Sex & Diabetes: Gay and Bisexual Men’s Experiences

Sex & Diabetes: Gay and Bisexual Men’s Experiences Adam Jowett, School of Life and Health Sciences

Overview • Diabetes and LGBT communities • Sex and Diabetes – some self help guides • Diabetes and erectile dysfunction • Heteronormativity within research and sources of support • Findings from my own research • Opportunity for questions • General discussion

Diabetes • Diabetes is a condition in which the body cannot use glucose in the blood properly. • Diabetes Types • Type 1 The body is unable to produce insulin. An estimated 5 -15% of those with diabetes have type 1. • Type 2 The body is unable to produce enough insulin or cannot use insulin properly.

Risk factors of diabetes • Type 1: • The cause of Type 1 diabetes is currently unknown and unpreventable. • Type 2: • Age • Ethnicity • Weight • Family history • Other medical conditions Information available on Diabetes UK website

Diabetes and the LGBT community • Currently there are no statistics about LGBT people who have diabetes. • Diabetes UK estimates that there are currently over 2.5 million people with diabetes in the UK. • The UK Govt. estimates 6% (3.6million) of the UK population is lesbian, gay or bisexual. • 6% of those with diabetes in the UK = 150,000 people

LGBT people and risk of diabetes • More research is needed on weight and LGBT people (Boehmer et al., 2007; Saphira & Glover, 2000; Stonewall, 2008). • Incidence of diabetes among men receiving HIV treatment is 4x that of HIV negative men (Brown et al., 2005). • Hormone therapy has been associated with an increased risk of developing Type 2 diabetes in ‘overweight’ Trans women (Feldman, 2002) Full references available on request

Support for LGBT people with diabetes • Presently, health organisations such as Diabetes UK do not address LGBT issues. • LGBT people with diabetes have created their own groups inculding: • Yahoo groups • Facebook • TuDiabetes • Diabetes ANd Gay (DANG) Foundation - based in San Francisco

Diabetes and Sexual Dysfunction • Diabetes has been associated with ‘sexual dysfunction’ in both men and women • Particular attention has been given to ‘erectile dysfunction’ • Diabetes UK estimates that over 50% of men with diabetes will experience erectile dysfunction at some point. • Causes may include: • nerve damage (neuropathy) • narrowing of the arteries (atherosclerosis) • medications • low testosterone

Sex and Diabetes – Self help texts American Diabetes Association’s Sex and Diabetes: For Him and For Her. Diabetes UK’s Sex and Diabetes: A guide to sexual dysfunction. (previously ‘A guide to erection problems’)

Sexual dysfunction or (hetero)sexual dysfunction? “Since the time of Adam and Eve, men and women have connected sexually with one another” Sex and Diabetes: For Him and For Her “have you been experiencing difficulty recently in achieving erections that you and your partner consider adequate for vaginal intercourse?” Sex and Diabetes: For Him and For Her

Sexual problems among gay and bisexual men • Until relatively recently, there has been little research about gay and bisexual men’s sexual problems. • The focus has been on understanding sexual practices that may increase the likelihood of HIV transmission. • Interest in the sexual problems of gay men has been limited almost exclusively to those diagnosed with HIV and/or the impact of sexual dysfunction on ‘safer’ sex practices

In sum… • When sex and diabetes has been addressed there has been an almost exclusive focus on erectile dysfunction for men. • A lack of attention has been paid to the psychosocial impact of sexual problems and the context in which they are experienced. • No research to date has looked at gay and bisexual men’s experiences. • Support materials available for men with diabetes explicitly or implicitly address monogamously partnered heterosexuals.

The study • Part of a larger qualitative study about LGBT people’s experiences of diabetes. • Participants were recruited through a previous study involving an online survey and a call for participants in a magazine for people with diabetes. • 11 gay and 2 bisexual men took part in a semi structured interview

The participants • 10 Type 1 (mean duration = 27 years) • 3 Type 2 (mean duration = 6 years) • Ages ranged from 28-69 (mean = 48 years) • None of the participants came from an ethnic minority background • 9 of the participants lived in the UK, 4 lived in the US.

The Approach • The broader concept of ‘sexual difficulty’ was adopted over the more narrow medical concept of’ ‘sexual dysfunction’. • Understanding the social and relational context of sexual problems is key to providing adequate and appropriate support. • Thematic analysis was used to analyse the data.

Erectile problems “I think the diabetes has taken away some of the ability to perform that would have been there before. It’s hard to prove that exactly because age is kicking in as well and I think there’s probably quite a steep decline” (Alistair, 59, gay man, T2, single)

Erectile problems “it [‘impotence’] had over the years killed my social life for me anyway because I was too frightened to talk to anybody and I still am. That’s why I can’t socialise very easily when I go out. I can’t just chat to somebody in a pub…I remember on one occasion I went into a gay pub and there was a lad I’d been eyeing up for months, stunning from my point of view and erm…next thing I knew he was standing next to me. I couldn’t speak, I could not speak and he came to stand next to me; somebody he knew fancied him. I gulped it down and ran out the club. I can’t believe I did that now but I couldn’t even talk to him. I was too frightened because I wouldn’t want somebody on our local scene to know that erm, I couldn’t rise to the occasion. And that’s the one problem with gay life because if you meet somebody it’s, it’s now more like this in straight life than it used to be, but its straight away sexual. In the old days, in heterosexuality, you met on another occasion and you’d go out and you’d go for dinner, or for whatever, and you’d chat to them. It’s a long time before you actually got into bed but the gay life was never like that. That was almost always the first time you meet. So that was terrifying me I couldn’t do it” (Colin, 62, gay man, T1, single)

Erectile problems “…if it’s a one night stand then yeah, even if its only a hand job by them you want a reason for it, and they might think that they don’t turn me on, y’know, and that would be rotten for me. If I really was attracted to them physically then I don’t want it to look as if I wasn’t. So again its embarrassment I suppose in a way but yeah I’d lose them for that reason” (Colin, 62, gay man, T1, single)

Erectile problems “it can cause problems because as a gay guy, obviously a major part of the gay culture is basically sex, y’know it’s very promiscuous, very sexually orientated, very physically orientated and if you suffer from impotence- if you’re seventy odd then they don’t care, but when I was in my thirties, when I was in my early thirties and I’m going what!? Well if you go to a bath house, like a gay sauna, you know it can definitely be um, not so much the physical side, but it stresses your self worth, you lose your sense of self worth, you lose your confidence. It’s a confidence thing” (Enzo, 47, gay man, T2, single)

Erectile problems “the only thing I resent, if you said to me, ‘is there anything you resent about diabetes?’, it’s erm, because I’m a guy, I do things that guys do when they’re on their own, and the mechanics don’t work. There’s many a time I lie in bed and it doesn’t matter how hard I try, I’m on my own and my body just will not cooperate and that gets me down because when I’m with other people, I can find other things to do but if you’re on your own- and some guys use that mechanism to de-stress… erm and yet it becomes stressful because my body wont co-operate and you feel like you’re missing out on something that the rest of the world has got. You think ‘I hate this body’, not because its over weight but I can’t even enjoy my own body anymore and I resent diabetes for that” (Enzo, 47, gay man, T2, single)

Other physical problems - Thrush “There is one other issue that is related to sex and diabetes. As a diabetic, I sometimes suffer from a Candida in my buttocks. This makes it impossible to be the "bottom" in anal intercourse…It hasn't been all that much of a concern. I do prefer to top and my partner is usually willing to bottom, but there are times we'd like to switch and haven't been able to…there have been 2 or 3 occasions in which a particularly bad Candida infection has caused an odor which makes oral sex unpleasant. In those situations, my partner and I have been limited to mutual masturbation or have abstained from sexual contact altogether” (Ben, 28, gay man, T1, in a relationship)

Thrush “I feel that I'd have to discuss any sexual problems related to my diabetes with my endochrinologist. I did have to discuss the Candida with him, but I did not disclose its affect on my sex life. If the impotence problems continue, I will also discuss those concerns with him. The gay health clinic in Dallas seems to operate exclusively for the testing of STDs and the counseling of those who find themselves testing postive for an STD…I have considered exchanging the care of my endochrinologist for the care of an internal medicine specialist in Dallas who advertises as gay-friendly. If diabetes ever had a significant enough impact on my sex life as a gay man, then I almost certainly would make that change” (Ben, 28, gay man, T1, in a relationship)

Other physical problems – ‘Hypos’ “I’ve also gone hypo during sex, had to stop and explain that I needed something to eat/drink. That’s always fun. Lol [laugh out loud]… I explain ‘cause I lose my erection, am super sweaty and often get dry mouth, which sucks when giving oral ” (Justin, 41, gay man, T1, single)

Hypos “it affects your sex life radically. Erm there are times when, if it all gets too energetic, at the end of it I get the shakes or I’m half way to collapsing and the other guy who may have come to meet me for the first time, it’s gonna scare the shit out of em because they’re wondering what the hell they’ve walked into, y’know what I mean, so what I do now is I deliberately overload my body. I eat an entire packet of biscuits if I know somebody is coming, to counter balance y’know what I mean?” (Enzo, 47, gay man, T2, single)

Disclosing diabetes to sex partners “being on an insulin pump, I usually end up telling them what the infusion site is all about 'cause it does look odd especially when it’s an odd spot like my inner thigh or near a nipple on my chest… If it's on my arm I may not tell them at all. I just don't like guys wondering about it when they inevitably see it. I'm usually unhooked from pump, so it's just the site. I tell them that I'm a diabetic and on an insulin pump and that is where I hook up to it at. Sometimes it's before, sometimes after. But unless it's just a quickie thing, I tell them 'cause I usually don't like to be unhooked from pump for too long. Anonymous stuff, I don't bother unless they ask…from guys seeing site before I tell them it's like ‘oh man, what's that?!?!?’ or ‘what's wrong with you, you aren't sick or something are ya?’ (which I take to mean HIV status) and then explain” (Justin, 41, gay man, T1, single)

Disclosing diabetes to sex partners “Again, because it's different, they either don't ask but are looking at it (the insulin pump operates through a small tube that goes into the abdomen) or query what it is. A second device (Continuous Glucose Monitor - CGM) is a second device that attached to the body…The result is that when you first get intimate with someone, it's usually a shock to that person…Usually it's not a big deal since almost everyone has heard of diabetes. I always wondered whether people are worried about whether it's some sort of intraveneous HIV treatment” (John, 43, bisexual, T1, single)

Disclosing diabetes to sex partners “I’ve probably avoided you know even staying over and stuff. I probably would have avoided injecting in front of them or- I’d have it with me but I wouldn’t, because obviously you can’t really because then you’ve got to open up the whole thing so… again you just wouldn’t because it’s kind of like a one night stand so therefore you’re never gonna- I mean that would just be really strange if you sort of started talking about stuff like that” (Graham, 39, T1, in a relationship)

Conclusions • In line with the high prevalence of ED among men with diabetes, problems getting or maintaining erections were the most commonly reported sexual problem. • However, these accounts suggested that ED is more complex than medical definitions imply. • While ED is often the only sexual problem among men addressed within clinical and self help texts, these men identified a range of sexual problems.

Conclusions • This study highlights the need for a contextually sensitive approach to sex and diabetes, which explicitly recognises a diversity of sexual identities, practices and relationships among men with diabetes. • These men identified a number of reasons why experiencing sexual problems may be different as a gay/bi man with diabetes.

Acknowledgements • I’d like to acknowledge my PhD supervisor, Dr Elizabeth Peel for her support, encouragement and feedback. • Thanks go to the Editor’s of Diabetes UK’s Balance magazine who kindly published a call for participants. • Most of all, thanks must go to the men who kindly gave their time to participate in the study and for their honesty.

Websites • Diabetes UK http://www.diabetes.org.uk/ • The Diabetes ANd Gay (DANG) Foundation http://diabetesandgay.com • Queer diabetics group on TuDiabetes (a social networking site for people with diabetes) http://tudiabetes.com/group/queerdiabetics

References

Sex & Diabetes: Gay and Bisexual Men’s Experiences