The silent struggle: How diabetes and insulin resistance are affecting intimacy in India

In the hustle of our daily lives—managing homes, careers, and family expectations—many of us quietly carry a burden that affects not just our bodies, but our closest relationships. Diabetes has become alarmingly common in our country. What many don’t realise is how deeply it touches our sexual health, confidence, and emotional well-being. India is often referred to as the diabetes capital of the world. According to recent estimates, over 89 million adults are living with diabetes, with numbers projected to rise significantly in the coming years. Even more concerning is the rise of insulin resistance and prediabetes in younger people—busy professionals, new parents, and even adolescents in our cities—driven by sedentary jobs, stress, sugary diets, and lack of sleep.Think of insulin as the key that helps your body use sugar for energy. When you have insulin resistance, your body’s cells don’t respond well to this key. Sugar builds up in the blood, causing inflammation and damage over time. This affects tiny blood vessels and nerves everywhere, including those crucial for sexual function. Dr. Paras Agarwal, clinical director & head - diabetes, obesity & metabolic disorders at Marengo Asia Hospitals, Gurugram, explains it plainly: Poor glucose control is often at the heart of these problems. “Wherever diabetes remains uncontrolled — meaning blood sugar levels are consistently outside the normal range prescribed by a doctor for a person’s age and condition — it can impact multiple organs in the body. One of the most significant complications is neuropathy, or nerve damage. This reduced nerve function can lead to loss of sensation and may contribute to several sexual health issues, including erectile dysfunction,” explains Dr Agarwal.Recent studies suggest that sexual dysfunction affects nearly 50% of men with diabetes, while more than half of women with diabetes may also experience significant sexual health issues. In men, erectile dysfunction (ED) is often one of the earliest — and most overlooked — warning signs of uncontrolled diabetes. Many patients fail to recognize that difficulty in achieving or maintaining erections, or even the absence of morning erections, may indicate underlying blood vessel and nerve damage caused by persistently high blood sugar levels.Dr. Sanjay Prakash, clinical lead – andrology, consultant urologist & men’s health expert at AINU Hospital, Chennai, shares a powerful perspective: “What makes the situation particularly concerning today is the changing face of diabetes in India. Increasingly, younger adults are being diagnosed with the condition due to sedentary lifestyles, chronic stress, obesity, poor sleep, and diets high in processed foods. Alarmingly, insulin resistance and prediabetes are now being reported even among adolescents and young professionals in metropolitan cities. Estimates suggest that nearly 20% of Indian men below the age of 40 are living with diabetes, while several reports indicate that nearly one in six young adults may already have prediabetes or early metabolic dysfunction.”Insulin resistance adds to this by causing endothelial dysfunction – impairing blood flow. Many men ignore morning erections disappearing or blame stress, but it’s often the body signalling deeper issues. The good news? Early action can help reverse or manage it.When diabetes brings vaginal dryness, painful intercourse, recurrent infections, low desire, or difficulty reaching orgasm, many of us suffer in silence. High blood sugar creates an environment for fungal and bacterial growth, leading to frequent UTIs and yeast infections that make intimacy uncomfortable. Dr. Prakash highlights that more than half of women with diabetes may face significant sexual health problems. Yet in Indian society, these conversations remain deeply stigmatised. “Many women normalise symptoms, suffer in silence, or attribute them to aging or stress,” he says. Female sexual dysfunction affects 50-70% of women with diabetes globally, but we hesitate to discuss it even with partners.Hormonal shifts from insulin resistance can lower libido further. The emotional toll—feeling less desirable or disconnected from your partner—adds layers of anxiety and low self-esteem.In India, talking about sex is still tricky. Cultural conditioning makes many view issues as “not medical” or something to hide. Men might try unverified online remedies; women often don’t seek help at all. Dr. Prakash notes that patients sometimes turn to AI chatbots, but these lack personal accountability and individualised care. Sexual medicine has grey zones—treatments must be tailored.Diabetes-related sexual problems don’t stay in the bedroom. They fuel anxiety, depression, and low confidence. It becomes a vicious cycle—poor control worsens symptoms, which worsens mental health, which further affects desire. For couples, intimacy is a way to connect; when it fades, emotional distance grows. The encouraging part is that most of these issues are manageable, especially if caught early. Both doctors emphasise good sugar control as the foundation.Lifestyle changes: Regular walks (even 30 minutes daily), balanced home-cooked meals low in processed sugars, weight management, better sleep, and stress reduction through yoga or meditation.Medical help: Consult qualified doctors. Urologists, andrologists, or endocrinologists. Treatments range from oral medications to advanced options.Open conversations: Start with your doctor. Breaking the silence can strengthen bonds.Holistic care: Manage insulin resistance through diet and exercise to improve blood flow and hormone balance naturally.Dr. Prakash reminds us: “Sexual health should not be treated as an uncomfortable afterthought in diabetes care. It is an important indicator of vascular, hormonal, and psychological health.” Early detection through sexual issues might even prevent heart attacks or other complications.Medical experts consultedThis article includes expert inputs shared with TOI Health by:Dr. Sanjay Prakash, clinical lead – andrology, consultant urologist & men’s health expert at AINU Hospital, ChennaiDr. Paras Agarwal, clinical director & head - diabetes, obesity & metabolic disorders at Marengo Asia Hospitals, Gurugram