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İlaslan E, Yavaş G, Aflay U. Sexual life experiences of women with diabetes: A systematic review and synthesis of qualitative studies. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:272-288. [PMID: 38145331 DOI: 10.1080/0092623x.2023.2295254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
This study aims to systematically interpret and synthesize the data obtained from qualitative research about the sexual lives of women with diabetes. A thorough literature review was conducted between May and July 2023 across five electronic databases: PubMed, Web of Science, CINAHL, EBSCO, and Science Direct Embase. Eight studies published in English since 2000, which explored the sexual experiences of women with diabetes, were included in this assessment. The sexual experiences of women with diabetes were summarized under five main themes: perception of sexuality, changes in sexual life, adapting to the new normal, unmet care needs, and expectations. This review underlines the intricate nature of diabetic women's sexual experiences, acknowledging the substantial impact of diabetes-related complications and the associated emotional stress on their quality of life and intimate relationships. The study finds that awareness varies among women, with some adapting to the changes brought on by diabetes, while others remain uninformed about its impact on their sexual health. There is a pronounced need for integrating sexual health into diabetes care routines. Many women face unaddressed sexual health concerns and require education and empathetic care from knowledgeable health professionals.
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Affiliation(s)
- Emine İlaslan
- Department of Internal Medicine Nursing, Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Gamze Yavaş
- Department of Obstetrics and Gynecology Nursing, Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Uğur Aflay
- Department of Urology, Finike State Hospital, Antalya, Turkey
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Gordijn R, Teichert M, Nicolai MPJ, Elzevier HW, Guchelaar HJ, Hughes CM. Learning From Consultations Conducted by Community Pharmacists in Northern Ireland for Nonprescription Sildenafil: A Qualitative Study Using the Theoretical Domains Framework. Sex Med 2021; 9:100440. [PMID: 34628114 PMCID: PMC8766262 DOI: 10.1016/j.esxm.2021.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Nonprescription sildenafil was introduced to the United Kingdom in 2018 as the first pharmacy service concerning sexual function, an important but often ignored factor for quality of life. AIM This study aimed to evaluate pharmacists' views on providing nonprescription sildenafil, their perceptions of the barriers and facilitators to provide this service and strategies to overcome potential barriers, using a theory-based approach. METHODS Community pharmacists were purposefully sampled in Northern Ireland, followed by snowball sampling. Face-to-face interviews were conducted between October 2019 and January 2020. The semi-structured interviews used a piloted topic guide based on the 14-domain Theoretical Domains Framework (TDF). All interviews were audio-recorded, transcribed verbatim and anonymized. Transcripts were analyzed deductively in NVivo 13, utilizing the TDF domains as coding categories. Within each domain, content analysis was utilized to identify barriers and facilitators. MAIN OUTCOME MEASURE Barriers and facilitators within the TDF domains for pharmacists to provide nonprescription sildenafil. RESULTS Ten pharmacists were interviewed to reach data saturation. Eight pharmacists had experience with dispensing nonprescription sildenafil. They valued nonprescription sildenafil as an additional service ("Social/professional role and identity"). Training, concise product guidelines, and private consultation areas were important facilitators ("Environmental context and resources"). The service required trusting clients ("Optimism"), with concerns about abuse and men not visiting their GP. From experience gained, pharmacists became more confident dealing with difficult situations such as patients being vague about their medical history or alcoholism or mental problems as causes for erectile disfunction (ED) ("Skills" and "Beliefs about capabilities"). Pharmacists considered lifestyle and medication causes of ED important but preferred to focus on safe supply. In general, pharmacists were satisfied with the perceived professional recognition, using their clinical knowledge or helping patients resume sexual relationships ("Beliefs about consequences"). CONCLUSION Pharmacists welcomed nonprescription sildenafil to enhance their role as easily accessible healthcare providers for patients. Gordijn R, Teichert M, Nicolai MPJ, et al. Learning From Consultations Conducted by Community Pharmacists in Northern Ireland for Nonprescription Sildenafil: A Qualitative Study Using the Theoretical Domains Framework. Sex Med 2021;9:100440.
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Affiliation(s)
- Rineke Gordijn
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands.
| | - Martina Teichert
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands
| | - Melianthe P J Nicolai
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam, The Netherlands
| | - Henk W Elzevier
- Leiden University Medical Center, Department of Urology and Department of Medical Decision Making, Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Leiden University Medical Center, Department of Clinical Pharmacy & Toxicology, Leiden, The Netherlands
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
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"My wife's mistrust. That's the saddest part of being a diabetic": A qualitative study of sexual well-being in men with Type 2 diabetes in sub-Saharan Africa. PLoS One 2018; 13:e0202413. [PMID: 30199531 PMCID: PMC6130865 DOI: 10.1371/journal.pone.0202413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/02/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction Sexual dysfunction is a common complication for men with diabetes, yet little is known about the lived experiences of sexual difficulties within the context of diabetes, particularly in low-and-middle-income countries. This study explores how men with type 2 diabetes in three sub-Saharan African settings (Cape Town and Johannesburg, South Africa; Lilongwe, Malawi) perceive and experience sexual functioning and sexual well-being, and the biopsychosocial contexts in which these occur and are shaped. Methods We used a qualitative research design, including individual interviews (n = 15) and focus group discussions (n = 4). Forty-seven men were included in the study. We used an inductive thematic analysis approach to develop our findings. A biopsychosocial conceptual model on the relationship between chronic illness and sexuality informed the interpretation of findings. Results Men across the study settings identified sexual difficulties as a central concern of living with diabetes. These difficulties went beyond biomedical issues of erectile dysfunction, comprising complex psychological and relational effects. Low self-esteem, related to a sense of loss of masculinity and reduced sexual and emotional intimacy in partner relationships were common experiences. Specific negative relational effects included suspicion of infidelity, mutual mistrust, general unhappiness, and fear of losing support from partners. These effects may impact on men’s ability to cope with their diabetes. Further stressors were a lack of information about the reasons for their sexual difficulties, perceived lack of support from healthcare providers and an inability to communicate with partners about sexual difficulties. Conclusion More in-depth research is needed to better understand sexual functioning and well-being within the context of diabetes, and its potential impact on diabetes self-management. Holistic and patient-centered care should include raising awareness of sexual problems as a potential complication of diabetes amongst patients, their partners and care providers, and incorporating sexual well-being as part of routine clinical care.
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Sexual Satisfaction, Relationship Satisfaction, and Quality of Life in Individuals with Type 2 Diabetes: Evidence from Poland. SEXUALITY AND DISABILITY 2017. [DOI: 10.1007/s11195-017-9516-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kizilay F, Gali HE, Serefoglu EC. Diabetes and Sexuality. Sex Med Rev 2017; 5:45-51. [DOI: 10.1016/j.sxmr.2016.07.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 12/22/2022]
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Rutte A, Welschen LMC, van Splunter MMI, Schalkwijk AAH, de Vries L, Snoek FJ, Enzlin P, Nijpels G, Elders PJM. Type 2 Diabetes Patients' Needs and Preferences for Care Concerning Sexual Problems: A Cross-Sectional Survey and Qualitative Interviews. JOURNAL OF SEX & MARITAL THERAPY 2016; 42:324-337. [PMID: 25849308 DOI: 10.1080/0092623x.2015.1033578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sexual dysfunction is highly prevalent among patients with type 2 diabetes; however, little is known regarding these patients' needs and preferences for care for sexual problems. A cross-sectional survey and 25 semistructured interviews were therefore conducted among 40- to 75-year-old type 2 diabetes patients to explore this. We learned from the survey and interviews that most participants were unaware of the association between type 2 diabetes and sexual problems. Although certain barriers for discussing sexual problems with a care provider were identified (e.g., feelings of embarrassment), patients still reported a need for discussing their problems, because sex was viewed as an important part of their relationship. Some patients had sought help, but were dissatisfied with the offered care. Patients experienced a lack of attention and information from diabetes care providers. Improving this, together with a care provider-initiated conversation, was suggested to lower the threshold for discussion. Moreover, patients preferred a care provider with whom they have a close relationship, whereas age, gender, and medical specialty were regarded to be less important. An important recommendation was to make care for sexual problems an integral part of routine diabetes care. Future research should look into these recommendations.
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Affiliation(s)
- Anne Rutte
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Laura M C Welschen
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Maaike M I van Splunter
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Annemarie A H Schalkwijk
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Lianne de Vries
- b Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Frank J Snoek
- c Department of Medical Psychology, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Paul Enzlin
- d Department of Neurosciences, Institute for Family and Sexuality Studies, KU Leuven, Leuven, Belgium, and Centre for Clinical Sexology and Sex Therapy , UPC KU Leuven , Leuven , Belgium
| | - Giel Nijpels
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
| | - Petra J M Elders
- a Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , VU University Medical Centre , Amsterdam , The Netherlands
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Phillips A, Phillips S. Recognising female sexual dysfunction as an essential aspect of effective diabetes care. Appl Nurs Res 2015; 28:235-8. [PMID: 26074296 DOI: 10.1016/j.apnr.2015.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
The following literature review will focus on sexual dysfunction in women living with diabetes, drawing on international studies in this specialist field. The key aim of this paper is generate a greater understanding and recognition of the issues facing these women and to determine a more proactive approach to identification, consultation and potential treatment options. The main findings highlight the unique role practitioners have with women with diabetes and how to facilitate partnership working. Nurses have the most frequent contact with people living with diabetes in any healthcare system. Nurses' knowledge about sexuality in relation to diabetes should improve patient education, recognition and could signal undiagnosed or increased risk of sexual dysfunction to enable treatment so care can be optimised accordingly (Sivrikaya et al., 2014).
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Affiliation(s)
- Anne Phillips
- Diabetes Care, Seebohm Rowntree Building-Area 5, Dept of Health Sciences, Faculty of Science, University of York, Heslington, York, YO10 5DD, UK.
| | - Stephen Phillips
- Adult Nursing, Ramsden Building, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
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Şahin M, Şahin ZA. Effect of sexual dysfunction and sexual quality of life in type 2 diabetes women: a pilot study from Turkey. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Ritholz MD, Beverly EA, Brooks KM, Abrahamson MJ, Weinger K. Barriers and facilitators to self-care communication during medical appointments in the United States for adults with type 2 diabetes. Chronic Illn 2014; 10:303-13. [PMID: 24567195 PMCID: PMC4157962 DOI: 10.1177/1742395314525647] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Diabetes self-care is challenging and requires effective patient-provider communication to achieve optimal treatment outcomes. This study explored perceptions of barriers and facilitators to diabetes self-care communication during medical appointments. DESIGN Qualitative study using in-depth interviews with a semistructured interview guide. PARTICIPANTS Thirty-four patients with type 2 diabetes and 19 physicians who treat type 2 diabetes. RESULTS Physicians described some patients as reluctant to discuss their self-care behaviors primarily because of fear of being judged, guilt, and shame. Similarly, patients described reluctant communication resulting from fear of being judged and shame, particularly shame surrounding food intake and weight. Physicians and patients recommended trust, nonjudgmental acceptance, open/honest communication, and providing patients hope for living with diabetes as important factors for improving self-care communication. Further, patients stressed the clinical benefits of physicians directly addressing poor self-care behaviors while physicians described having few strategies to address these difficulties. CONCLUSIONS Physician-patient self-care communication barriers included patients' reluctance to discuss self-care behaviors and physicians' perceptions of few options to address this reluctance. Treatment recommendations stressed the importance of establishing trusting, nonjudgmental and open patient-provider communication for optimal diabetes treatment. Medical education is needed to improve physicians' strategies for addressing self-care communication during medical appointments.
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Affiliation(s)
- Marilyn D Ritholz
- Behavioral Health and Outcomes Research, Joslin Diabetes Center, Boston, USA Harvard Medical School, Boston, USA Boston Children's Hospital, Boston, USA
| | | | - Kelly M Brooks
- Behavioral Health and Outcomes Research, Joslin Diabetes Center, Boston, USA Tufts University School of Medicine, Boston, USA
| | - Martin J Abrahamson
- Behavioral Health and Outcomes Research, Joslin Diabetes Center, Boston, USA Harvard Medical School, Boston, USA
| | - Katie Weinger
- Behavioral Health and Outcomes Research, Joslin Diabetes Center, Boston, USA Harvard Medical School, Boston, USA
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Sexual Dysfunction and Depression in Turkish Women with Type 2 Diabetes Mellitus. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-013-9337-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saunamäki N, Engström M. Registered nurses' reflections on discussing sexuality with patients: responsibilities, doubts and fears. J Clin Nurs 2013; 23:531-40. [DOI: 10.1111/jocn.12155] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 01/23/2023]
Affiliation(s)
- Nina Saunamäki
- Faculty of Health and Occupational Studies; Department of Health and Caring Sciences; University of Gävle; Gävle
- The County Council of Gävleborg; Gävle
| | - Maria Engström
- Faculty of Health and Occupational Studies; Department of Health and Caring Sciences; University of Gävle; Gävle
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Li J, Drury V, Taylor B. A systematic review of the experience of older women living and coping with type 2 diabetes. Int J Nurs Pract 2013; 20:126-134. [PMID: 24713008 DOI: 10.1111/ijn.12135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper reports on a systematic review that sought to answer the research question: what is the experience of women living and coping with type 2 diabetes? A range of relevant terms were identified and electronic databases were searched. Only qualitative studies that explored the meaning of living and coping with type 2 diabetes and that included adult women aged ≥ 18 years were considered. We found evidence that women are challenged by their multi-caregiving roles and the complexities of managing their diabetes simultaneously. For female patients with diabetes, holistic care and individual psycho-education programmes appear to be facilitate more effective and successful diabetes management. In addition, carer programmes that provide information so that family and friends can support and assist the woman with diabetes are required.
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Affiliation(s)
- Jiemin Li
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Vicki Drury
- Educare Consulting, Bunbury, Western Australia, Australia.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Beverley Taylor
- School of Nursing and Midwifery, Monash University, Churchill, Victoria, Australia
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Jiménez-Garcia R, Martinez-Huedo MA, Hernandez-Barrera V, De Andres AL, Jimenez-Trujillo I, Carrasco-Garrido P. Sexuality among Spanish adults with diabetes: a population-based case control study. Prim Care Diabetes 2012; 6:269-276. [PMID: 22445726 DOI: 10.1016/j.pcd.2012.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/07/2012] [Accepted: 02/29/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe and compare sexuality between subjects with diabetes with matched non-diabetic controls. METHODS Population based case control study using individual data from the Spanish National Sexual Health Survey. Diabetes status was self reported, we selected type 2 patients. We identified 461 diabetes sufferers. Two controls were matched by age, sex and sexual partner for each diabetic case. Sexuality measures included: sexual activity, importance of sex, satisfaction with partner, bothersome with one's sexual life and self-rated sexual health. Independent variables included: socio-demographics, physical health, chronic diseases and medications use. RESULTS No differences were found in "Sexually activity", "Importance of sex" or "Bothersome" between those with and without diabetes. Dissatisfaction with partner was 25% in women with diabetes and 12.9% in non-diabetic controls (Adjusted-OR 1.82 95%CI 1.02-4.85). Diabetes sufferers reported sexual health as "fair/poor/very poor" more than their non-diabetic control, 58.1% vs. 45.1% for women (Adjusted-OR 1.74 95%CI 1.15-2.63) and 54.3% vs. 38% for men (Adjusted-OR 1.88 95%CI 1.29-2.75). Among diabetes sufferers "fair/poor/very poor" sexual health was associated with poorer physical health, not having a sexual partner and among men taking heart medications. CONCLUSIONS Women and men with diabetes have significantly worse sexuality measures than non diabetic controls.
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Affiliation(s)
- Rodrigo Jiménez-Garcia
- Preventive Medicine Unit, Rey Juan Carlos University, Av. Atenas, Alcorcón 28922, Spain.
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Gask L, Macdonald W, Bower P. What is the relationship between diabetes and depression? a qualitative meta-synthesis of patient experience of co-morbidity. Chronic Illn 2011; 7:239-52. [PMID: 21840916 DOI: 10.1177/1742395311403636] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To develop an explanatory framework concerning patient experience of diabetes and depression and the relationship between these disorders; to better understand how interventions and health services should be delivered for this group of patients. METHODS The study used meta-synthesis. Published qualitative studies were identified using a structured search, and themes synthesized across studies to develop a new explanatory framework. RESULTS Searches of three databases identified 5506 papers, and 22 were included. Diagnosis of diabetes and the impact of symptoms on functioning were associated with varied psychological reactions, not all of which are negative, and the concept of 'depression' only captures aspects of the experience. Similarly, the relationship between diabetes and relationships with professionals and family were variable, with relationships serving as both a buffer of the effects of diabetes and potentially as a cause of further difficulties for patients. Depression and other psychological states were significant barriers to effective coping. Definition of 'self' emerged as a key potential moderator of the relationship between depression and diabetes. CONCLUSIONS The variability in psychological reactions to diabetes suggested three key clinical implications, reflecting increasing levels of complexity for practitioners.
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Affiliation(s)
- Linda Gask
- School of Community Based Medicine, National School for Primary Care Research, Manchester Academic Health Sciences Centre, University of Manchester, UK.
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Abstract
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.
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Affiliation(s)
- Krzysztof Nowosielski
- Department of Gynecology and Obstetrics, Specialistic Clinical Hospital, Tychy, Poland.
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Ziaei-Rad M, Vahdaninia M, Montazeri A. Sexual dysfunctions in patients with diabetes: a study from Iran. Reprod Biol Endocrinol 2010; 8:50. [PMID: 20482781 PMCID: PMC2887879 DOI: 10.1186/1477-7827-8-50] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 05/18/2010] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a chronic disease that causes short and long-term complications. This study aimed to investigate the prevalence of sexual dysfunctions (SD) among diabetic patients in Iran and to examine whether glycemic control has a role in SD. METHODS A consecutive sample of diabetic women and men who were registered in the Isfahan Endocrine and Metabolism Center, Iran were studied. Sexual dysfunction was evaluated using the Female Sexual Function Index (FSFI) in women and the International Index of Erectile Function (IIEF) in men. In addition the level of glycosylated hemoglobin was assessed to classify the diabetes status in patients. RESULTS In all 200 patients (100 male and 100 female) were entered into the study. The mean age of patients was 48.6 (SD = 7.3) years and most had type 2 diabetes (91.0%). The results showed that sexual dysfunctions were widespread in both gender and 165 (82.5%) patients reported that experienced at least one sexual dysfunction. There were significant associations between sexual dysfunctions and gender and type of diabetes (P = 0.04). Women and patients with type 1 diabetes had higher rates of SD. No major differences were found between SD and age, diabetes status, duration of diabetes and hypertension. In addition, glycemic control did not show a significant association with SD in both genders. CONCLUSION The findings of this study showed that SD prevalence was high in diabetic patients of both genders and the glycemic control did not correlate with the frequency of SD in the study population. It is recommended that SD should be addressed more precisely in health care practice in Iran.
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Affiliation(s)
- Marzieh Ziaei-Rad
- Faculty of Nursing and Midwifery, Islamic Azad University, Khorasgan Branch, Isfahan, Iran
| | - Mariam Vahdaninia
- Department of Social Medicine, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Ali Montazeri
- Department of Mental Health, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Giraldi A, Kristensen E. Sexual dysfunction in women with diabetes mellitus. JOURNAL OF SEX RESEARCH 2010; 47:199-211. [PMID: 20358461 DOI: 10.1080/00224491003632834] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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.
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Affiliation(s)
- Annamaria Giraldi
- Sexological Clinic, Mental Health Services, Psychiatric Center Rigshospitalet, 2100, Copenhagen, Denmark.
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Mcgrath C, Rofail D, Gargon E, Abetz L. Using qualitative methods to inform the trade-off between content validity and consistency in utility assessment: the example of type 2 diabetes and Alzheimer's disease. Health Qual Life Outcomes 2010; 8:23. [PMID: 20152041 PMCID: PMC2844366 DOI: 10.1186/1477-7525-8-23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 02/12/2010] [Indexed: 05/17/2024] Open
Abstract
BACKGROUND Key stakeholders regard generic utility instruments as suitable tools to inform health technology assessment decision-making regarding allocation of resources across competing interventions. These instruments require a 'descriptor', a 'valuation' and a 'perspective' of the economic evaluation. There are various approaches that can be taken for each of these, offering a potential lack of consistency between instruments (a basic requirement for comparisons across diseases). The 'reference method' has been proposed as a way to address the limitations of the Quality-Adjusted Life Year (QALY). However, the degree to which generic measures can assess patients' specific experiences with their disease would remain unresolved. This has been neglected in the discussions on methods development and its impact on the QALY values obtained and resulting cost per QALY estimate underestimated. This study explored the content of utility instruments relevant to type 2 diabetes and Alzheimer's disease (AD) as examples, and the role of qualitative research in informing the trade-off between content coverage and consistency. METHOD A literature review was performed to identify qualitative and quantitative studies regarding patients' experiences with type 2 diabetes or AD, and associated treatments. Conceptual models for each indication were developed. Generic- and disease-specific instruments were mapped to the conceptual models. RESULTS Findings showed that published descriptions of relevant concepts important to patients with type 2 diabetes or AD are available for consideration in deciding on the most comprehensive approach to utility assessment. While the 15-dimensional health related quality of life measure (15D) seemed the most comprehensive measure for both diseases, the Health Utilities Index 3 (HUI 3) seemed to have the least coverage for type 2 diabetes and the EuroQol-5 Dimensions (EQ-5D) for AD. Furthermore, some of the utility instruments contained items that could not be mapped onto either of the proposed conceptual models. CONCLUSIONS Content of the utility measure has a significant impact on the treatment effects that can be observed. This varies from one disease to the next and as such contributes to lack of consistency in observable utility effects and incremental utility scores. This observation appears to have been omitted from the method development considerations such as reference methods. As a result, we recommend that patients' perspectives obtained via qualitative methods are taken into consideration in the ongoing methods development in health state descriptions for generic utility instruments. Also, as a more immediate contribution to improving decision making, we propose that a content map of the chosen utility measure with patient-reported domains be provided as standard reporting in utility measurement in order to improve the transparency of the trade-offs in relation to patient relevance and consistency.
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Affiliation(s)
- Clare Mcgrath
- Health Technology Assessment Policy, Medical Division, Worldwide Pharmaceutical Operations, 3-1-60 Walton Oaks, Tadworth, Surrey KT20 7NS, UK
| | - Diana Rofail
- Mapi Values, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Elizabeth Gargon
- Mapi Values, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
| | - Linda Abetz
- Mapi Values, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB, UK
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Nowosielski K, Drosdzol A, Sipiński A, Kowalczyk R, Skrzypulec V. Diabetes Mellitus and Sexuality—Does it Really Matter? J Sex Med 2010; 7:723-35. [DOI: 10.1111/j.1743-6109.2009.01561.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Sexual function in female diabetic patients is much less investigated than in males. Empirical studies do not show uniform results, but it appears that diabetic women experience more frequent sexual dysfunction in general than age-matched healthy controls, independent of the sociocultural environment. The most frequently cited dysfunctions are desire and arousal disorders, such as lubrication difficulties, while orgasmic capacity appears to be less affected. Direct pathophysiological effects on lubrication are proven, but the impact on mental arousal is unclear. The role of diabetic complications is controversial. The comorbidity with depression plays a major role. Individual coping with the disease and the quality of the relationship are also contributing factors. Patients should be encouraged to talk about their sexual problems, as both biomedical and psychosocial factors have to be explored. Therapeutic interventions include basic counseling, biomedical treatment of atrophy and lubrication difficulties, as well as treatment of comorbidities and/or sex therapy.
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Affiliation(s)
- J Bitzer
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland.
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22
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Kim NN. Sex steroid hormones in diabetes-induced sexual dysfunction: focus on the female gender. J Sex Med 2009; 6 Suppl 3:239-46. [PMID: 19267847 DOI: 10.1111/j.1743-6109.2008.01182.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Noel N Kim
- The Institute for Sexual Medicine, San Diego, CA 92121, USA.
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Grandjean C, Moran B. The impact of diabetes mellitus on female sexual well-being. Nurs Clin North Am 2008; 42:581-92; vi. [PMID: 17996756 DOI: 10.1016/j.cnur.2007.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
For women, the risk for developing diabetes mellitus is reaching epidemic levels. As a result of the impact of diabetes on multiple body systems, women may suffer from medical and psychologic problems, including sexual dysfunction. It is difficult to separate sexual response from the many emotional and other contributing factors that may influence a relationship. Therefore, it is vital that clinicians address the issue of sexuality with their female diabetic patients. This article provides a brief review of the literature, followed by a discussion addressing the proper approach for sexual dysfunction screening. Finally, this article considers some of the current and future treatment modalities that can be used to enhance sexual functioning in female diabetics with impaired sexual function.
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Abstract
Stroke survivors are a major group of patients served by rehabilitation nurses. The lingering sequelae of a stroke may be devastating to a couple's relationship. This article provides practical advice that nurses can give to a stroke patient and his or her partner to cope with or overcome changes in intimacy and sexuality after a stroke. This article addresses the wide range of changes likely to occur in the patient and his or her partner, and readers are referred to additional resources for the nurse, the patient, and his or her partner. This information provides the tools for nurses to help our patients and their partners maintain their hope for love.
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Affiliation(s)
- Donald D Kautz
- University of North Carolina, Greensboro School of Nursing, Adult Health Department, 27402-6170, USA.
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Ferrini MG, Nolazco G, Vernet D, Gonzalez-Cadavid NF, Berman J. Increased vaginal oxidative stress, apoptosis, and inducible nitric oxide synthase in a diabetic rat model: implications for vaginal fibrosis. Fertil Steril 2006; 86:1152-63. [PMID: 16978624 DOI: 10.1016/j.fertnstert.2006.01.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 01/03/2006] [Accepted: 01/03/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether vaginal fibrosis occurs in diabetic animals and is associated with oxidative stress and cell death and with the expression of inducible nitric oxide synthase (iNOS), as a putative antifibrotic mechanism. DESIGN Research experimental project. SETTING University research laboratory. ANIMAL(S) Female Wistar rats. INTERVENTION(S) Female rats were injected with streptozotocin or saline and killed at 3 months. The vaginas were excised and processed for paraffin-embedded sections (n = 6 per group) or were frozen for biochemical and molecular biology procedures. MAIN OUTCOME MEASURE(S) Immunohistochemistry and quantitative image analysis were applied to tissue sections to measure alpha-smooth muscle actin, transforming growth factor beta1, plasminogen activator inhibitor, NOS isoforms, Cu/Zn superoxide dismutase, apoptotic index, and nitrotyrosine. Xanthine dehydrogenase, reactive oxygen species (ROS), and hydroxyproline were measured in fresh vaginal tissue (n = 5 per group). Reactive oxygen species also were determined in blood. RESULT(S) Diabetes was associated with vaginal fibrosis, as evidenced by increased collagen, transforming growth factor beta1, plasminogen activator inhibitor, and apoptosis, and by decreased alpha-smooth muscle actin. The increment of ROS and the reduction of superoxide dismutase indicated oxidative stress in diabetic tissue, accompanied by iNOS induction and increased nitric oxide-ROS reaction. CONCLUSION(S) Diabetes in the rat causes oxidative stress and fibrosis in the vagina, which may be compensated partially by iNOS induction to reduce ROS.
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Affiliation(s)
- Monica G Ferrini
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.
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Muniyappa R, Norton M, Dunn ME, Banerji MA. Diabetes and female sexual dysfunction: moving beyond "benign neglect". Curr Diab Rep 2005; 5:230-6. [PMID: 15929871 DOI: 10.1007/s11892-005-0014-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Ranganath Muniyappa
- SUNY Downstate Medical Center and Kings County Hospital, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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DERLEGA VALERIANJ, ROBINETT IVA, WINSTEAD BARBARAA, SAADEH GHANDIM. PSYCHOLOGICAL IMPACT OF COMPARING ONESELF TO OTHER PERSONS WITH DIABETES. JOURNAL OF LOSS & TRAUMA 2005. [DOI: 10.1080/15325020590928234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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