Sex is good for diabetes. It's good for the heart and circulation, helps sleep, and improves mood. So why are many women with diabetes not enjoying sex? The reason, of course, is that although sex may be good for diabetes, having diabetes is not always good for sex. Nerve damage, or neuropathy, can make it difficult to have orgasms, and can cause vaginal dryness, making intercourse painful. Bruising from injections and fears about blood sugar plummeting can zap your self-confidence. And if you wear an insulin pump, where does it fit into intimacy? Diabetes-related issues may seem overwhelming, but they're solvable, experts say. "Many times I've heard people say, 'I'm done with sex,'" says Janis Roszler, RD, a diabetes educator and coauthor of Sex and Diabetes(American Diabetes Association, 2007). "It's sad because there's so much that can be done." As with most diabetes complications, high blood sugar levels are often the cause of sexual side effects, so keeping them under control is the No. 1 strategy. But even women with tight control of their blood sugars can face some sexual challenges. Here are some common problems and ways to conquer them.   Sex and Diabetes: Dealing with vaginal dryness Experts say that for women, vaginal dryness is the most common sexual side effect of diabetes. Emotional issues such as depression, or damage to the nerves responsible for vaginal lubrication can cause vaginal dryness. Vaginal dryness can become a painful cycle. "If a woman has pain during sex because of inadequate lubrication, she may anticipate pain the next time, and then have it because she tenses up," Roszler says. Diabetes-related vaginal dryness can also be due to yeast infections associated with poor blood sugar control, especially in women with type 1 diabetes. In older women, menopause and hormonal swings may also play a role. If you have symptoms of a yeast infection, such as vaginal itching, burning, or pain during intercourse or while urinating, an over-the-counter topical antifungal medication may help but speak with your health care provider first. For other vaginal dryness, water-based vaginal lubricants can help. Some lubricants may also help with sexual arousal. If you plan to become pregnant, be sure to ask your obstetrician for advice on choosing a lubricant, because some can affect conception. "Estrogen replacement, including vaginal estrogen, can be helpful in post-menopausal women," says Vivian Fonseca, MD, FRCP, chief of endocrinology at Tulane University School of Medicine in New Orleans and president-elect of medicine and science for the American Diabetes Association. Although hormone replacement therapy may increase risk of breast cancer and stroke, using estrogen in a vaginal cream or ring is thought to be a lower-risk treatment. That's because it's used at a lower dose and is only applied in the vagina. You and your doctor can weigh the risks and benefits for you. Blood sugar, insulin pumps, and spontaneity For some women with diabetes, worrying about low blood sugar, or hypoglycemia, during sex makes it difficult to live in the moment. "Hypoglycemic events during sex are a real buzz kill," says Kerri Morrone Sparling, who blogs about her life with type 1 diabetes from her home in Providence, R.I. "Your body just shuts down during a low, so it crushes the enjoyment." Lois Jovanovic, MD, FACE, CEO and chief scientific officer of Sansum Diabetes Research Institute in Santa Barbara, Calif., suggests that women who are concerned about low blood sugar eat a hard candy or a little ice cream before getting intimate. "Or if you have surprise sex in the middle of the night, afterward have something with sustained sugar, like juice with the fruit pulp in it or milk," she adds. Sparling, who wears an insulin pump, has found a way to deal with her diabetes so that "spontaneity is never an issue." She wears a continuous glucose monitor (CGM), which she can simply consult to see if she's "in a decent range" to get romantic. She often wears her infusion set on her thigh because, she says, she feels sexier when it's adhered, working, and out of sight. Sparling removes her pump before sex, as she does when she exercises. (Pumps can be safely disconnected for 45 minutes to an hour.) Afterward, she checks her blood sugar again and takes a dose of insulin if her blood sugar is high or has a snack if it's low. "I don't know other people who have so many cookies by the bed," she says. "For me, this works," Sparling says. "But just like everything else, you need to find what works for you and to not be afraid to go through a trial-and-error period." Problems with libido and orgasm Difficulties with sexual arousal -- whether from loss of interest in sex or problems having orgasms -- are more common, and can be more complicated for women with diabetes. Poor blood sugar control can drag down a woman's libido. So can depression, which is more common in women than in men. Some antidepressants may also dampen sex drive. If you've been depressed or anxious for more than a couple of weeks, talk to your doctor. Counseling, medication, or stress reduction can help. If you are already taking a depression medication and think it may be lowering your interest in sex, talk to your doctor about finding one that is less likely to cause sexual side effects. Some women with diabetes may need more time and stimulation to climax. Whether the cause is nerve damage or emotional issues, problems with sexual arousal are a good reason to make foreplay part of your sexual experience, if it isn't already. Oral stimulation, sex toys, caressing, and cuddling can help arouse women and men, especially as they age. "Self-stimulation, or masturbation, can also help a woman get to know her body better," Roszler says. If you are unable to climax because of significant nerve damage, counseling can help you learn to make sex an enjoyable experience without orgasm. 4 Tips for better sex Along with strategies for specific sexual issues, these tips can help keep your sex life strong with diabetes: - Limit alcohol: A little alcohol may increase sexual desire, but drinking can also make your blood sugar level drop quickly. If you drink alcohol, stick with one drink. Have it with a meal or snack to limit its effects on blood sugar. - Be honest with your partner: Trying to deny or hide your diabetes only makes you more uncomfortable during sex, Sparling says. When she was dating, she made a point of getting to know boyfriends well before she got intimate with them, and they got to know her -- and her pump. "I never had a partner reject me because of diabetes," she says. "If anything, it brought us closer together." - Nurture your relationship: Little things like taking walks, working out together, or even doing chores for each other are important to keeping a couple's romantic life fresh and loving, Roszler says. Conversely, neglecting your love life may damage other aspects of your relationship. "When couples have difficulty in the bedroom, it spreads throughout their relationship," she says. "If you're angry with your partner, you're less likely to do things to take care of him or her." - Get help: If you are uncomfortable talking to your doctor about sex, ask for a referral to a gynecologist or other  doctor with expertise in sexual issues. "If you don't get the answers or help you need, don't give up," Roszler says. "You can have a great sex life with diabetes."