The differential impact of diabetes type on female sexuality

The association between marital quality and diabetes mellitus: A systematic review

Background and Aims

Marital relationship and its quality are among the major psychological factors affecting the multiple aspects of a person's health status. Chronic diseases are also among the factors that affect various aspects of the lives of millions of people including their marital quality status. One of the most important underlying chronic diseases is diabetes. Since the correlation between diabetes mellitus and marital quality has been neglected, this systematic review, as the first one, aims to investigate the association between marital quality and diabetes mellitus.

Methods

A comprehensive search was conducted among three databases (Medline, Scopus, and Web of Science) until September 2021, which resulted in 189 articles. After assessing the studies based on the inclusion criteria, 14 studies were included.

Results

The included studies were divided into two general groups. The first group consisted of 3 articles examining the effect of factors related to diabetes on marital quality, and the second group included 11 articles studying the effect of marital quality on diabetes and its factors. In general, the articles investigating the impact of diabetes-related factors on marital quality showed that diabetes has negative impacts on levels of marital quality. Also, the articles investigating the impact of marital quality on diabetes-related factors, showed that higher marital quality is associated with a lower risk of developing diabetes, a better quality of life in patients with diabetes, and better adherence to diabetes care regimen. The results regarding diabetes management were conflicting. Gender was mentioned as an important modulator in some of the investigated relationships.

Conclusion

Marital quality remarkably influences diabetes-related factors and is itself affected by the condition resulting from diabetes in individuals with diabetes mellitus. However, further studies are required due to the limited number of studies investigating this correlation.

Prevalence of female sexual dysfunction among diabetic females: a cross sectional case controlled study

BACKGROUND

Sexual relationships, sexual functions are all parts of the female sexual identity and which influence physiological, psychological and reproductive functions of women.

AIM OF THE WORK

The study aimed to identify prevalence of Female Sexual Dysfunction (FSD) in women affected by type 1 and type 2 Diabetes Mellitus (DM) and to evaluate the impact of diabetes on female sexuality.

PATIENT AND METHODS

This cross-sectional study was carried out on 400 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 300 diabetes patients (134 patients with type 1 DM and 166 patients with type 2 DM), while the second included 100 women not diagnosed with diabetes who served as controls.

RESULTS

Considering female sexual dysfunction (score < 26.55), there was statistically significant increase of patients with female sexual dysfunction (FSD) in Type1 DM (50.7%) when compared to type 2 DM patients (28.9%) or control group (10.0%).. Conclusion FSD is a significant health problem in premenopausal women complaining of DM. Females with type 1 DM were more affected than females with type 2 DM, who in turn were more affected than healthy controls. Long duration of the disease was the main risk factor for developing FSD.

Diabetic Peripheral Neuropathy and Urological Complications in Type 1 Diabetes: Findings From the Epidemiology of Diabetes Interventions and Complications Study

OBJECTIVE

To evaluate associations between diabetic peripheral neuropathy (DPN) and urological complications in men and women with type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS

Measurements of DPN at Epidemiology of Diabetes Intervention and Complications (EDIC) years 1, 14, and 17 and urological complications at EDIC year 17 were examined in 635 men (mean age 51.6 years, diabetes duration 29.5 years) and 371 women (mean age 50.6 years, diabetes duration 29.8 years) enrolled in the Diabetes Control and Complications Trial (DCCT)/EDIC study. DPN was defined by symptoms, signs, and abnormal electrophysiology or by abnormal Michigan Neuropathy Screening Instrument (MNSI) examination or questionnaire scores.

RESULTS

Erectile dysfunction (ED) in combination with lower urinary tract symptoms (LUTS) was reported in 15% of men and female sexual dysfunction (FSD), LUTS, and urinary incontinence (UI) in 16% of women. Adjusted for age, drinking status, BMI, depression, DCCT/EDIC time-weighted mean HbA1c, microalbuminuria, hypertension, triglycerides, and statin medication use, the odds of reporting ED and LUTS versus no ED or LUTS at EDIC year 17 were 3.52 (95% CI 1.69, 7.31) times greater in men with confirmed DPN at EDIC year 13/14 compared to men without confirmed DPN. Compared to men without DPN, men with DPN based on abnormal MNSI examination or questionnaire scores had significantly higher odds of reporting ED and LUTS versus no ED or LUTS at EDIC year 17. There were no significant differences in DPN between women reporting both FSD and LUTS/UI compared with those without FSD or LUTS/UI at EDIC year 17.

CONCLUSIONS

In long-standing T1D, DPN is associated with the later development of urological complications in men.

Quality of Life, Sexual Functioning and Chronic Disease: A Comparative Study with Portuguese Women without Chronic Disease, and Women with Diabetes Type 1 and 2, and Arterial Hypertension

Aims: Previous research has focused on the impact of chronic diseases on men's sexual functioning and quality of life; however, little is known about the association between chronic disease and women's sexual functioning and quality of life. Current study aimed at exploring the differences in quality of life and sexual functioning between women without chronic disease, and women with type 1 diabetes, with type 2 diabetes, and with arterial hypertension. Methods: A web-survey was completed by 313 Portuguese women (167 without chronic disease, 48 with type 1 diabetes, 48 with type 2 diabetes, and 50 with arterial hypertension). Results: Women without chronic disease scored significantly higher than women with chronic disease in quality of life and sexual functioning, adjusting for age. Conclusions: Quality of life and sexual functioning in women with chronic diseases is impaired.

Reduced sexual motivation of diabetic female rats: Restoration with insulin

The aim of this study was to evaluate female rat sexual motivation in a model of diabetes mellitus type 1. Severe hyperglycemia was induced in ovariectomized Wistar rats by injecting streptozotocin [STZ, 100 mg/kg, i.p.]. Ten days later, females received estradiol benzoate (10 μg/rat, s.c.) plus progesterone (3 mg/rat, s.c.). A group of STZ-treated animals was administered with insulin (2-4 U) every 12 h for 10 days, which normalized glucose levels. In the partner preference (PP) and sexual incentive motivation (SIM) tests, control females spent more time close to a sexually experienced male (SE) than with a castrated male (CM). STZ-treated females stayed the same amount of time with both stimuli, that is, they lost their sexual preference. We also evaluated the sense of smell using two behavioral tests, one related to sexual odors (SO) and another one to food odors (FO). In the SO test, control females spent more time sniffing the sawdust coming from cages that contained SE males; hyperglycemic females remained the same amount of time sniffing the sawdust of both stimuli: SE and CM. In the FO test, no differences were found between control and STZ-treated groups. Insulin treatment reverted the changes observed in hyperglycemic females in the PP, SIM and SO tests. These data suggest that severe hyperglycemia decreases sexual motivation and that insulin recovers such diminution.

Association between type 1 diabetes and female sexual dysfunction

BACKGROUND

This study aims to evaluate: 1) the prevalence of Female Sexual Dysfunction (FSD) in women affected by type 1 Diabetes Mellitus (DM) and the control group; 2) the correlation between duration of DM, HbA1C levels and sexual life quality; 3) the relationship between different methods of insulin administration and sexual life quality; 4) the correlation between FSD and diabetes complications.

METHODS

We selected 33 women with type 1 DM and 39 healthy women as controls. Each participant underwent a detailed medical history and physical examination and completed the 6-item Female Sexual Function Index questionnaire (FSFI-6). In patients affected by type 1 DM, the different methods of insulin administration (Multi Drug Injection - MDI or Continuous Subcutaneous Insulin Infusion - CSII) and the presence of DM complications were also investigated.

RESULTS

The prevalence of FSD (total score ≤ 19) was significantly higher in the type 1 DM group than in the control group (12/33, 36.4% and 2/39, 5.2%, respectively; p = 0.010). No statistically significant differences were found regarding FSD according to the presence of complications, method of insulin administration or previous pregnancies.

CONCLUSIONS

This study underlined that FSD is higher in women affected by type 1 DM than in healthy controls. This could be due to the diabetic neuropathy/angiopathy and the type of insulin administration. Therefore, it is important to investigate FSD in diabetic women, as well as erectile dysfunction in diabetic men.

Evaluation of sexual dysfunction and female sexual dysfunction indicators in women with type 2 diabetes: a systematic review and meta-analysis

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.

Does Chronic Hyperglycemia Affect Female Rat Sexual Behavior? Differences in Paced and Non-Paced Mating

INTRODUCTION

Diabetes mellitus has been associated with sexual dysfunction; however, in women this relationship is controversial. A study using a model of type 2 diabetes mellitus (DM2) failed to find a reduced receptivity in the non-paced mating (NPM), but the appetitive aspects of female sexual behavior have not been evaluated, for example, in the paced mating (PM) paradigm.

AIM

To evaluate all components of female sexual behavior (in NPM and PM) in a model of DM2 using ovariectomized (OVX) (treated with steroids) or intact female rats (non-OVX) in natural proestrus.

METHODS

Neonatal females (3-4 days) were administered streptozotocin (STZ, 70 mg/kg, intraperitoneally) or citrate buffer. At week 8, a glucose tolerance test was performed. At week 10, half of the females were OVX, and in the other half (non-OVX) the estrous cycle was monitored. At the twelfth week, the sexual behavior tests were conducted; OVX females were treated with estradiol benzoate (10 μg, -24 hours) and progesterone (3 mg, -4 hours), whereas the non-OVX were evaluated on vaginal proestrus.

MAIN OUTCOME MEASURES

We registered in NPM and PM receptivity (lordosis quotient and intensity), as well as the number of proceptive and aggressive behaviors. Additionally, in PM we calculated the percentage of exits and the return latencies after receiving stimulation and the time the female remained in the male's compartment.

RESULTS

The STZ-treated females presented glucose intolerance and were hyperglycemic. Neonatal STZ treatment provoked changes in the females' sexual behavior depending on the paradigm and the hormonal condition. In the NPM, STZ-OVX females had decreased lordosis quotient and intensity and increased aggression, whereas, in the STZ-non-OVX females, there was a decrease in proceptivity; such changes were not observed in PM. Regardless of whether the STZ-treated females were OVX, they failed to perform the pacing behavior.

CLINICAL IMPLICATION

These data support the idea that chronic mild hyperglycemia, like that observed in DM2 (which represents 90% of the clinical cases), provokes marginal changes in most aspects of female sexual behavior.

STRENGTHS & LIMITATIONS

The main strength of this work is the evaluation of consummatory and motivational aspects of female sexual behavior in a model of DM2. The main limitation is the duration of the experimental design that does not resemble the course of the disease in humans. No histologic or biochemical analyses were performed.

CONCLUSION

These results suggest that chronic hyperglycemia produces decreases in sexual behavior. Hernández-Munive AK, Rebolledo-Solleiro D, Fernández-Guasti A. Does Chronic Hyperglycemia Affect Female Rat Sexual Behavior? Differences in Paced and Non-Paced Mating. J Sex Med 2019;16:1130-1142.

Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes

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.

Sexual Dysfunctions in Female with Neurological Disorders

Female sexuality is a controversial issue due to its embarrassment and to paucity of literature publications. The neuroanatomy and neuromediators involved in female sexuality are important but not so fundamental as in men. There are three sexual female dysfunctions (SFD): primary, secondary, tertiary. In the primary one, the sexual dysfunction (SD) is correlated to the neurological disease, in the secondary the SD derives from the symptoms of the neurological disease, in the tertiary the SD is the psychological reaction to the effects of the disease. We analyse the FSD in neurological diseases, as the outcome of medulla trauma, multiple sclerosis, epilepsy, Alzheimer, Parkinson, diabetes, outcome of pelvic surgery. Female sexuality (FS) is difficult and complex compared to male sexuality. Women with medulla lesion feel some discomfort when having to go and speak to their doctor: they are afraid of pregnancy, sexual intercourses, bladder and rectal functions. In women with newly diagnosed multiple sclerosis, there is a tertiary sexual dysfunction. Medical therapy worsens female sexuality as in case of epilepsy. Emotional and behavioural disorders involve sexual dysfunctions in women with Alzheimer. In Parkinson, reduction of sexual desire involves break of sexual intercourses. SD are more frequent in complicated diabetes. In pelvic surgery, pelvic autonomic dysfunction and depression correlated to the oncology disease, contribute to the FSD. Sexual counselling, especially in young women with medulla lesion or multiple sclerosis, is the best therapy, and learning erotic extragenital areas able to make sensations similar to the orgasms.

Review: Female sexual dysfunctions — the new models

A new model of women's sexual response reflects their various motivations to be sexual and the fact that psychological and biological factors strongly influence their arousability. Examples of factors stemming from diabetes are included. To increase emotional intimacy with their partner, women will deliberately find or be receptive to sexual stimuli that can potentially be sexually arousing. Only later do they sense specifically sexual need to continue for the sake of sexual sensations, sexual tension and possible orgasmic release. A model of women's subjective sexual arousal reflects the ongoing modulation from her emotions and cognitions as well as highly variable genital feedback.

Intimacy and Women With Type 2 Diabetes: An Exploratory Study Using Focus Group Interviews

PURPOSE

this study explored if and how women perceived diabetes as affecting their social and sexual intimacy and if they wished to receive professional attention for any sexual disturbances that they experience.

METHODS

A series of five focus group interviews were conducted with 33 women with type 2 diabetes, ages 44 to 80 years, who also completed a questionnaire on sexual functioning. Two thirds were married and one third were sexually active.

RESULTS

Categories resulting from the qualitative analysis were guilt and embarrassment in diabetes; female intimacy and shame; sexual dysfunction, an invisible problem; and the female patient. Asking women about intimacy revealed self-blame and embarrassment regarding their diabetes and sexual functioning. Several women who had experienced sexual dysfunction described barriers that made it difficult to obtain optimal care and/or self-care measures to cope with vaginal dryness, pain during intercourse, and decreased desire. Many of the women had the social and emotional resources to cope with their disease. Nonetheless, they experienced guilt, shame, and embarrassment, which are potentially oppressive features of having type 2 diabetes.

CONCLUSIONS

Asking women with type 2 diabetes about intimacy in a contextually adequate way at routine follow-up visits could give them a chance to discuss both sexual and social intimacy concerns related to their diabetes.

Sexual dysfunction in diabetic women: prevalence and differences in type 1 and type 2 diabetes mellitus

BACKGROUND

The aim of this work was to evaluate the impact of diabetes on female sexuality and to highlight any differences between sexuality in the context of type 1 and type 2 diabetes mellitus (DM).

METHODS

The subjects selected were 49 women with type 1 DM, 24 women with type 2 DM, and 45 healthy women as controls. Each participant was given the nine-item Female Sexual Function Index questionnaire to complete. The metabolic profile was evaluated by body mass index and glycosylated hemoglobin assay.

RESULTS

The prevalence of sexual dysfunction (total score ≤30) was significantly higher in the type 1 DM group (25/49, 51%; 95% confidence interval [CI] 18-31) than in the control group (4/45, 9%; 95% CI 3-5; P=0.00006); there were no significant variations in the type 2 DM group (4/24, 17%; 95% CI 3-4) versus the control group (P=0.630, not statistically significant). The mean total score was significantly lower in the type 1 DM group (30.2±6.9) versus the control group (36.5±4.9; P=0.0003), but there was no significant difference between the type 2 DM group and the control group (P=0.773). With regard to specific questionnaire items, the mean values for arousal, lubrication, dyspareunia, and orgasm were significantly lower only in the type 1 DM group versus the control group. The mean values for desire were reduced in type 1 and type 2 DM groups versus control group.

CONCLUSION

Type 1 DM is associated with sexual dysfunction. This may be due to classic neurovascular complications or to the negative impact of the disease on psychosocial factors. Larger and ideally longitudinal studies are necessary to better understand the relationship between DM and sexual dysfunction.

Sexual dysfunction in patients with peripheral nervous system lesions

Peripheral nervous system (PNS) disorders may cause sexual dysfunction (SD) in patients of both genders. These disorders include mainly polyneuropathies (particularly those affecting the autonomic nervous system (ANS)) and localized lesions affecting the innervation of genital organs. Impaired neural control may produce a malfunction of the genital response consisting of loss of genital sensitivity, erectile dysfunction, loss of vaginal lubrication, ejaculation disorder, and orgasmic disorder. In addition, there is often a loss of desire which actually has a complex pathogenesis, which goes beyond the mere loss of relevant nerve function. In patients who have no manifest health problems - particularly men with erectile dysfunction - one should always consider the possibility of an underlying polyneuropathy; in patients with SD after suspected denervation lesions of the innervation of genital organs within the lumbosacral spinal canal and in the pelvis, clinical neurophysiologic testing may clarify the PNS involvement. SD can alter self-esteem and lower patients' quality of life; opening up a discussion on sexual issues should be a part of the management of patients with PNS disorders. They may greatly benefit from counseling, education on coping strategies, and specific treatments.

Effect of metabolic syndrome on sexual function in pre- and postmenopausal women

Female sexual dysfunction is a prevalent and multidimensional disorder related to many biological, psychological, and social determinants. The authors assessed the effect of one of the many factors affect sexual function-metabolic syndrome-on female sexual function. They equally divided 400 women participants among 4 groups: (a) premenopausal with metabolic syndrome, (b) premenopausal without metabolic syndrome, (c) postmenopausal with metabolic syndrome, and (d) postmenopausal without metabolic syndrome. The authors used the Female Sexual Function Index to assess women's sexual function. Female sexual dysfunction was found more often in both pre- and postmenopausal women with metabolic syndrome (p =.001). Overall Female Sexual Function Index score and satisfaction, pain, and desire domain scores independently of the menopause status showed statistically significant differences across women with metabolic syndrome in comparison with participants with no metabolic syndrome (p <.05). The authors also evaluated the associations among 5 components of metabolic syndrome and Female Sexual Function Index scores. Higher fasting glucose levels were significantly associated with the Female Sexual Function Index score (p <.05). This study shows that sexual dysfunction is more prevalent in pre- and postmenopausal women with the metabolic syndrome.

Comparison of sexual dysfunction between diabetic and non-diabetic women

CONTEXT

Sexual dysfunction (SD) among diabetic women is an important disorder. It has many negative effects on general health.

AIMS

This study aimed to compare SD status between diabetic and non-diabetic women.

SETTINGS AND DESIGN

This study was conducted on 200 women, half of them diabetic and the others as non-diabetic in Tohid Hospital (Sanandaj, Iran).

MATERIALS AND METHODS

The non-diabetic group was matched for age (±5 years) and education. Data were collected using an interview-based questionnaire containing demographic characteristics and female sexual function index (FSFI).

STATISTICAL ANALYSIS USED

Univariate and multivariate analyses were performed to assess and interpret the results.

RESULTS

Analyses of the data showed that low educational levels, longer duration of diabetes and poor controlled diabetes were associated with the lower FSFI scores. In both groups the prevalence of SDs for all FSFI domains was high. Furthermore, multivariate analysis showed that these three variables were associated with lower FSFI scores.

CONCLUSIONS

Study confirms that Kurdish Iranian diabetic women are at an increased risk of SD. Low educational level, longer duration of diabetes, and poor controlled diabetes were associated with a lower FSFI score.

Does the diabetes of type 2 affect the sexual functions of women?

This study aimed to investigate female sexual dysfunction in patients with type 2 diabetes. Using the Index of Female Sexual Function, the authors compared the sexual function of type 2 diabetic women with that of nondiabetic women. Participants were 76 sexually active women with type 2 diabetes (study group) and 100 sexually active nondiabetic women (control group); all women were 24-47 years of age and had similar backgrounds. The participants with type 2 diabetes were selected from those women who applied to the Diabetes Polyclinic of the Istanbul University. Results were analyzed using chi-square and Student's t test. The prevalence of sexual dysfunction was significantly higher among the study group than in the control group. The authors found that if HbA1c, body mass index, and duration of diabetes increase, the prevalence of sexual dysfunction also increases. The authors of this article conclude that all diabetic patients should be considered to have sexuality, and patients with sexual dysfunction should be referred to appropriate medical centers.

Female sexual dysfunction and diabetes: a systematic review and meta-analysis

INTRODUCTION

Sexual dysfunction is reported in diabetic women (female sexual dysfunction [FSD]).

AIM

To examine the frequency of FSD in diabetic women, and its clinical or metabolic correlates, through meta-analysis of available studies.

METHODS

We searched in MEDLINE, EMBASE, Cochrane Library, and in reference lists of articles and systematic reviews; we considered human clinical studies published as full articles reporting on FSD in diabetic and control women. In total, we considered 26 studies, including 3,168 diabetic and 2,823 control women.

MAIN OUTCOME MEASURES

Frequency of FSD and score of Female Sexual Function Index (FSFI) as a function of study size, patient details (age, body mass index [BMI], duration of diabetes, metabolic control [HbA1c], chronic complications, Beck Depression Inventory [BDI] score).

RESULTS

Frequency of FSD was higher in type 1 (OR [95%CI] 2.27 [1.23, 4.16]), in type 2 diabetes (2.49 [1.55, 3.99]), and in "any diabetes" (type 1 and 2) women (2.02 [1.49, 2.72]) than in controls for any duration of diabetes. FSFI was lower in type 1 (-0.27 [-0.41, -0.12]), in type 2 diabetes (-0.65 [-0.75, -0.54]), and in "any diabetes" women (-0.80 [-0.88, -0.71]) than in controls. Depression was significantly more frequent in diabetic than in control women. At meta-regression only BMI was significantly associated with effect size (P = 0.005). At weighed regression, the only significant association was found between age and FSFI (P = 0.059). The limitations were as follows: only studies of observational nature were available, and heterogeneity was seen among studies.

CONCLUSIONS

FSD is more frequent in diabetic than in control women, but it is still poorly understood; low FSFI is associated with high BMI. Further studies are necessary to better understand risk factors for FSD in diabetic women.

Mediators of sexual functions in women with diabetes

INTRODUCTION

Sexual disorders in women with diabetes mellitus (DM) may not necessarily have only the biological etiology.

AIMS

To establish the mediators of sexual functions in the population of women with DM.

METHODS

Five hundred seventeen females, aged 18-55 years old, were included in a questionnaire-based, cross-sectional study. This is the second part of the study on sexual functions in females with DM where only females with DM (n=242) were analyzed. Sexual functions were compared between women with type 1 (n=109) and type 2 DM (N=133).

MAIN OUTCOME MEASURES

To assess reported female sexual functions by using the Female Sexual Function Index (FSFI) in women with type 1 and type 2 DM. To establish the risk factors of female sexual dysfunction (FSD) in women with DM by using multivariate logistic regression model.

RESULTS

Sexual dysfunction was diagnosed in 32.65% (n=64) of women with DM. Women with type 2 DM had a significantly lower number of points scored in all FSFI domains except pain compared to type 1 respondents. The only variables associated with DM significantly influencing sexual functioning were: type 2 diabetes in desire, arousal, as well as in global FSD (odds ratio [OR]=1.40; 2.70 and 3.31, respectively), the presence of retinopathy in lubrication (OR=7.8), and treatment with insulin in satisfaction domain (OR=0.29). Neither the presence of comorbidities, the duration of diabetes, the presence of diabetes complications nor the glycemic control was a moderator of FSD. The strongest significant predictors of FSD were: the presence of depressive symptoms, the importance of sex to the respondent, and satisfaction with the partner as a lover.

CONCLUSIONS

Women with DM, especially type 2, are at risk of sexual dysfunctions. Diabetes-related factors have little impact on sexual functions in women with DM. Depressive symptoms, partner-related factors, and individual perception of sexuality should be evaluated when counseling females with DM.

Chronic disease and sexuality: a generic conceptual framework

Although sexual dysfunctions are frequently comorbid with many chronic diseases and their treatments, until recently, these dysfunctions have been neglected in both research and clinical practice. Fortunately, sexual functioning in the context of chronic disease has now begun to receive more scientific attention. Studies in the field are, however, quite diverse in terms of topics and methodology, not only making comparisons across studies on a single disease difficult, but also making comparisons across different diseases impossible. In an attempt to inspire researchers, this article presents a "generic" conceptual framework regarding the impact of chronic diseases (and their treatments) on sexual function. The major goals of this conceptual framework are to provide an in-depth analysis of, and insight into, the process by which disease-related psychological and relational factors impact the sexual functioning and well-being of patients, their partners, and their relationships. Some of the associations within the conceptual framework have already been supported by the results of empirical studies on various diseases. This review ends with an overview of the limitations of previous research, proposes a research agenda for the field, and presents a research tool that may be helpful in developing new studies investigating the association between chronic diseases and sexuality.

Sexual dysfunction in women with diabetes mellitus

Diabetes mellitus (DM) is an increasing health concern throughout the world. DM is categorized as either type 1 (DM-1) or type 2 (DM-2), where DM-1 represents a lack of insulin production, and DM-2 is characterized by a relative lack of insulin (i.e., decreased sensitivity to the effect of insulin). DM has long been considered a risk factor for sexual dysfunction in men and women, although the evidence in women is less clear. This review attempts to give an overview of female sexual dysfunction in women with DM. Although women with DM are at higher risk of developing sexual dysfunction than women without DM, there is great variability in results across studies, with the incidence of sexual dysfunction in women with DM generally linked less to organic factors and more to psychological factors, especially coexisting depression. This review hypothesizes several presumed causes for such variation in findings across studies and uses these explanations as the basis for a discussion of differences between men's and women's sexuality.

Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints

BACKGROUND

Postmenopausal metabolic changes increase cardiovascular risk and impair quality of life (QoL). Despite this, few reports have addressed the association of these changes with female sexuality.

OBJECTIVE

To determine the association between the metabolic syndrome (METS), and its components, and female sexuality.

METHODS

Data of sexually active postmenopausal women who participated in a METS screening program who filled out the menopause-specific quality of life questionnaire (MENQOL) were assessed. Specifically the sexual domain of the MENQOL was analyzed in regard to mean total and item scores (decreased libido, vaginal dryness, and sexual avoidance). Criteria of the Third Adult Treatment Panel (ATP III) were used to identify women with the METS.

RESULTS

Two hundred six women fulfilled inclusion criteria. Mean age of participants was 54 ± 6.9 years (median: 54 years). Prevalence of the METS in this sexually active postmenopausal series was 39.8%. About 52.9% of them presented abdominal obesity, 35.4% hypertension, 55.8% high triglycerides, 17.5% hyperglycemia, and 59.7% decreased high density lipoprotein cholesterol (HDL-C). Women with the METS as compared with those without the syndrome displayed no significant differences in MENQOL sexual scorings (total or of its composing items). Equally there were also no score differences among those presenting any of the five components of the METS, except women with hyperglycemia who significantly displayed a higher total sexual domain score (5.6 ± 2.1 vs. 4.8 ± 2.3, p < 0.05) in association to a higher mean score in the decreased libido item (6.0 ± 2.3 vs. 4.8 ± 2.6, p < 0.01). After controlling for several confounding factors, logistic regression confirmed that women with hyperglycemia were significantly at higher risk for presenting decreased libido (higher item score, OR 2.4, CI 95%: 1.0-5.7, p < 0.05) and more impaired sexuality (higher total MENQOL sexual domain score: OR, 2.5, CI 95%: 1.1-5.4, p < 0.05).

CONCLUSION

Despite the limitations of this study, as assessed with the MENQOL, hyperglycemia in postmenopausal women screened for the METS was associated to a negative impact in sexuality. More research is warranted in this regard.

Sexual functioning among women with and without diabetes in the Boston Area Community Health Study

AIM

To examine sexual dysfunction among women with and without diabetes in a community-based sample of women aged 30-79 years.

METHODS

We conducted a cross-sectional analysis of survey responses of female participants in the Boston Area Community Health Study, a community-based random sample, who answered questions regarding sexual functioning and diabetes status and also reported sexual activity (n = 1,291). Associations between diabetes and overall sexual function as well as domain of sexual function were examined in multivariable linear regression models.

RESULTS

Women with type 2 diabetes (n = 75) were older, less often white, and more likely to have decreased physical activity levels, elevated body mass index, and cardiovascular disease than women without diabetes (n = 1,190). Women with type 1 diabetes (n = 26) were similar to women without diabetes except for higher depression scores and lower levels of activity. Age, marital status, and depressive symptoms were correlated with overall sexual function. After adjustment for age and race, women with and without diabetes had similar arousal, lubrication, orgasm, dyspareunia, satisfaction, and desire. After further adjustment for other factors, including age, depression, and marital status, women with type 1 diabetes had increased dyspareunia compared with women without diabetes, and women with type 2 diabetes had similar functioning to women without diabetes.

CONCLUSION

Women with type 2 diabetes may have similar sexual functioning to women without diabetes, although women with type 1 diabetes may more often have dyspareunia. Factors such as depression, which are common in women with diabetes, are more strongly related to sexual dysfunction than diabetes status.

Sex steroid hormones in diabetes-induced sexual dysfunction: focus on the female gender

INTRODUCTION

Diabetes is associated with gender-specific changes in sex steroid hormones. However, the mechanisms responsible for these associations as well as the link to sexual dysfunction are not well understood.

AIM

To discuss key clinical and laboratory findings linking diabetes, sex steroid hormones, and sexual dysfunction, with particular focus on the female gender.

METHODS

A comprehensive literature review was conducted using the PubMed database. Search terms were used in appropriate combinations, including diabetes, insulin, insulin sensitivity, androgen, estrogen, sexual function, women, men, estrogen receptor, and androgen receptor. Over 400 citations were selected, based on topical relevance, and examined for study methodology and major findings.

MAIN OUTCOME MEASURES

Data from peer-reviewed publications.

RESULTS

Imbalances in sex steroid hormone levels are strongly associated with diabetes and this may negatively impact upon sexual function. Although numerous factors are likely to contribute to the development of diabetes and its complications, the role of sex steroid hormones must be acknowledged.

CONCLUSIONS

Research related to diabetic women and sexual dysfunction is severely lacking. Identifying underlying causes for a given hormonal imbalance in diabetic patients, as well as determination of genetic and age-dependent factors, will become important in identifying the subpopulations in which hormonal replacement regimens will be most effective. Investigation into treating diabetic patients with adjunct hormonal therapies or steroid hormone receptor modulators holds much promise.

Laboratory-induced hyperventilation differentiates female sexual arousal disorder subtypes

The effects of heightened sympathetic nervous system (SNS) activity via laboratory-induced hyperventilation (LIH) on subjective and physiological sexual arousal were examined in a heterogeneous group of women with Sexual Arousal Disorder (SAD; n = 60), as well as across subtypes of SAD, in comparison to a control group of women without sexual difficulties (n = 42). Participants took part in 2 min of rapid breathing, a technique previously found to increase SNS activity, immediately prior to viewing erotic stimuli. Physiological arousal (i.e., vaginal pulse amplitude; VPA) was measured via the vaginal photoplethysmograph and subjective arousal was measured via self-report questionnaires. LIH differentiated women with SAD from those in the control group, with LIH increasing VPA in the latter, but having no significant effect in the heterogeneous SAD group. However, among subtypes of SAD, LIH differentiated women with genital (n = 16) and subjective (n = 16) subtypes of SAD from women with combined SAD (n = 28) and women without sexual difficulties. Specifically, women in the control group and those with combined SAD had a significant increase in VPA whereas women with genital or subjective SAD had a significant decrease in VPA following LIH. There was no significant effect of LIH on any self-report measure of sexual arousal following erotic stimuli. Implications of the results for the conceptualization, diagnosis, and treatment of SAD are discussed.

Frequency and correlates of sexual dysfunction in women with diabetes mellitus

INTRODUCTION

Sexual dysfunction (SD) in women with diabetes mellitus (DM) is an important but understudied aspect of DM complications in women with DM.

AIM

This report is an attempt to document the prevalence, clinical correlates, and determinants of SD in a cross sectional study of women with diabetes mellitus (DM).

MAIN OUTCOME MEASURES

The main outcome measures were demographic, clinical parameters, psychological morbidity, and frequency of SD.

METHODS

A total of 58 married women with type 2 DM and 30 age-matched women who did not have DM had their sexual function and psychological status assessed using the Female Sexual Function Index (FSFI) and General Health questionnaires (GHQ 12) respectively. Glycemic control was assessed using glycosylated hemoglobin.

RESULTS

The prevalence of SD in women with DM and in the control population was 88% and 80%, respectively. The mean (standard deviation) FSFI score in the women with DM was significantly lower than that of the control group (16.2 [9.5] vs. 21 [8.5], P = 0.02). Women with DM attempted sex less frequently than those in the control group. Poor mental health status which was found to be associated with SD was noted more in women with DM than those in the control group.

CONCLUSIONS

SD is high in women with and without DM. A possible determinant of SD in women with DM is psychological morbidity.

Effect of Diabetes Mellitus on Female Sexual Function and Risk Factors

The study was conducted to investigate the effect of diabetes mellitus upon female sexual function, and to detect possible risk factors that might predict sexual dysfunction. The study consisted of 127 married women: 21 women with type 1 diabetes, 50 women with type 2 diabetes and 56 healthy women as a control. Female sexual functions were evaluated with a questionnaire to assess sexual desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was 71% in the type 1 diabetic group, 42% in the type 2 diabetic group and 37% in the control subjects. The scores for sexual desire, arousal and lubrication were significantly lower in the type 1 diabetes group than in the control subjects (p < 0.05). The scores of orgasm, satisfaction, dyspareunia and total sexual function were slightly lower in the type 1 diabetic group than in the other groups. No factor predicted sexual dysfunction in the diabetic women while further age, poor education, absence of occupation and menopause predicted sexual dysfunction in the control subjects. The prevalence of sexual dysfunction was significantly higher in the type 1 diabetic women than in the type 2 diabetics and control subjects. However, no risk factors that might cause sexual dysfunction could be predicted in diabetic women.

Estradiol ameliorates diabetes-induced changes in vaginal structure of db/db mouse model

INTRODUCTION

Women with diabetes experience diminished genital arousal, reduced vaginal lubrication, vaginal atrophy, dyspareunia, and increased infections. Limited studies are available investigating the effects of diabetic complications on the vagina.

AIMS

The goals of this study were to investigate type 2 diabetes-induced changes in vaginal structure, and to determine if estradiol treatment ameliorates these changes.

METHODS

Eight-week-old female diabetic (db/db) mice (strain BKS*Cg-m+/+Lepr(db)/J) and age-matched control normoglycemic female littermates were used to investigate the effects of type 2 diabetes on vaginal tissue structural integrity. Diabetic animals were divided into two subgroups: diabetic treated with vehicle only and diabetic treated with pellets containing estradiol. At 16 weeks, the animals were sacrificed, and the vaginal tissues were excised and analyzed by histological and immunohistochemical methods to assess diabetes-induced changes in vaginal tissue and the extent by which these parameters are restored by estradiol treatment.

MAIN OUTCOME MEASURES

The effects of type 2 diabetes and estradiol supplementation were investigated on vaginal histoarchitecture.

RESULTS

Diabetic animals exhibited high blood glucose levels (>600 mg/dL), increased body weight (43.0 +/- 6.0 g vs. 24.4 +/- 2.0 g), and reduced plasma estradiol levels (65.5 +/- 6.6 pg/mL vs. 80.77 +/- 13.2 pg/mL) when compared to control animals. Diabetes resulted in significant thinning of the epithelium (P <or= 0.05), marked decrease in the muscularis area (P </= 0.05), distinct truncation of elastic fibers, and significant reduction of the nitrergic immunoreactive nerve fibers (P <or= 0.05). Treatment of diabetic animals with estradiol restored epithelial thickness (P <or= 0.05), muscularis area (P <or= 0.05), and elastic fiber distribution, and partially restored the density of nitrergic nerve fibers.

CONCLUSIONS

The data in this study demonstrate that type 2 diabetes disrupts vaginal structural integrity and that estradiol supplementation ameliorates the diabetes-induced vaginal pathology.

Evaluation of sexual function in women with type 2 diabetes mellitus

Sexual health is an important, but often neglected, component of diabetes care. In contrast to erectile dysfunction among men with diabetes, female sexual dysfunction has not been well studied among diabetic women. The aim of this study was to assess the prevalence of sexual dysfunction in women with type 2 diabetes compared to that in an age-matched control group. In all, 50 married women with type 2 diabetes attending the outpatient endocrine clinic of Ghaem Hospital between April 2007 and March 2008 were selected. Fasting plasma glucose and glycosylated haemoglobin were measured and sexual function was assessed by questionnaire. Scores in each domain of sexual function were compared with those of 40 non-diabetic controls. Sexual function scores for the sexual drive, arousal, vaginal lubrication, orgasm and overall satisfaction domains were all lower in the diabetic women (p value < 0.05). Duration of diabetes and age correlated negatively with all domains of sexual function. There was no significant relationship between sexual function and body mass index (BMI), glycaemic control, education or employment status. Diabetes significantly impairs the sexual performance of diabetic women. Determinants of sexual function include age and duration of diabetes.

The illness demands of diabetes on couples in Botswana

This report is part of a larger study that investigated the relationships between illness demands, marital support, and psychological adjustment in the context of diabetes mellitus in rural and urban middle-aged marital couples in Botswana. Ninety-six persons experiencing diabetes and 87 of their spouses participated in the study. This report is based on data from 87 diabetic patients and their spouses. Data were collected through face-to-face interviews. Patients and their spouses were interviewed separately. Three open-ended questions elicited participants' personal experiences of illness demands. The couple participants reported many challenging illness experiences associated with the illness and contextual factors that influenced their perception about the burden of illness and reported that the illness experienced was often a growth-enhancing and maturing process.

Impact of diabetes mellitus on the sexuality of Peruvian postmenopausal

AIM

To evaluate sexual function among postmenopausal diabetic women.

PATIENTS AND METHODS

A total of 72 postmenopausal women, 36 diabetic, with a stable partner were included in this study. Sexual functioning was assessed using the Female Sexual Functioning Index (FSFI) and depression using the Beck Depression Inventory scale.

RESULTS

There was no difference between diabetic and control women regarding age, years of schooling, number of children, age at menarche, age at first sexual experience, years postmenopausal or body mass index. Diabetics had a worse score for depression (11.5 +/- 5.6 vs. 8.9 +/- 4.7, p < 0.03), a lower frequency of sexual intercourse per month (2.7 +/- 2.8 vs. 4.4 +/- 2.9, p < 0.01) and a more deteriorated marital relationship (scale of 0-20: 13.4 +/- 2.9 vs. 15.1 +/- 1.9, p < 0.009). Diabetics demonstrated worse scores globally (19.3 +/- 8.1 vs. 26.8 +/- 4.5, p < 0.0001) and in all domains of the FSFI: desire (2.6 +/- 1.4 vs. 3.8 +/- 1.1, p < 0.0001), arousal (3.5 +/- 1.9 vs. 4.7 +/- 0.8, p < 0.002), lubrication (3.2 +/- 1.9 vs. 4.5 +/- 1.3, p < 0.003), orgasm (3.2 +/- 1.8 vs. 4.5 +/- 1.1, p < 0.002), satisfaction (3.8 +/- 1.3 vs. 4.8 +/- 0.9, p < 0.0005) and pain (3.1 +/- 1.7 vs. 4.6 +/- 1.3, p < 0.0001) (values all mean +/- standard deviation). Considering sexual dysfunction as a score higher than 26.55, the prevalence of sexual dysfunction among diabetics was 75.0% vs. 30.6% in the control group (p < 0.001). After adjusting for depression, years of schooling, hysterectomy, marital relationship and age, diabetes mellitus remained an important risk factor for sexual dysfunction (odds ratio 6.2, 95% confidence interval 2.0-19.6, p < 0.02).

CONCLUSION

Diabetes mellitus affects all areas of female sexuality and this condition is independent of depression.

An Efficient reproductive method for Irs2-/- mice with C57BL/6JJcl genetic background

Efficient reproduction using natural mating and reproduction technology [in vitro fertilization (IVF) and embryo transfer (ET)] was investigated in IRS2 deficient mice with C57BL/6JJcl genetic background (Irs2(-/-) mice) as a typical type 2 diabetes model. From the results using various combinations of Irs2(-/-) and Irs2(-/+) mice, the combination of female Irs2(-/+) x male Irs2(-/-) was found to be more efficient than other combinations. In applications of reproduction technology using IVF and ET, the combination of female Irs2(-/+) x male Irs2(-/-) involves the possibility of Irs2(-/-) production by repeats using female Irs2(-/+) mice. However, reproductive continuity using this combination is difficult because of dependence on human technique and the cost of ET. Therefore, we concluded that Irs2(-/-) mice should be produced by embryo transfer using Irs2(-/-) mice from a colony consisting of female Irs2(-/+) x male Irs2(-/-).

Changes in clitoral blood flow in premenopausal women affected by type 1 diabetes after single 100-mg administration of sildenafil

OBJECTIVES

To verify whether sildenafil is effective in modifying clitoral blood flow in premenopausal women affected by type 1 diabetes.

METHODS

The setting was a diabetes outpatient clinic in which 30 premenopausal women affected by type 1 diabetes treated with insulin therapy and 39 healthy premenopausal women participated in our prospective open-label clinical study. Each diabetic woman received a single oral dose of 100 mg sildenafil. Translabial color Doppler ultrasonography was used to measure the resistance index, pulsatility index, peak systolic velocity, and end-diastolic velocity of the clitoral arteries 1 and 4 hours after sildenafil intake.

RESULTS

One hour after the administration of sildenafil, the mean resistance index was significantly lower and the mean pulsatility index, mean peak systolic velocity, and mean end-diastolic velocity of the clitoral arteries were significantly greater compared with baseline and 4 hours after sildenafil (P <0.05). The baseline clitoral blood flow of the diabetic women was lower compared with that of the control group (P <0.001).

CONCLUSIONS

Sildenafil seems to improve the clitoral blood flow of premenopausal women with type 1 diabetes.

Sildenafil improves sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder: a double-blind, crossover, placebo-controlled pilot study

OBJECTIVE

To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD).

DESIGN

Double-blind, crossover, placebo-controlled study.

SETTING

Gynecological diabetic outpatient clinic and sexual clinic.

PATIENT(S)

Thirty-six type 1 premenopausal diabetic women affected by SAD.

INTERVENTION(S)

Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences.

MAIN OUTCOMES MEASURE(S)

Each woman submitted blood samples to measure HbA(1c), and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5-point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries.

RESULT(S)

Thirty-two women completed the study. The mean HbA(1c) value was 8.0% +/- 1.8%, and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo.

CONCLUSION(S)

Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.

Sexual function and endocrine profile in fertile women with type 1 diabetes

OBJECTIVE

Aims of this study were 1) to assess sexual function and endocrine profile among fertile type 1 diabetic women during the follicular and luteal phases of the menstrual cycle, 2) to compare these results with those obtained among healthy fertile women who served as control subjects, and 3) to explore the correlations between sexual function and endocrine milieu among patients and control subjects during the follicular and luteal phases of the menstrual cycle.

RESEARCH DESIGN AND METHODS

Fifty fertile women with type 1 diabetes and 47 healthy control subjects completed a semistructured medical interview and filled in self-administered validated instruments to evaluate sexual function, depression, and sexual distress. Venous blood samples were drawn to measure glycated hemoglobin and an endocrine profile during either the follicular or the luteal phase of the menstrual cycle.

RESULTS

Type 1 diabetic women had decreased sexual function and increased sexual distress compared with control subjects during the luteal, but not the follicular, phase of the menstrual cycle. During the follicular phase, patients had lower estrogenic basal tone, lower "weak" androgen (namely Delta4-androstenedione and dehydroepiandrosterone sulfate) production, and lower free-triiodothyronine and free-thyroxine levels compared with control subjects. During the luteal phase, total testosterone levels were higher in patients than control subjects, while 17beta-estradiol and progesterone levels were lower in patients than control subjects.

CONCLUSIONS

Among type 1 diabetic women, sexual function and sexual distress vary according to the phase of the menstrual cycle. This finding may have implications on the clinical assessment of sexual function in type 1 diabetic women.

Sexual dysfunction in women with diabetes mellitus

Sexual problems in men with diabetes mellitus are common and often result from diabetic complications. However, although diabetic complications are similar in both sexes, little attention has been given to the effects of diabetes on female sexuality and sexual function. It is reasonable to suggest that women with diabetes will experience sexual problems due to neuropathy, endocrine changes and vascular complications. However there is little research into the physical effects of diabetes on female sexual function. Reduced vaginal lubrication in women with diabetes has been reported yet this is rarely documented as a sexual problem. Previous studies in women with diabetes may also neglect the importance of the subjective qualities associated with female sexuality and sexual expression.

Activity of angiotensin peptides in clitoral cavernosum of alloxan induced diabetic rabbit

OBJECTIVES

To assess the role of peptides of the angiotensin (ANG) on the regulation of clitoral cavernosum tone and changes in ANG binding affinity in the rabbit with diabetes mellitus.

MATERIAL AND METHODS

The isometric tension measurement and in vitro autoradiography were used in sham and diabetic clitoral cavernosum.

RESULTS

In tension study, contractility in response to ANG I, ANG II, ANG III and ANG IV was enhanced in diabetic clitoral cavernosum strips (EC50 was 67.6 +/- 27.2, 4.3 +/- 0.4, 189.3 +/- 37.3, 443.2 +/- 0.4 nM for diabetic versus 155.2 +/- 76.1, 38.3 +/- 0.1, 528.0 +/- 75.2, 616.9 +/- 69.5 nM for sham, respectively). Contractile responses to ANG II was significantly inhibited by type 1 ANG II receptor (AT1) antagonist but not by type 2 ANG II receptor (AT2) antagonist in both groups. Percentages in contractions by ANG II (1 nM) in the presence of Dup 753 decreased significantly 36.2 +/- 4.6 to 6.3 +/- 2.4% in sham and 56.1 +/- 7.7 to 6.0 +/- 4.8% in diabetic group. The binding affinities were enhanced in diabetic clitoral cavernosum for ANG II (dissociation constant, 4.9 +/- 1.0 for sham versus 0.9 +/- 0.2 nM for diabetic) and for ANG I, ANG III, and ANG IV (inhibitory constant, 28.6 +/- 1.5, 398.7 +/- 157.2, and 3966.5 +/- 1524.1 nM for sham versus 20.6 +/- 5.7, 78.5 +/- 23.7, and 1098.7 +/- 195.5 nM, for diabetic, respectively, all p < 0.05). Sensitivities of AT1 and AT2 receptors to ANG II enhanced in diabetic than sham clitoral cavernosum tissue.

CONCLUSIONS

This results suggest that the contractile responses to all four ANG peptides are enhanced in the diabetic clitoral cavernosum. Enhancement of contractility in diabetic clitoral cavernosum may be related to the increased affinity to ANG II receptors for ANG peptides.

Diabetes and female sexual dysfunction: moving beyond "benign neglect"

Female sexual response is a complex, nonlinear progression from desire to arousal and orgasm. Diabetes may affect all these, but it particularly affects arousal with decreased genital sensation and lubrication. Vaginal dryness and infections may lead to dyspareunia. Predictors of sexual dysfunction in women include depression. Neither age, duration of diabetes, glycemic control, nor complications predict sexual dysfunction in women as they do in men. Objective measures of decreased genital sensation or lubrication do not correlate with a subjective sense of female sexual arousal disorder. Low androgens and possibly estrogens may be etiologic, as may numerous medications used by patients with diabetes. Practitioners should recognize the high prevalence of female sexual dysfunction (up to 50%) and potential increase, in tandem with that of diabetes. In the absence of definitive treatment evidence, psychological counseling, improvised vaginal lubricants, and low doses of estrogens or androgens have been used to relieve the personal distress of female sexual dysfunction.