Association between cardiovascular disease and risk of female sexual dysfunction: a systematic review and meta-analysis

My (Un)Sexy World: A Mixed-Methods Study

Sexual dysfunction is frequent problem among women during the postpartum period, which is a sensitive period of life. Body image and genital self-image, which is an aspect of body image, are significant issues. Women with a heightened focus on their physical appearance and negative body image are at an increased risk of experiencing sexual dysfunction linked to their body image. The aim of this research was to examine the relationships among sexual dysfunction, genital self-image, and body perception during sexual intercourse in the postpartum period and to explore the causes of sexual dysfunction. To accomplish these aims, a consecutive, mixed-methods study was performed, consisting of a survey (N = 379) and follow-up interviews (n = 24) with women up to 1 year postpartum in Turkey. Having a vaginal birth, being multipara, and desiring genital plastic surgery are associated with a negative genital self-image and sexual dysfunction in women postpartum. Negative genital self-image was also found to be associated with sexual dysfunction. When examined in-depth, complications during birth and the postpartum period (e.g., perineal trauma, episiotomy, lacerations, stitches), combined with preexisting problems, contributed to sexual dysfunction in women postpartum. The postpartum period is often a very sensitive time, during which women's lives may change completely. Birth complications that may affect their sexual lives and women's perceptions about their genital organs may be related to sexual dysfunction. Genital self-image needs to be addressed when providing postpartum care.

Diabetes mellitus, vaginal microbiome and sexual function: Outcomes in postmenopausal women

Diabetes mellitus is a chronic disease and a public health challenge worldwide, associated with numerous complications, including genitourinary infections and sexual dysfunction in women, particularly in menopause. The vaginal microbiome, which comprises beneficial and pathogenic bacteria, their genomes, and the surrounding environment, plays a crucial role in maintaining genitourinary health. Chronic hyperglycemia disrupts immune functions, exacerbates oxidative stress, and alters the vaginal microbiome, increasing the risk of genitourinary infections. Recent advances in microbial analysis, including 16S rRNA sequencing, have provided insights into the complex composition of the vaginal microbiome and its dysbiosis in diabetes mellitus. Some glucose-lowering drugs, such as sodium-glucose cotransporter 2 inhibitors, may increase the risk of genitourinary infections. Additionally, psychological distress, hormonal imbalances, and diabetes-related genitourinary symptoms contribute to sexual dysfunction in diabetic women. Healthcare for diabetic women requires a multidisciplinary approach, including not only glycemic control but also vaginal and sexual health assessment. A holistic approach is essential to advance personalized strategies, including medications and psychological support.

Sexual dissatisfaction and its association with health status among older adults in China: a nationwide study

Background Most population-based sexual health research in China excludes older adults. To fill the gap, this study aims to characterise sexual dissatisfaction among people aged 50years or older from a nationwide, population-representative sample and to explore its association with physical, mental, and self-reported overall health indicators. Methods Data were collected as part of the China Family Panel Studies in 2020, led by the Institute of Social Science Survey of Peking University. Multivariable logistic regressions with robust estimators were used to investigate the association between sexual dissatisfaction and health indicators and potential demographic confounders. Results Among the 8222 partnered Chinese adults aged 50years or older (median age: 59, IQR: 54-66, 47% identified as women), 78% (6380/8222) reported being satisfied or very satisfied in their sex life. After adjusting for demographic variables, poor self-rated health status (aOR: 1.59, 95% CI: 1.42-1.77), experiencing depression symptoms (aOR: 2.02, 95% CI: 1.80-2.26), and having chronic diseases (aOR: 1.20, 95% CI: 1.07-1.36) were positively associated with sexual dissatisfaction in multivariable analyses. Among sociodemographic factors, younger age, female gender, and education level at senior high school or above were more likely to experience sexual dissatisfaction (all P Conclusion Based on our sample, more than one in five Chinese adults aged 50years or older might face sexual dissatisfaction. Comorbidities common in older age likely exacerbate sexual dissatisfaction. Greater attention to sexual satisfaction research and sexual health programs among older adults is needed with respect to gender differences and chronic disease comorbidities.

Prevalence and Risk Factors Associated With Sexual Dysfunction in Malagasy Women With and Without Type 2 Diabetes Mellitus: A Cross-Sectional Study in a University Hospital Center, Antananarivo Madagascar

Background and Aims

Female sexual dysfunction (FSD) remains a very little studied subject in Madagascar, despite the resulting alteration of quality of life. Our study aims to determine the prevalence and risk factors for sexual dysfunction in Malagasy women with and without type 2 diabetes (T2DM).

Methods

This was a descriptive and analytical cross-sectional study, carried out in the Endocrinology department of the Joseph Raseta Befelatanana University Hospital Center over a period of 18 months. FSD was assessed using the Female Sexual Function Index questionnaire in women with and without T2DM.

Results

We retained 122 patients with T2DM and 127 without T2DM. The prevalence of FSD was 47.5% in diabetics and 44.1% in non-diabetics. In patients with T2DM, factors associated with FSD were age [50-59 years] (OR = 2.03 [1.03-4.51]), nephropathy (OR = 2.18 [1.09-3.98]), ischemic stroke (p = 0.0483), ischemic heart disease (p = 0.005), carotid atherosclerosis (OR = 2.64 [1.09-7.85]), obesity (OR = 3.64 [1.22-12.3]), calcium channel blocker use (OR = 4.71 [1.35-21.0]), history of genitourinary infections (OR = 2.06 [1.07-4.28]). In patients without T2DM, they were age [50 - 59 years] (OR = 4.86 [2.16-11.3]), age of first sexual intercourse < 18 years (OR = 2.06 [1.04-4.57]), irregular menstrual cycle (OR = 2.02 [1.00-6.37]), number of gestations ≥ 4 (OR = 1.99 [1.00-5.41]), abortion (OR = 3.15 [1.21-29.1]) and number of children ≥ 4 (OR = 2.17 [1.01-4.81]).

Conclusion

FSD was more common in diabetics than non-diabetics. Its early management and associated risk factors are necessary to improve the quality of life of patients.

Cardiometabolic effects of hypoprolactinemia

The fall of PRL levels below the lower limit of the normal range configures the condition of hypoprolactinemia. Unlike PRL excess, whose clinical features and treatments are well established, hypoprolactinemia has been only recently described as a morbid entity requiring prompt identification and proper therapeutic approach. Particularly, hypoprolactinemia has been reported to be associated with the development of metabolic syndrome and impaired cardiometabolic health, as visceral obesity, insulin-resistance, diabetes mellitus, dyslipidaemia, chronic inflammation, and sexual dysfunction have been found more prevalent in patients with hypoprolactinemia as compared to those with normoprolactinemia. This evidence has been collected mainly in patients on chronic treatment with dopamine agonists for PRL excess due to a PRL-secreting pituitary tumour, and less frequently in those receiving the atypical antipsychotic aripiprazole. Nowadays, hypoprolactinemia appears to represent a novel and unexpected risk factor for cardiovascular diseases, as is the case for hyperprolactinemia. Nevertheless, current knowledge still lacks an accurate biochemical definition of hypoprolactinemia, since no clear PRL threshold has been established to rule in the diagnosis of PRL deficiency enabling early identification of those individual subjects with increased cardiovascular risk directly ascribable to the hormonal imbalance. The current review article focuses on the effects of hypoprolactinemia on the modulation of body weight, gluco-insulinemic and lipid profile, and provides latest knowledge about potential cardiovascular outcomes of hypoprolactinemia.

Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and meta-analysis

Background

Previous studies have established that diabetes mellitus (DM) markedly raises the risk of developing erectile dysfunction (ED). Despite extensive investigations, the risk factors associated with ED in diabetic men have yet to be unequivocally determined, owing to incongruent and inconclusive results reported in various studies.

Objective

The objective of this systematic review and meta-analysis was to assess the risk factors for ED in men with DM.

Methods

A comprehensive systematic review was conducted, encompassing studies published in the PubMed, Scopus and Embase databases up to August 24th, 2023. All studies examining the risk factors of ED in patients with DM were included in the analysis. To identify significant variations among the risk factors, odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were employed. The risk of bias was evaluated using the Newcastle-Ottawa Scale(NOS) for longitudinal studies and the Agency for Healthcare Research and Quality Scale(AHRQ) for cross-sectional studies.

Results

A total of 58 studies, including a substantial participant pool of 66,925 individuals diagnosed with DM, both with or without ED, were included in the meta-analysis. Mean age (OR: 1.31, 95% CI=1.24-1.37), smoking status (OR: 1.32, 95% CI=1.18-1.47), HbA1C (OR: 1.44, 95% CI=1.28-1.62), duration of DM (OR: 1.39, 95% CI=1.29-1.50), diabetic neuropathy (OR: 3.47, 95% CI=2.16-5.56), diabetic retinopathy (OR: 3.01, 95% CI=2.02-4.48), diabetic foot (OR: 3.96, 95% CI=2.87-5.47), cardiovascular disease (OR: 1.92, 95% CI=1.71-2.16), hypertension (OR: 1.74, 95% CI=1.52-2.00), microvascular disease (OR: 2.14, 95% CI=1.61-2.85), vascular disease (OR: 2.75, 95% CI=2.35-3.21), nephropathy (OR: 2.67, 95% CI=2.06-3.46), depression (OR: 1.82, 95% CI=1.04-3.20), metabolic syndrome (OR: 2.22, 95% CI=1.98-2.49), and diuretic treatment (OR: 2.42, 95% CI=1.38-4.22) were associated with increased risk factors of ED in men with DM.

Conclusion

Our study indicates that in men with DM, several risk factors for ED have been identified, including mean age, HbA1C, duration of DM, diabetic neuropathy, diabetic retinopathy, diabetic foot, cardiovascular disease, hypertension, microvascular disease, vascular disease, nephropathy, depression, metabolic syndrome, and diuretic treatment. By clarifying the connection between these risk factors and ED, clinicians and scientific experts can intervene and address these risk factors, ultimately reducing the occurrence of ED and improving patient management.