Sexual dysfunction in female patients with type 2 diabetes mellitus: a cross-sectional single-centre study among Turkish patients

Prevalence and associated factors of female sexual dysfunction among type 2 diabetes patients in Indonesia: A systematic review and meta-analysis

BACKGROUND AND AIMS

Female sexual dysfunction (FSD) is a neglected chronic complication of diabetes. However, there is a scarcity of data in Indonesia, which is currently ranked as the 5th in the world for the number of people with Type 2 Diabetes (T2D). Our study aims to analyze the prevalence and factors of FSD among T2D patients in Indonesia.

METHOD

Literature searching was performed in PubMed/Medline®, CINAHL®, Embase®, Proquest®, Scopus®, local journals and libraries. All studies in searching keywords "sexual", "diabetes" and "Indonesia" with Medical Subject Headings (MeSH) terms were included, without time or language restriction. Pooled prevalence and odds ratio of associated factors of FSD were analyzed using STATA.

RESULTS

Ten studies comprised 572 females with T2D were included in this review. The pooled prevalence of FSD reached 52% (95% CI = 0.49-0.56; I2 93.9%, p < 0.001). After removing one study that was conducted with an unstandardized questionnaire cut-off value, the pooled prevalence of FSD was 62% (95% CI = 0.58-0.66; I2 68.7%, p = 0.001). Age more than 45 years old and or menopause, and the use of antihypertensives were associated with FSD. While Hemoglobin A1c (HbA1c) is only correlated with a desire for sexual dysfunction.

CONCLUSION

FSD was prevalent among T2D patients in Indonesia and was associated with age more than 45 years old, menopause, and the use of antihypertensive medications.

Global prevalence of sexual dysfunction among diabetic patients from 2008 to 2022: Systematic review and meta-analysis

Background

Both men and women can have a wide range of physical, emotional, and sexual issues as a result of diabetes. One of them is sexual dysfunction, which has an effect on marital relationships as well as the effectiveness of therapy and can develop into a serious social and psychological condition. As a result, the purpose of this study was to identify the global prevalence of sexual dysfunction among diabetic patients.

Methods

Science Direct, Scopus, Google Scholar, and PubMed were all searched for information. Data were extracted using Microsoft Excel (v. 14), STATA statistical software, and STATA. Publication bias was investigated by a forest plot, rank test, and Egger's regression test. To detect heterogeneity, I² was calculated and an overall estimated analysis was performed. Subgroup analysis was done by study region and sample size. The pooled odds ratio was also computed.

Results

The study was able to include 15 of the 654 publications that were evaluated since they met the criteria. 67,040 people participated in the survey in all. The pooled global prevalence of sexual dysfunction among diabetic patients was 61.4% (95% CI: 51.80, 70.99), I2 = 71.6%. The frequency of sexual dysfunction was highest in the European region (66.05%). For males, the prevalence of sexual dysfunction was 65.91%, while for females, it was 58.81%. Patients with type 2 diabetes mellitus were more likely (71.03%) to experience sexual dysfunction.

Conclusion

Finally, sexual dysfunction was fairly common all across the world. There were variations in the prevalence of sexual dysfunction depending on the sex, type of diabetes, and location of the study participant. Our findings imply that screening and appropriate treatment are required for diabetes persons exhibiting sexual dysfunction.

The Relationship Between Pelvic Floor Function and Sexual Function in Perimenopausal Women

INTRODUCTION

Perimenopausal women with pelvic floor dysfunction have worse sexual function than women with functional pelvic floor muscle (PFM), especially in terms of libido, orgasm, sexual satisfaction, and total Female Sexual Function Index (FSFI) scores.

AIM

To explore the relationship between pelvic floor muscle function, hormone levels and sexual function in perimenopausal women.

METHODS

An analytical cross-sectional study was conducted in 252 women aged 40-55 without pelvic floor disease with FSFI, pelvic floor muscle strength and the hormone levels.

MAIN OUTCOME MEASURE

The principle aim was to determine the relationships between sexual dysfunction, PFM strength, and hormone levels.

RESULTS

In the functional PFM group, the proportion of menopausal hormone therapy was higher. The proportion of overweight in the dysfunctional PFM group was higher, and had more sexual desire disorder, more orgasm disorder, lower sexual satisfaction, and poor FSFI scores. The correlation between PFM strength, sexual function and female sex hormones suggested that PFM strength and libido, sexual satisfaction and FSFI score are significantly positively correlated, while PFM strength and sexual arousal disorder and vaginal lubricity had a positive correlation. In the multivariate analysis of the risk of sexual dysfunction among perimenopausal women, the higher the PFM strength, the lower the risk of sexual dysfunction.

CONCLUSIONS

Perimenopausal women with pelvic floor dysfunction have worse sexual function than women with functional PFM, especially in obese women, those with central adiposity, and not using hormone replacement therapy. The PFM strength was weakly positively correlated with sexual arousal, orgasm, sexual satisfaction, and FSFI score. Zhuo Z, Wang C, Yu H, et al. The Relationship Between Pelvic Floor Function and Sexual Function in Perimenopausal Women. Sex Med 2021;9:100441.

Betaine ameliorates impaired steroidogenesis and apoptosis in mice granulosa cells induced by high glucose concentration

Betaine is a bioactive peptide whose beneficial effects on diabetes complications have been considered, previously. The present study aimed to investigate the possible protective effects of betaine against hyperglycemia-induced steroidogenesis impairment and apoptosis in mice granulosa cells. Ovarian granulosa cells were isolated from C57/BL6 mice and cultured in steroidogenesis medium (SM) containing 30 ng/ml FSH and 0.5 µM testosterone. The cells were cultured in SM containing low (5 mM) or high (30 mM) glucose concentrations for 24 h in the presence or absence of betaine (5 mM). At the end of the experiment, estradiol and progesterone were measured by ELISA in the culture medium. Expression of apoptosis and steroidogenesis associated genes and caspase-3 activity were determined by qRT-PCR and colorimetric assays, respectively. Exposure of mice granulosa cells to high glucose concentration inhibited the steroidogenesis by decreasing estradiol and progesterone secretion and downregulation of steroidogenesis-related genes including 3βHSD, Cyp11a1, Cyp19a1, and StAR. Betaine treatment could ameliorate the steroidogenesis impairment at molecular and biochemical levels. High glucose concentration also enhanced apoptosis in mice granulosa cells that were characterized by elevation of caspase-3 activity, upregulation of bax gene and downregulation of bcl2 gene. Betaine treatment could attenuate the apoptotic-related changes induced by high glucose concentration in granulosa cells. According to the results of the present study, betaine could ameliorate the adverse effects of hyperglycemia on the physiological function of ovarian granulosa cells. The results highlight the potential role of betaine for the intervention of ovarian dysfunction in diabetic patients. Abbreviations: AABA: Betaine-α-aminobutyric acid; AGEs: Advanced glycation end products; bax: bcl2 Associated X; bcl2: B-cell lymphoma 2; AMPK: AMP-activated protein kinase; BHMT: Betaine homocysteine methyltransferase; C/EBP: CCAAT-enhancer-binding proteins; Cyp11a1: Cholesterol side-chain cleavage cytochrome P450; Cyp19a1: Cytochrome P450 aromatase; DM: Diabetes mellitus; E2: Estradiol; ERS: Endoplasmic reticulum stress; GCs: Granulosa cells; GLUT: Glucose transporter; FSH: Follicle-stimulating hormone; 3βHSD: 3β-hydroxysteroid dehydrogenase; IL-1β: interleukin-1ß; LH: Luteinizing hormone; MDCK: Madin-Darby Canine Kidney cell; MT: Methionine synthase, MTT: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide; NLRP3: NLR Family Pyrin Domain Containing 3; NF-κB: Nuclear factor κB; P4: Progesterone; ROS: Reactive oxygen species; SGLT: Sodium dependent glucose transporter; SLC7A6: Solute Carrier Family 7 Member 6; StAR: Steroidogenic acute regulatory protein; STZ: Streptozotocin; Tumor necrosis factor α: TNF-α; TXNIP: Thioredoxin interacting protein.

The Impact of Metabolic Syndrome and Its Components on Female Sexual Dysfunction: A Narrative Mini-Review

Background

The impact of metabolic syndrome on female sexual dysfunction received modest consideration in clinical practice. The aim of the research was to analyze the international literature to determine the relationship between the metabolic syndrome, its components and female sexual disorders.

Methods

We identified relevant full-length papers by electronic databases as Index Medicus/Medline, Scopus, Life Science Journals, from 2005 to the present. Studies were searched using the following as search query: metabolic syndrome, female sexual dysfunction, obesity, systemic arterial hypertension, diabetes mellitus, dyslipidemia.

Results

Women with metabolic syndrome showed higher prevalence of sexual inactivity and low sexual desire, orgasm and satisfaction respect to women without metabolic syndrome. Particularly metabolic components as diabetes mellitus, dy-slipidemia, systemic arterial hypertension were strongly associated with lower sexual desire, activity and Female Sexual Function Index total score. In contrast, other studies showed no relationship.

Conclusion

Our study showed that in the clinical evaluation of women with metabolic syndrome routine inquiring about female sexual dysfunction should be recommended to ameliorate sexual function and quality of life. However more prospective and longitudinal studies on the sexual effects of metabolic syndrome should also be suggested to know the factors related to women's sexuality better.

Psychaesthenic Syndrome: A Review on its Implication in Female Sexual Arousal

Objectives: Psychaesthenic syndrome in the recent classification of DSM-5 comes under ‘Cultural Concepts of Distress.’ This can be the equivalent of Dhat syndrome in males. There is a paucity of literature regarding psychaesthenic syndrome. In this paper, we have tried to review the available literature regarding psychiatric and sexual comorbidities of psychaesthenic syndrome. Our paper also aims to ascertain the role and implication of psychaesthenic syndrome in female sexual arousal.

Methods: PubMed, Google Scholar, and other databases were used to conduct the search. Research published in English was included. We searched the databases using the terms ‘psychaesthenic syndrome,’ ‘female Dhat syndrome,’ ‘nonpathological white discharge per vagina (NPWDPV),’ ‘leucorrhea,’ ‘female sexual disorders,’ etc.

Results: For this review, we could find around 65 papers pertaining to the subject. These focused on the presence and effect of psychiatric disorders on sexual functioning. The effect of psychaesthenic syndrome on sexual functioning was also explored. The discomfort caused by NPWDPV may itself lead to decreased interest in sex. As inhibited sexual desire and sexual arousal disorder are estimated to be among the most common sexual disorders in women, it is probable that difficulty in sexual arousal is one of the major perceived effects of psychaesthenic syndrome. It has been found that depression often leads to difficulty in sexual arousal, amongst other sexual dysfunctions. Thus, there is an indirect causation of female sexual arousal disorder in psychaesthenic syndrome if depression is the manifestation of the syndrome.

Conclusion: Very few studies have been done regarding the role of psychaesthenic syndrome in female sexual arousal till now. We are in the process of a major population-based study to delineate the epidemiological aspects, clinical features, management, and prevention aspects related to psychaesthenic syndrome. This review presents the available literature, issues of concern, and methods to manage NPWDPV.

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 function and qualify of life in women with spina bifida: Are the women with spina bifida satisfied with their sexual activity?

AIMS

As the life expectancy of persons with spina bifida increases, sexual life in adulthood presents a considerable challenge for this population. The purpose of this study was to evaluate the sexual function of young women with spina bifida and its impact on their quality of life (QOL).

METHODS

To assess sexual function and QOL by using self-administered questionnaires (Female Sexual Function Index [FSFI] and 36-Item Short Form Health Survey) in young women with spina bifida, we collected data from 44 young women with spina bifida between June 2013 and October 2013 at the spina bifida clinic of our hospital.

RESULTS

Sexual dysfunction was noted in 55.5% of women with spina bifida who had sexual activity in the previous month. In sexually active women, the diagnosis, ventriculoperitoneal shunt in situ, mobility, and clean intermittent catheterization did not show a significant difference between each subdomain (desire, arousal, lubrication, orgasm, satisfaction, and pain) and the total FSFI score. However, women who did not have urinary incontinence experienced better sexual function in terms of lubrication and pain scores (P = 0.033 and P = 0.026, respectively). Both the physical and mental composites of QOL were positively weakly correlated with the arousal score of FSFI (r = 0.455, P = 0.044 and r = 0.507, P = 0.023, respectively).

CONCLUSIONS

More than half of sexually active women with spina bifida experience sexual dysfunction. Therefore, health-care providers should pay attention to the symptoms and their management.