says, flagging the need to look for possible nerve and vascular damage.

What can help?

Evidence supports maintaining blood glucose levels, HbA1c and blood pressure within target range. Drinking water across the day can help flush the bacteria through your urinary tract.

Wiping from front to back also prevents the transfer of escherichia coli to the urinary tract.

Latest research published in the Cochrane Systematic Review concluded cranberry juice did not have a significant benefit in preventing UTIs.

Sex and hypos

For people using insulin or the sulphonylurea class of tablets that include Diamicron, it is important to be aware that sex, like any physical activity, can put you at risk of a hypo.

The last thing you want to deal with when you and your partner are enjoying yourselves is having to call a halt and treat a hypo, so here are some tips:

  • Track if this is an issue for you. As is always the case, monitoring what your trends are helps work out a plan to manage.
  • If you know you have hypos during sex, have some quick acting carbohydrate beforehand to reduce the risk of it happening.
  • If you have a delayed hypo in the hours after sexual activity, have some longer acting carbohydrate afterwards to prevent this.
  • If you disconnect an insulin pump for sexual activity, remember to reconnect before you fall asleep so you do not risk developing Diabetic Ketoacidosis (DKA).

Female Sexual Dysfunction

While living with diabetes is an established risk factor for sexual dysfunction in men, women often suffer in silence.

What you need to know:

Symptoms of FSD include decreased libido, reduced sensation in the genitalia, loss of orgasm (anorgasmia), inadequate lubrication and painful intercourse (dyspareunia).

There are medical reasons secondary to diabetes linked with FSD including depression, anxiety and psychological distress. Physiological changes during pregnancy and menopause can also play a role.

Diabetes and female sexual dysfunction:

A higher prevalence of diabetes is the main theory for symptoms of FSD, however poor diabetes control over time can damage the blood vessels and nerves that make arousal possible. FSD is common and can vary depending on age and duration of diabetes. Loss of arousal and depression are particularly high among younger women with type 1 diabetes.

A 2012 study published in the Journal of Obstetrics and Gynecology exploring the prevalence of FSD in middle-aged and older women found those requiring insulin were more than twice as likely to report difficulty with lubrication and 80 per cent more likely to report difficulty achieving orgasm compared to women not requiring insulin, and women without diabetes.

What can help?

Professor Campbell says both sexual counselling and medical help is ideal. She recommends speaking with a GP who has chosen sexual health as a special interest. In terms of medication, studies suggest that Viagra type drugs can improve FSD symptoms. US regulators have recently approved a drug known as Addyi developed for women experiencing sudden or severe loss of libido.

 

For more information visit: Your state family planning service or call the NDSS Helpline on 1300 136 588 and ask to speak to a Credentialled Diabetes Educator.

Me is all about what you need to do for yourself, managing your diabetes and doing what you can.

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