Mediators of sexual functions in women with diabetes

[Diabetes complications and sexual health: Addressing them without taboos]

In France, 1.5 million women live with diabetes. This chronic metabolic disease disrupts every aspect of the lives of sufferers, right down to the most intimate. The impact of diabetes on women's sexuality is less well documented than for men. Yet a holistic approach to the management of the disease is essential to provide quality care.

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.

Prevalence and predictors of sexual dysfunction in females with type 1 diabetes: a systematic review and meta-analysis

BACKGROUND

Several observational studies have explored the prevalence and predictors of female sexual dysfunction (FSD) among females with type 1 diabetes. However, no systematic review and meta-analysis of pooled data provide reliable estimates of FSD prevalence among females with type 1 diabetes.

AIM

To investigate the global prevalence of FSD, analyze the association between FSD risk and type 1 diabetes, and evaluate the predictors of FSD among females with type 1 diabetes.

METHODS

The study search of the present systematic review was conducted through the Wanfang Database, China National Knowledge Infrastructure, PubMed, and Embase from the inception date to February 28, 2023. Heterogeneity among the studies was analyzed with the Q and I2 tests. The sources of heterogeneity were detected through subgroup analyses and meta-regression.

OUTCOMES

Outcomes included the pooled prevalence of FSD among females with type 1 diabetes, the association between FSD risk and type 1 diabetes, and the predictors of FSD among females with type 1 diabetes.

RESULTS

The pooled prevalence of FSD among females with type 1 diabetes was 38.5% (95% CI, 32.1%-45.0%). The risk of FSD was higher in patients with type 1 diabetes than in healthy controls (odds ratio [OR], 3.77; 95% CI, 2.24-6.35). The significant predictors of FSD among females with type 1 diabetes were depression status (OR, 2.77; 95% CI, 1.29-5.93) and longer diabetes duration (OR, 1.19; 95% CI, 1.06-1.34).

CLINICAL IMPLICATIONS

Females with type 1 diabetes had a significantly increased prevalence of FSD, indicating that clinicians should be concerned about FSD among females with type 1 diabetes.

STRENGTHS AND LIMITATIONS

The strength of the present study is that it is the first systematic review and meta-analysis to investigate the global prevalence and predictors of FSD among females with type 1 diabetes. The limitation is that the results revealed significant heterogeneity after pooling the articles.

CONCLUSIONS

The present systematic review and meta-analysis revealed that the overall prevalence of FSD among females with type 1 diabetes was 38.5%, demonstrating a significant association between FSD risk and type 1 diabetes among females. Furthermore, we found that the significant predictors for FSD among females with type 1 diabetes were depression and a longer duration of diabetes.

The Impact of Type 2 Diabetes on Women's Health and Well-being During Their Reproductive Years: A Mixed-methods Systematic Review

BACKGROUND

The incidence of Type 2 Diabetes (T2DM) among younger women now accounts for 40% of females with T2DM. Women of reproductive age with T2DM have additional health considerations and their needs may differ from older populations.

OBJECTIVES

The aims were (1) to identify the health issues encountered by women aged 16-45 years living with T2DM; (2) to determine the modifiable risk factors associated with living with diabetes; (3) to specify ideas for interventions to meet age and gender-specific diabetes-related healthcare needs.

METHODS

A systematic search was performed in the following databases; MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Maternity and Infant Care. Databases were searched without time and study design limits. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Data were narratively synthesised due to mixed methods evidence included.

RESULTS

A total of 32 papers were included in the review from which six domains were identified from the synthesis: (1) diabetes related modifiable risk factors: blood glucose, cardiovascular risk, neuropathy/nephropathy/retinopathy, diabetes self-management barriers (2) reproductive health: diabetes care before pregnancy, pre-pregnancy care barriers and expectations of women, contraceptive use (3) psychosocial wellbeing: depression symptoms and diabetes distress, perception of T2DM, emotional concerns about pregnancy (4) sexual function; (5) menopause; (6) sociocultural factors: social support, cultural norms.

CONCLUSION

This review highlighted specific health issues affecting women of reproductive age with T2DM and which represent an important focus for health services research and health care delivery. Future research needs to address identified health domains to improve women's health and well-being living with T2DM.

Sexual Dysfunction in Men and Women with Diabetes: A Reflection of their Complications?

BACKGROUND

Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality.

OBJECTIVE

The study aimed to investigate and report current evidence with regard to the association between sexual dysfunction and diabetes.

METHODS

A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to the study topic.

RESULTS

Female and male sexual dysfunction often occurs in diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet they should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects in both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease, a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and exerting beneficial effects for cardiovascular health being reported for pro-erectile drugs.

CONCLUSION

Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessments are therefore needed to provide the best chances for adequate treatment.

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.

Diabetes Distress and Marriage in Type-1 Diabetes

Background

In spite of the large number of people with Type-1 diabetes mellitus (T1DM) in India, India is not a diabetes-friendly society. The society suffers from lots of myths regarding diabetes and insulin use. This review highlights challenges faced by young people living with T1DM with regards to marriage, associated diabetes distress, and suggests potential solutions.

Methods

PubMed, Medline, and Embase search for articles published up to October 2017, using the terms "marriage" (MeSH Terms) OR "diabetes distress" (All Fields) OR "depression" (All Fields) AND "diabetes" (All Fields). The reference lists of the articles thus identified were also searched. The search was not restricted to English-language literature.

Results

Misconception regarding social, occupational, marital abilities, fertility, genetics, quality of life, sexism in young people living with T1DM raises major barriers to marriage, resulting in significant diabetes distress, depression, and psychological issues in them. People with T1DM are wrongly assumed to be sick, disabled, dependent persons, unsuitable for marriages, and likely to have complicated pregnancies with the possibility of having children with diabetes. Counseling at the level of individual, spouse, family, and society can help in obviating such issues.

Conclusion

Diabetes distress and psychological issues are major problems related to marriage in young people with T1DM. Counseling of patients, family, relatives, prospective spouse, and increasing social awareness regarding diabetes through mass communication are the keys to their resolution.

The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective

INTRODUCTION

Little is known about sexual activity and function in women with multiple chronic health conditions.

AIM

To examine the impact of multimorbidity on sexual activity and function in middle-aged and older women.

METHODS

Multiethnic cross-sectional cohort of 1,997 community-dwelling women (mean age of 60.2 [±9.5] years) in California. Structured questionnaires assessed prior diagnoses of common cardiometabolic, colorectal, neuropsychiatric, respiratory, musculoskeletal, and genitourinary conditions.

MAIN OUTCOME MEASURES

Sexual desire, frequency of sexual activity, overall sexual satisfaction, and specific sexual problems (i.e., difficulty with arousal, lubrication, orgasm, and pain) were assessed by structured questionnaires.

RESULTS

Seventy-one percent of women had two or more diagnosed chronic conditions. Fifty-nine percent reported low sexual desire, 53% reported less than monthly sexual activity, and 47% reported low overall sexual satisfaction. Multimorbidity was associated with increased odds of reporting low sexual desire (OR = 1.11, 95% CI = 1.06-1.17, per each additional chronic condition), less than monthly sexual activity (OR = 1.11, 95% CI = 1.05-1.17 per each additional condition), and low sexual satisfaction (OR = 1.10, 95% CI = 1.04-1.16 per each additional condition), adjusting for age, race/ethnicity, and partner status. Depression and urinary incontinence were each independently associated with low desire (OR = 1.53, 95% CI = 1.19-1.97, and OR = 1.23, 95% CI = 1.00-1.52, respectively), less than monthly sexual activity (OR = 1.39, 95% CI = 1.06-1.83, and OR = 1.29, 95% CI = 1.02-1.62, respectively), and low sexual satisfaction (OR = 1.49, 95% CI = 1.14-1.93, and OR = 1.38, 95% CI = 1.11-1.73, respectively), adjusting for other types of conditions. After adjustment for total number of chronic conditions, age remained a significant predictor of low desire and less than monthly sexual activity, but not sexual satisfaction.

CONCLUSIONS

Women with multiple chronic health conditions are at increased risk for decreased sexual function. Depression and incontinence may have particularly strong effects on sexual desire, frequency of activity, and satisfaction in women, independent of other comorbid conditions. Women's overall sexual satisfaction may be more strongly influenced by multimorbidity than age.

Diabetes mellitus and sexual function in middle-aged and older women

OBJECTIVE

Diabetes mellitus is an established risk factor for sexual dysfunction in men, but its effect on female sexual function is poorly understood. We examined the relationship of diabetes to sexual function in middle-aged and older women.

METHODS

Sexual function was examined in a cross-sectional cohort of ethnically diverse women aged 40-80 years using self-administered questionnaires. Multivariable regression models compared self-reported sexual desire, frequency of sexual activity, overall sexual satisfaction, and specific sexual problems (difficulty with lubrication, arousal, orgasm, or pain) among insulin-treated diabetic, non-insulin-treated diabetic, and nondiabetic women. Additional models assessed relationships between diabetic end-organ complications (heart disease, stroke, renal dysfunction, and peripheral neuropathy) and sexual function.

RESULTS

Among the 2,270 participants, mean±standard deviation age was 55±9.2 years, 1,006 (44.4%) were non-Latina white, 486 (21.4%) had diabetes, and 139 (6.1%) were taking insulin. Compared with 19.3% of nondiabetic women, 34.9% of insulin-treated diabetic women (adjusted odds ratio [OR] 2.04, 95% confidence interval [CI] 1.32-3.15) and 26.0% of non-insulin-treated diabetic women (adjusted OR 1.42, 95% CI 1.03-1.94) reported low overall sexual satisfaction. Among sexually active women, insulin-treated diabetic women were more likely to report problems with lubrication (OR 2.37, 95% CI 1.35-4.16) and orgasm (OR 1.80, 95% CI 1.01-3.20) than nondiabetic women. Among all diabetic women, end-organ complications such as heart disease, stroke, renal dysfunction, and peripheral neuropathy were associated with decreased sexual function in at least one domain.

CONCLUSION

Compared with nondiabetic women, diabetic women are more likely to report low overall sexual satisfaction. Insulin-treated diabetic women also appear at higher risk for problems such as difficulty with lubrication and orgasm. Prevention of end-organ complications may be important in preserving sexual activity and function in diabetic women.

LEVEL OF EVIDENCE

II.

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.