Diabetes and female sexual health: an ongoing challenge

Abstract

Female sexual health remains a much‐neglected area in diabetes clinical medicine; however, it is important for psychological and social well‐being as well as reproductive function. We aimed to explore the views of women regarding the impact of diabetes on sexual health beyond pregnancy and reproduction. We conducted an online survey distributed via social media platforms including Twitter, Facebook and LinkedIn; the survey remained open for four weeks. Questions addressed a range of medical and psychological factors including body image, self‐esteem and confidence. A total of 258 participants, aged 18–73 years, completed the survey. Results show a significant deterioration over the past 20 years, with issues including negative impact on self‐esteem (68.6%) and relationships (61.6%), feeling less attractive (57.8%), feeling lonely/isolated (66.3%), worries about fertility (52.7%) and pregnancy (69.4%), and worry about diabetes being passed on to children (79.5%). Medical factors included vaginal infections (77.9%), dyspareunia (51.2%), and general orgasmic problems (57.4%). Almost half (49.2%) were unaware that these problems were more common in women with diabetes. Shorter duration of diabetes was negatively associated with self‐esteem (p<0.002), loneliness (p<0.001), and impact on relationships (p<0.017). Those without children and those aged under 35 years were more worried about fertility (p=0.000) and pregnancy (p=0.000). It was concluded that sexual health issues continue to pose challenges for women with diabetes in terms of medical and psychological challenges. The psychosocial aspects of diabetes and sexuality, including feeling unattractive both physically and emotionally are widely reported by participants, demonstrating the very damaging and distressing personal consequences. Copyright © 2019 John Wiley & Sons. Practical Diabetes 2019; 36(5): 165–169

Diabetes and male sexual health: an unmet challenge

“…The current study also highlights the limited awareness and knowledge about ED possessed by men with diabetes. It is noteworthy that recruitment to the study was challenging, as compared to recruitment for similar research with women with diabetes that recruited over 250 participants in half the time . This may be a reflection of the ‘taboo’ nature of the subject and the reduced willingness of men to engage or seek help.

Sexual health is an integral part of overall health, well‐being and quality of life Diabetes has been shown to have a significant detrimental effect on sexual healthand well‐being Sexual health problems affect over three‐quarters of people with diabetes The psychosocial impact of sexual health problems results in loss of self‐esteem, loss of feelings of attractiveness, loneliness and negative effects on relationships It is clear that there is still a need for support/resources to be readily available as well as heightened health care professional awareness to help individuals

…”

Sexual health and function in women with diabetes

“…14 There are three diabetes-related issues that affect sexual function in women. [19][20][21] First, physical problems related to sexual intercourse such as a lack of vaginal lubrication, pain during sex, and a lack of ability to orgasm, can all be a consequence of either high or low blood glucose levels. 22 Second, that people with diabetes are twice as likely to experience depression and this is associated with reduced sexual drive.…”

“…Women may not be willing to discuss the problems they experience with a HCP, we know from a cross-sectional questionnaire study (N = 179) that ~70% of women with diabetes had not sought help from a HCP for their sexual dysfunction. 21 Second, women may be unaware that sexual dysfunction might be diabetes related, the same study identified that approximately 50% of women did not know this. 21 Third that some structured education programmes, such as X-PERT Diabetes, Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) and Dose Adjustment For Normal Eating (DAFNE), in the United Kingdom do not discuss it, perhaps because this is not recognized as a problem in UK diabetes guidelines.…”

“…21 Second, women may be unaware that sexual dysfunction might be diabetes related, the same study identified that approximately 50% of women did not know this. 21 Third that some structured education programmes, such as X-PERT Diabetes, Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) and Dose Adjustment For Normal Eating (DAFNE), in the United Kingdom do not discuss it, perhaps because this is not recognized as a problem in UK diabetes guidelines. 26 Fourth, that diabetes specialists might be more concerned with preventing un-planned pregnancy in women with diabetes, a significant issue for women with both types of diabetes 27,28 rather than the problems experienced by women with sexual dysfunction or feel awkward initiating a conversation.…”

“…However, awareness of the issue among diabetes specialists has not been widely considered nor is there currently an awareness or scoping of the resources available to support women and HCPs, although diabetes charities, such as Diabetes UK and the Diabetes, Research and Wellness Foundation, have recently published advice for women on their websites and in the form of leaflets. 21 Similarly, there are pockets of treatment excellence for women with sexual dysfunction and diabetes to access, such as a fully integrated diabetes and psychotherapy service for Sussex Community NHS Trust-Diabetes Care for You (DCFY) which is described in more detail below. and Avanafil (Stendra), are licensed for the treatment of erectile dysfunction in men with diabetes.…”