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Abstract
Diabetic neuropathy is a highly prevalent complication of diabetes. It consists of a broad range of neuropathic conditions, such as distal symmetric polyneuropathy and various forms of autonomic neuropathies involving the cardiovascular, gastrointestinal, and urogenital systems. Prevention or diagnosis in early stages of disease is crucial to prevent symptomatic onset and progression, particularly in the absence of current disease-modifying therapies. In this review, we describe the four main types of diabetic neuropathy. We review current understanding with respect to diagnosis and treatment while highlighting knowledge gaps and future directions.
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Affiliation(s)
- Brendan R Dillon
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA;
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA; ,
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan, USA; ,
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Flotyńska J, Filip-Bocian N, Araszkiewicz A, Zozulińska-Ziółkiewicz D, Uruska A. Physical Activity Protects Women with Type 1 Diabetes from Sexual Dysfunctions. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:932-938. [PMID: 37317780 DOI: 10.1080/0092623x.2023.2224319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The aim of the study was to evaluate the relationship between physical activity and sexual function in women with type 1 diabetes mellitus (T1DM). The study group consisted of 171 women with T1DM. All the participants voluntarily filled out anonymous questionnaires. Women who were sexually inactive or had some psychological, psychiatric, or endocrine diseases were excluded from the analysis. The scores about sexual function were obtained using a Female Sexual Function Index (FSFI) questionnaire. Results equal to or below 26 points indicate clinically significant sexual dysfunction. Physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Participants were divided into two groups depending on the Metabolic Equivalent of Task (MET-min/week) score with a cutoff point 3000 MET-min/week. Results above 3000 points indicate higher physical activity in woman. There were statistically significant differences in lubrication, orgasm, pain, satisfaction, and total score of FSFI. A positive correlation was revealed between results in total FSFI score and MET-min/week score (Rs = 0.18, p = 0.016). Univariate logistic regression does not show significant associations, but the multivariate logistic regression model shows an association between the MET-min/week and the total FSFI score. The higher the MET-min/week score, the higher the FSI score, and thus better sexual function.
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Affiliation(s)
- Justyna Flotyńska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Filip-Bocian
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Poznan, Poland
| | - Dorota Zozulińska-Ziółkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Poznan, Poland
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Blair Y, Wessells H, Pop-Busui R, Ang L, Sarma AV. Urologic complications in diabetes. J Diabetes Complications 2022; 36:108288. [PMID: 36088680 PMCID: PMC10783766 DOI: 10.1016/j.jdiacomp.2022.108288] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022]
Abstract
Urologic complications such as bladder and sexual dysfunction among men and women with diabetes have received relatively little attention. This is despite emerging evidence that demonstrates that urologic complications increase with age in the general population and are more common in individuals with diabetes compared to those without diabetes. Here we summarize the latest information about the epidemiology of urologic complications in the setting of diabetes and the most recent findings regarding pathophysiology. In addition, we identify knowledge gaps and need for future funding to address these gaps that will reduce the burden of urologic complications in diabetes and optimize quality of life for all individuals affected by it.
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Affiliation(s)
- Yooni Blair
- Department of Urology, University of Michigan, Ann Arbor, MI, United States of America
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, WA, United States of America
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America
| | - Lynn Ang
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI, United States of America.
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Rahmanian E, Salari N, Mohammadi M, Jalali R. Evaluation of sexual dysfunction and female sexual dysfunction indicators in women with type 2 diabetes: a systematic review and meta-analysis. Diabetol Metab Syndr 2019; 11:73. [PMID: 31467595 PMCID: PMC6712652 DOI: 10.1186/s13098-019-0469-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/21/2019] [Indexed: 01/02/2023] Open
Abstract
Type 2 diabetes is one of the most common chronic diseases worldwide, and one of the long-term complications of this disease is sexual dysfunction in women with type 2 diabetes, which has been studied in fewer studies. The aim of this study is to determine the overall prevalence of sexual dysfunction in women with type 2 diabetes and its indicators with systematic and meta-analysis approach. The present meta-analysis study reviewed articles published foreign journals by searching the MEDLINE, Cochrane Library, Science direct, Embase, Proquest and Persian databases, including Iranmedex, Magiran, and SID between January 2000 to December 2018. The heterogeneity of studies was studied using the I2 index and data analysis was carried out in Comprehensive Meta-Analysis software. The Meta-analysis review of 25 studies and 3892 individuals aged 70-18 years showed that the overall prevalence of sexual dysfunction in women with type 2 diabetes was 68.6% (95% CI 61.1-75.3%). The highest and lowest prevalence of sexual dysfunction was 94.4% in Iranian women with type 2 diabetes (95% CI 91.9%-96.3%) in 2014 and 17% in Italian women with diabetes Type 2 (95% CI 6.4-36.9%) in 2015. Results of meta-regression showed that with the increase in sample size and year of study, the overall prevalence of sexual dysfunction decreased and increased, respectively and the differences were statistically significant (P < 0.05). Regarding the high prevalence of sexual dysfunction in women with type 2 diabetes, health policymakers need to take appropriate measures to address this disorder in patients with type 2 diabetes.
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Affiliation(s)
- Elham Rahmanian
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Flotynska J, Uruska A, Michalska A, Araszkiewicz A, Zozulinska-Ziolkiewicz D. Sexual Dysfunction Is a More Common Problem in Young Women with Type 1 Diabetes than in Healthy Women. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:643-651. [PMID: 31007158 DOI: 10.1080/0092623x.2019.1610121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of the study was to analyze the relationship between the presence of type 1 diabetes and sexual dysfunction among young women. The study group consisted of 230 women, including 70 healthy and 160 with diabetes mellitus type 1 (DM1). All the participants voluntarily filled anonymous questionnaire. The results regarding sexual function were obtained using a Female Sexual Function Index (FSFI) questionnaire. Statistical analysis was performed for sexually active people. In the study group, 180 women declared sexual activity: 62 healthy (88%) and 118 with DM1 (82.5%). Women with DM1 in comparison with healthy women were older, had higher BMI, weight, and had more pack-years of cigarette smoking. Women with DM1 had lower results in FSFI and more often achieved scores below the clinical cutoff point. In a multiple linear regression model, the presence of diabetes predicted lower FSFI results. DM1 is independently associated with the presence of impaired sexual function. Sexual dysfunctions are more common among young women with DM1 than in healthy controls. The relationship is significant despite of the age, duration of diabetes, body weight, and presence of angiopathy.
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Affiliation(s)
- Justyna Flotynska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Anna Michalska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
| | - Dorota Zozulinska-Ziolkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital , Poznan , Poland
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Zakiei A, Faridmarandi B, Komasi S. The Perspectives of Diabetic Men about Sexual Problems, Consequences, and Therapeutic Measures. Malays J Med Sci 2019; 25:133-135. [PMID: 30918463 PMCID: PMC6422585 DOI: 10.21315/mjms2018.25.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Zakiei
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Saeid Komasi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Caruso S, Cianci A, Cianci S, Monaco C, Fava V, Cavallari V. Ultrastructural Study of Clitoral Cavernous Tissue and Clitoral Blood Flow From Type 1 Diabetic Premenopausal Women on Phosphodiesterase-5 Inhibitor. J Sex Med 2019; 16:375-382. [PMID: 30773497 DOI: 10.1016/j.jsxm.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/29/2018] [Accepted: 01/04/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND The effects of phosphodiesterase-type 5 (PDE5) inhibitors on the in vivo clitoral structure of women with diabetes have never been investigated. AIM To study the in vivo structural and hemodynamic changes of the clitoris in premenopausal women with type 1 diabetes on PDE5 inhibitors. METHODS 38 premenopausal women with type 1 diabetes aged 36 -46 years. A randomized 1:1 study design was used: Study Group (group A) on Tadalafil 5 mg daily, and control group (group B). Blood samples were taken from each woman to measure HbA1c, testosterone, and Free Androgen Index. The women underwent microbiopsy of the clitoral body by means of semiautomatic gun during total anesthesia for surgery therapy of a benign gynecological pathology. The tissue removed was processed for electron microscopy. Translabial color Doppler ultrasound was used to measure the peak systolic velocity (PSV), the end diastolic velocity (EDV), and the pulsatility index (PI) of clitoral arteries. MAIN OUTCOME MEASURES Micro-ultrastructure observation of clitoral tissue and color Doppler sonography of clitoral blood flow. RESULTS Of the 38 women, 13 (68.4%) of group A and 15 (78.9%) of group B completed the study. Group A showed a mean PSV and EDV increase, and a mean PI decrease with respect to baseline (P < .001). Group B did not show any change in both the parameters (P = NS). By a quantitative study in both groups a variable degree of ultrastructural abnormalities of smooth muscle cells (SMCs) was observed, consisting in increased glycogen and lipoic deposits, cytoplasmic vacuoles, and focal increase of electron density of SMCs. Moreover, the mean SMC thickness of group A (1.83 ± 0.68 µm) was larger than that of group B (1.3 ± 0.41 µm) (P = .02). CLINICAL IMPLICATIONS PDE5 inhibitors could be used to treat diabetic women with genital arousal disorder. STRENGTHS & LIMITATIONS The study shows a clear effect of PDE5 inhibitors on clitoral SMCs. However, a limit was to not have investigated the sexual function/behavior of women of both groups, this was because of the short time of the study. CONCLUSION This study could help to understand in what way PDE5 inhibitors act on the ultrastructural pathophysiological clitoral cavernous tissue of women with diabetes. It could support PDE5 inhibitor usage in women with genital sexual arousal disorder due to metabolic diseases. Caruso S, Cianci A, Cianci S, et al. Ultrastructural Study of Clitoral Cavernous Tissue and Clitoral Blood Flow From Type 1 Diabetic Premenopausal Women on Phosphodiesterase-5 Inhibitor. J Sex Med 2019;16:375-382.
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Affiliation(s)
- Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy.
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy
| | - Stefano Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy
| | - Caterina Monaco
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy
| | - Valentina Fava
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy
| | - Vittorio Cavallari
- Unit of Ultrastructural Pathology, Department of Human Pathology, University of Messina, Messina, Italy
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Does Type 1 Diabetes Modify Sexuality and Mood of Women and Men? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050958. [PMID: 29751592 PMCID: PMC5981997 DOI: 10.3390/ijerph15050958] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022]
Abstract
Background: Sexual disorders occurring in women and men with type 1 diabetes have not been sufficiently investigated and described until now. This study attempts to evaluate sexuality in women and men. Methods: Altogether, the study comprised 115 patients with type 1 diabetes and 105 healthy people constituting the control group. All the studied persons underwent survey studies determining sexuality using the Female Sexual Function Index (FSFI-19) in women and the International Index of Erectile Function (IIEF-15) in men, and the occurrence of depression using the Beck Depression Inventory. The acceptance of illness among patients with diabetes was examined using the Acceptance of Illness Scale questionnaire. Results: In 35% of the examined women with diabetes, the study demonstrated sexual dysfunction as determined by total FSFI. The point values of all the investigated FSFI domains were significantly lower in women with diabetes than in healthy ones (p < 0.001). Erectile dysfunction occurred in 50% of the studied men with diabetes and in 23% of the control group of men (p = 0.0017). Conclusions: Type 1 diabetes leads to sexual disorders which occur in 1/3 of women and in 1/2 of men. Sexual disorders in patients with diabetes more frequently occur in men, persons with coexisting complications of diabetes, and in those with a concentration of glycated hemoglobin higher than 6.5%.
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Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018; 6:508-524. [PMID: 29730315 DOI: 10.1016/j.sxmr.2018.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Erectile dysfunction is recognized as an opportunity for preventing cardiovascular (CV) events, and assessing the impairment of penile vascular flow by Doppler ultrasound is an important tool to ascertain CV risk. Conversely, the role of genital vascular impairment in the pathophysiology of female sexual dysfunction (FSD) remains contentious. AIM To focus on the current scientific support for an association between CV risk factors and female sexual health in the 1st part of a 2-part review. METHODS A thorough literature search of peer-reviewed publications on the associations between CV risk factors and FSD and their underlying mechanisms was performed using the PubMed database. MAIN OUTCOME MEASURES We present a summary of the evidence from clinical studies and discuss the possible mechanisms providing the pathophysiologic bases of vasculogenic FSD syndromes. RESULTS The peripheral sexual response in women is a vascular-dependent event, and evidence suggests that cardiometabolic-related perturbations in endothelial function can determine vascular insufficiency in female genital tissues. Although epidemiologic and observational studies demonstrate that the prevalence of FSD is higher in women with diabetes mellitus, a cause-effect relation between these clinical conditions cannot be assumed. Evidence on the effect of obesity, metabolic syndrome, and polycystic ovary syndrome on sexual function in women is controversial. Data on the associations of dyslipidemia and hypertension with FSD are limited. CONCLUSION Common cardiometabolic alterations could affect vascular function in the female genital tract. Based on limited data, there is an association between CV risk factors and female sexual health in women; however, this association appears milder than in men. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018;6:508-524.
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Sexual Satisfaction, Relationship Satisfaction, and Quality of Life in Individuals with Type 2 Diabetes: Evidence from Poland. SEXUALITY AND DISABILITY 2017. [DOI: 10.1007/s11195-017-9516-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bąk E, Marcisz C, Krzemińska S, Dobrzyn-Matusiak D, Foltyn A, Drosdzol-Cop A. Relationships of Sexual Dysfunction with Depression and Acceptance of Illness in Women and Men with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091073. [PMID: 28926936 PMCID: PMC5615610 DOI: 10.3390/ijerph14091073] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 02/08/2023]
Abstract
An increased prevalence of sexual disorders has been reported in patients with type 2 diabetes. The aim of this study is the assessment of the influence of the psychical condition, the concentration of glycated hemoglobin, the duration of diabetes, the body mass index, the age, and the subjective acceptance of the illness on sexual disorders occurring in women and men with type 2 diabetes. The study enrolled 215 patients (114 women and 101 men) with type 2 diabetes and 183 controls. Sexuality was determined in all of the studied subjects using: the Female Sexual Function Index (FSFI) in women and the International Index of Erectile Function (IIEF) in men. The occurrence of depression symptoms was determined using the Beck Depression Inventory (BDI), whereas the acceptance of the illness in diabetic patients using the Acceptance of Illness Scale (AIS). A sexual dysfunction was found in 68% of the studied diabetic women and 17% of controls. The point values of all the examined FSFI domains were significantly lower in women with diabetes than in controls (p < 0.001). Erectile disorders occurred in 82% of the studied men with diabetes and in 41% of the controls (p < 0.001). The point values of all the domains of FSFI and IIEF demonstrated a significantly negative correlation with the total BDI score, which was higher in patients with diabetes than in patients without diabetes, and a positive correlation with the total AIS score (p < 0.001). The occurrence of sexual dysfunction in patients with diabetes correlated with the age and the duration of diabetes. We conclude that sexual disorders in patients with type 2 diabetes demonstrate the correlation with the occurrence of depression and the acceptance of their illness. Sexual disorders in diabetic patients occur more frequently in older patients and in those with a longer duration of diabetes.
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Affiliation(s)
- Ewelina Bąk
- Faculty of Health Sciences, University of Bielsko-Biala, 43-309 Bielsko-Biala, Poland.
| | - Czeslaw Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Sylwia Krzemińska
- Department of Clinical Nursing Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland.
| | - Dorota Dobrzyn-Matusiak
- Department of Nursing Propaedeutics, School of Health Sciences, Medical University of Silesia, 40-752 Katowice, Poland.
| | - Agnieszka Foltyn
- Faculty of Health Sciences, University of Bielsko-Biala, 43-309 Bielsko-Biala, Poland.
| | - Agnieszka Drosdzol-Cop
- Chair of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
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Muthiah B, Kallikadavil A, Shivaswamy R, Menon VB. The Study of Gonadal Hormonal Abnormalities and Sexual Dysfunction in HIV Positive Females: An Exploratory Study. J Clin Diagn Res 2016; 10:OC11-4. [PMID: 27190860 PMCID: PMC4866158 DOI: 10.7860/jcdr/2016/18992.7581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Every endocrine gland has been reported to be affected at varying rates in HIV. HIV is a highly stigmatized chronic disease with a substantial co-occurrence of mental and sexual health problems; however the sexual health problems in women have not been extensively studied. AIM To study the gonadal hormonal abnormalities and sexual dysfunction in HIV positive female patients and its possible association. MATERIALS AND METHODS This descriptive/exploratory study was conducted in the Department of General Medicine at a tertiary care hospital from September 2013 to August 2015. The study group included 50 diagnosed HIV-positive patients. They were also subjected to specific questions regarding sexual dysfunction by female counselors using female sexual function index. Visits of the subjects were scheduled independent of the menstrual cycle. Hormonal levels (free testosterone, FSH, LH) were measured. RESULTS Out of 50 patients, 26 patients in our study had sexual dysfunction (52%). Patients with age group between 30-39 years had the maximum sexual dysfunction compared to the other groups (<0.001). Patients with a CD4 count between 200 and 499 had the maximum sexual dysfunction (<0.02). Mean duration of HIV in the study was 30 months in sexual dysfunction group which was significant (p<0.005). Hormonal levels were found to be in normal range. All the study patients reported desire, arousal and lubrication problems whereas orgasm and satisfaction problems were noted in 60% patients with pain reported in 52%. CONCLUSION We identified that although the hormonal levels were in the normal range, they were comparatively in the lower range in the dysfunction group than the non-dysfunctional group. Both free testosterone and FSH levels were low indicating involvement of the pituitary rather than the gonads. We also conclude that duration of HIV and also level of CD4 count is related to sexual dysfunction.
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Affiliation(s)
- Bhanukumar Muthiah
- Associate Professor, Department of General Medicine, JSS Medical College and Hospital, SS Nagar, Mysore, Karnataka, India
| | - Abithraj Kallikadavil
- Post Graduate, Department of General Medicine, JSS Medical College and Hospital, SS Nagar, Mysore, Karnataka, India
| | - Rajendraprasad Shivaswamy
- Assistant Professor, Department of General Medicine, JSS Medical College and Hospital, SS Nagar, Mysore, Karnataka, India
| | - Vineetha Bharathan Menon
- Research Scholar, Department of Clinical Pharmacy, JSS Medical College and Hospital, SS Nagar, Mysore, Karnataka, India
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Trifi M, Elkissi Y, Slim I, Chaïeb M, Ben Nasr S, Chaïeb L, Ben Hadj Ali B. Évaluation de la fonction sexuelle des femmes ayant un diabète de type 2 : étude cas-temoins. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Şahin M, Şahin ZA. Effect of sexual dysfunction and sexual quality of life in type 2 diabetes women: a pilot study from Turkey. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Rutte A, van Oppen P, Nijpels G, Snoek FJ, Enzlin P, Leusink P, Elders PJM. Effectiveness of a PLISSIT model intervention in patients with type 2 diabetes mellitus in primary care: design of a cluster-randomised controlled trial. BMC FAMILY PRACTICE 2015; 16:69. [PMID: 26032852 PMCID: PMC4450606 DOI: 10.1186/s12875-015-0283-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/20/2015] [Indexed: 01/23/2023]
Abstract
Background Sexual dysfunction is prevalent in patients with type 2 diabetes mellitus, but remains one of the most frequently neglected complications in diabetes care. Both patients and care providers appear to have difficulty with discussing sexual problems in diabetes care. A sexual counselling model for care providers, such as the PLISSIT model, might be a useful tool to improve the discussion of sexual issues in patients with type 2 diabetes mellitus. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Even though the use of the PLISSIT model has often been recommended in diabetes care, no evidence with regards to its effectiveness in patients with type 2 diabetes mellitus exists. This study describes the design of a cluster-randomised controlled trial evaluating the effectiveness of a PLISSIT-model intervention in men and women with type 2 diabetes mellitus in primary care. Methods/Design Patients with type 2 diabetes mellitus, aged 40–75 years, who indicate to be dissatisfied about their sexual functioning and that they would like to talk about their sexual problem(s) with their general practitioner are recruited. All participants receive an information leaflet from the practice nurse. In the intervention group, each participant will also receive sexual counselling based on the PLISSIT model from their general practitioner. In the control group, usual care will be provided to those participants requesting an appointment with their general practitioner when the information leaflet was not deemed sufficient. Primary outcomes include sexual functioning, satisfaction about sexual function, and quality of life. Secondary outcomes are depressive symptoms, sexual distress, emotional well-being, and treatment satisfaction. Outcomes will be measured by means of self-report questionnaires at baseline, and after 3 and 12 months post-baseline. Treatment satisfaction will be assessed in telephone interviews. Discussion This paper describes the design of a cluster-randomised controlled trial that will investigate the effectiveness of a PLISSIT-model intervention in patients with type 2 diabetes mellitus in primary care. Our study will add important and currently missing insight into the effectiveness of PLISSIT on important patient-reported outcomes of men and women with type 2 diabetes mellitus. Trial registration Dutch Trial Registry NTR4807.
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Affiliation(s)
- Anne Rutte
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. .,VU University Medical Centre, Department of General Practice and Elderly Care Medicine, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Patricia van Oppen
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Frank J Snoek
- Department of Medical Psychology, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Paul Enzlin
- Department of Neurosciences, Institute for Family and Sexuality Studies, KU Leuven, Leuven, Belgium. .,Centre for Clinical Sexology and Sex Therapy, UPC KU Leuven, Leuven, Belgium.
| | - Peter Leusink
- Department of Sexology, Groene Hart Hospital, Gouda, The Netherlands.
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
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Rutte A, van Splunter MMI, van der Heijden AAWA, Welschen LMC, Elders PJM, Dekker JM, Snoek FJ, Enzlin P, Nijpels G. Prevalence and Correlates of Sexual Dysfunction in Men and Women With Type 2 Diabetes. JOURNAL OF SEX & MARITAL THERAPY 2014; 41:680-690. [PMID: 25256659 DOI: 10.1080/0092623x.2014.966399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study aimed to assess the prevalence and correlates of sexual dysfunction in a sample of Dutch men and women with type 2 diabetes. Patients with type 2 diabetes who were between the ages of 40 and 75 years from 4 Dutch diabetes centers were asked to complete self-report questionnaires covering sociodemographic characteristics, medical characteristics, clinical depression (Center for Epidemiological Studies), and sexual dysfunction (in men: International Index of Erectile Function; in women: Female Sexual Function Index). In total, 158 type 2 diabetes patients (68% men) completed the cross-sectional survey. On the basis of predefined criteria, 69% of men and 70% of women were classified with some degree of sexual dysfunction. Univariable logistic regression analyses revealed that sexual dysfunctions were associated with higher age, clinical depression (Center for Epidemiological Studies score ≥16), and one or more diabetes-related complications in both men and women. Multivariable logistic regression analyses revealed that clinical depression was most strongly associated with both male (OR = 6.87, 95% CI [1.77, 26.63]) and female (OR = 9.33, 95% CI [1.03, 84.87]) sexual dysfunction. In conclusion, sexual dysfunction is highly prevalent in men and women with type 2 diabetes and is associated with higher age, clinical depression, and diabetes-related complications. These results suggest that addressing sexual dysfunction in diabetes care is important.
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Affiliation(s)
- Anne Rutte
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research VU University Medical Center , Amsterdam , The Netherlands
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Abstract
Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It has been associated with sexual dysfunction, both in males and in females. Diabetes is an established risk factor for sexual dysfunction in men, as a threefold increased risk of erectile dysfunction was documented in diabetic men, as compared with nondiabetic men. Among women, evidence regarding the association between diabetes and sexual dysfunction are less conclusive, although most studies have reported a higher prevalence of female sexual dysfunction in diabetic women as compared with nondiabetic women. Female sexual function appears to be more related to social and psychological components than to the physiological consequence of diabetes. Hyperglycemia, which is a main determinant of vascular and microvascular diabetic complications, may participate in the pathogenetic mechanisms of sexual dysfunction in diabetes. Moreover, diabetic people may present several clinical conditions, including hypertension, overweight and obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are themselves risk factors for sexual dysfunction, both in men and in women. The adoption of healthy lifestyles may reduce insulin resistance, endothelial dysfunction, and oxidative stress - all of which are desirable achievements in diabetic patients. Improved well-being may further contribute to reduce and prevent sexual dysfunction in both sexes.
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Affiliation(s)
- Maria Ida Maiorino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
- Correspondence: Katherine Esposito, Endocrinology and Metabolic Diseases Unit, University Hospital at Second University of Naples, Piazza L Miraglia no 2, 80138 Napoli, Italy, Tel +39 081 566 5031, Fax +39 081 566 5054, Email
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18
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Kalra S, Sridhar GR, Balhara YPS, Sahay RK, Bantwal G, Baruah MP, John M, Unnikrishnan AG, Madhu K, Verma K, Sreedevi A, Shukla R, Prasanna Kumar KM. National recommendations: Psychosocial management of diabetes in India. Indian J Endocrinol Metab 2013; 17:376-95. [PMID: 23869293 PMCID: PMC3712367 DOI: 10.4103/2230-8210.111608] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Department of Endocrine and Diabetes Centre, Visakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi, India
| | | | - Ganapathy Bantwal
- Department of Endocrinology, St. John's Medical College, Bengaluru, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, India
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | | | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Komal Verma
- Department of Psychology, Consultant Psychologist, Noida, India
| | - Aswathy Sreedevi
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Rishi Shukla
- Department of Endocrinology, Center For Diabetes, Kanpur, Uttar Pradesh, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology, CDEC and Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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19
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Jiménez-Garcia R, Martinez-Huedo MA, Hernandez-Barrera V, De Andres AL, Jimenez-Trujillo I, Carrasco-Garrido P. Sexuality among Spanish adults with diabetes: a population-based case control study. Prim Care Diabetes 2012; 6:269-276. [PMID: 22445726 DOI: 10.1016/j.pcd.2012.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/07/2012] [Accepted: 02/29/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe and compare sexuality between subjects with diabetes with matched non-diabetic controls. METHODS Population based case control study using individual data from the Spanish National Sexual Health Survey. Diabetes status was self reported, we selected type 2 patients. We identified 461 diabetes sufferers. Two controls were matched by age, sex and sexual partner for each diabetic case. Sexuality measures included: sexual activity, importance of sex, satisfaction with partner, bothersome with one's sexual life and self-rated sexual health. Independent variables included: socio-demographics, physical health, chronic diseases and medications use. RESULTS No differences were found in "Sexually activity", "Importance of sex" or "Bothersome" between those with and without diabetes. Dissatisfaction with partner was 25% in women with diabetes and 12.9% in non-diabetic controls (Adjusted-OR 1.82 95%CI 1.02-4.85). Diabetes sufferers reported sexual health as "fair/poor/very poor" more than their non-diabetic control, 58.1% vs. 45.1% for women (Adjusted-OR 1.74 95%CI 1.15-2.63) and 54.3% vs. 38% for men (Adjusted-OR 1.88 95%CI 1.29-2.75). Among diabetes sufferers "fair/poor/very poor" sexual health was associated with poorer physical health, not having a sexual partner and among men taking heart medications. CONCLUSIONS Women and men with diabetes have significantly worse sexuality measures than non diabetic controls.
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Affiliation(s)
- Rodrigo Jiménez-Garcia
- Preventive Medicine Unit, Rey Juan Carlos University, Av. Atenas, Alcorcón 28922, Spain.
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20
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Ziaei-Rad M, Vahdaninia M, Montazeri A. Sexual dysfunctions in patients with diabetes: a study from Iran. Reprod Biol Endocrinol 2010; 8:50. [PMID: 20482781 PMCID: PMC2887879 DOI: 10.1186/1477-7827-8-50] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 05/18/2010] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a chronic disease that causes short and long-term complications. This study aimed to investigate the prevalence of sexual dysfunctions (SD) among diabetic patients in Iran and to examine whether glycemic control has a role in SD. METHODS A consecutive sample of diabetic women and men who were registered in the Isfahan Endocrine and Metabolism Center, Iran were studied. Sexual dysfunction was evaluated using the Female Sexual Function Index (FSFI) in women and the International Index of Erectile Function (IIEF) in men. In addition the level of glycosylated hemoglobin was assessed to classify the diabetes status in patients. RESULTS In all 200 patients (100 male and 100 female) were entered into the study. The mean age of patients was 48.6 (SD = 7.3) years and most had type 2 diabetes (91.0%). The results showed that sexual dysfunctions were widespread in both gender and 165 (82.5%) patients reported that experienced at least one sexual dysfunction. There were significant associations between sexual dysfunctions and gender and type of diabetes (P = 0.04). Women and patients with type 1 diabetes had higher rates of SD. No major differences were found between SD and age, diabetes status, duration of diabetes and hypertension. In addition, glycemic control did not show a significant association with SD in both genders. CONCLUSION The findings of this study showed that SD prevalence was high in diabetic patients of both genders and the glycemic control did not correlate with the frequency of SD in the study population. It is recommended that SD should be addressed more precisely in health care practice in Iran.
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Affiliation(s)
- Marzieh Ziaei-Rad
- Faculty of Nursing and Midwifery, Islamic Azad University, Khorasgan Branch, Isfahan, Iran
| | - Mariam Vahdaninia
- Department of Social Medicine, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Ali Montazeri
- Department of Mental Health, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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21
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Sexualität bei chronischen neurologischen Erkrankungen. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Traish AM, Cushman T, Hoyt R, Kim NN. Diabetes Attenuates Female Genital Sexual Arousal Response via Disruption of Estrogen Action. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.3.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Abdulmaged M. Traish
- Department of Biochemistry and Urology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Tulay Cushman
- Departments of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Richard Hoyt
- Departments of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Noel N Kim
- Department of Urology, Boston University School of Medicine, Boston, MA 02118, USA
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