Welcome to Diabetes Health's new column on sex and diabetes, by David Spero RN and Aisha Kassahoun. Once a month, we'll publish questions submitted by our readers, along with David and Aisha's responses. Send your questions to love@diabeteshealth.com and watch for their answers to appear in this column. 

Dear Sex & Diabetes,

My husband was diagnosed with type 2 diabetes seven years ago and put on oral medication. We've had some sexual problems since then, and lately there has been no sex at all. He says that he doesn't want it or need it. We had a very good sex life before this.  What can I do? I think we all need intimacy in our lives. At least I do. I don't feel that it is fair to me to be left high and dry, and I want to do something to help him.

High and Dry in Tennessee

Dear H and D,

Yours is a sad and very common story. Diabetes can impact our sex and love lives physically and emotionally.  But there are ways of maintaining and even improving sex and intimacy with diabetes. 

Here are some possibilities to consider:

• How good is your husband's diabetes control? High sugars can drag a person down so he doesn't feel like doing anything physical, including sex. If his glucose is up, he probably won't be down for loving. 

• How physically active is he otherwise? Maybe he needs to get his body moving. Exercise can make him feel more positive, improve his blood sugar control, and increase his sexual desire. 

• He might be depressed. Is he being treated for that, and if so, how? Depression kills desire, and sometimes antidepressant medicines (especially the SSRIs) can knock out sex drive. Blood pressure medicines can also have sexual side effects.

• Quite possibly he is reacting to erection problems by withdrawing, without admitting that's the reason. Diabetes can make erections (and lubrication in women) more difficult. Some men will say "I don't want to" when they really mean "I'm afraid I can't."

• His testosterone level may be low. Many men and women with diabetes are low in testosterone and consequently have low sex drive.  

• Other relationship issues and other emotions might be involved.  There may be anger, grief, fear, or disagreements in your lives that interfere with his wanting you. These feelings could be his, yours, or both of yours.     

Talk about it

Your husband seems to be hurting, but he is not being fair to you. You two really need to talk about how you feel. You may want to start by saying something like, "I really love you honey, and I hear you when you say that you don't want or need intimacy, but I do. What are we going to do?"  You may want to seek help with this conversation or follow-up conversations from a counselor or diabetes educator. 

Your doctor might be able to help with a testosterone level check and maybe a change of antidepressant or blood pressure medicine. Perhaps your husband could benefit from one of the erection drugs. These drugs (sildenafil, or Viagra, tadalafil, or Cialis, and vardenafil, or Levitra) work well for most men and some women (although they are not approved for women). They're worth a try at least. Unfortunately, some doctors are not comfortable talking about sex. If you sense that yours isn't, ask him firmly to refer you to someone who is. 

Try something new

If you're willing, you can enjoy non-intercourse ways to have sexual pleasure. Hopefully, you and your husband are open to trying new approaches. There are things you and he can do with your hands, mouths, other parts of your body, and with toys that don't require erections and can give both of you a lot of pleasure, closeness, and orgasms. Here's a good starter article on sexual touch.  All these things work best if you explore, talk about them ("I really like this." "I really want to try that."), and treat it as play. 

But how do you get him interested in the first place? It's important to set aside time both for pleasure and for talking about issues in your relationship. If you try to jump into bed after a hard day, with tense feelings and with all your concerns unmentioned, you are not going to have good sex. Even healthy twenty-five-year olds can't do that. 

Try making a date. Set aside some time for loving but honest talk. Maybe put on some music. Dancing is a good way to get him moving and in the mood. (And it's great exercise!) Take a shower together. Use your imagination. 

Bottom line: Don't give up. Sex problems are just like all the other problems that diabetes and life throw at us. We can manage them with some creativity, courage, and communication.  Keep trying, keep talking, and see what happens.

We encourage you to send questions pertaining to love and diabetes to love@diabeteshealth.com. And by the way, this column isn't just for couples. Single people with diabetes have love and sex issues too. 

David Spero 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 on-line at http://www.davidsperorn.com or  http://sexandintimacy.vpweb.com. You can read David's blog at http://www.diabetesselfmanagement.com/blog/David_Spero