Sexual dysfunction in pre-menopausal diabetic women: clinical, metabolic, psychological, cardiovascular, and neurophysiologic correlates

Abstract

An increased prevalence of female sexual dysfunction (FSD) has been reported in women with diabetes mellitus (DM). Our aim was to evaluate correlates (psychological, cardiovascular, and neurophysiologic) of FSD in DM women without chronic diabetic complications. Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI), Michigan Diabetic Neuropathy Index (DNI), and the symptoms of diabetic neuropathy (SDN) questionnaires, metabolic variables, endothelial vascular function (flow-mediated dilation, FMD), echocardiography, and electromyography were studied. 109 pre-menopausal women (18-50 years) [48 with DM (14 type 1 DM, 34 type 2 DM, duration 12.6 ± 1.91 years), and 61 healthy women] received the above questionnaires; physical activity, smoking habits, parity, BMI, waist circumference, HOMA-IR index, fibrinogen, cholesterol (total, HDL, LDL), triglycerides, HbA1c, high-sensitivity C-reactive protein, total testosterone, and estradiol were measured; echocardiography, assessment of intima-media thickness (IMT), FMD, ECG (heart rate and Qtc, indexes of sympathetic activity), and electromyography were performed. FSFI total score and score for arousal, lubrication, and orgasm domains were lower in DM women than in controls (P < 0.05); DM women had higher BDI, Doppler A wave peak velocity, DNI, and SDN score (P < 0.001 to P < 0.04). Doppler E wave peak velocity, peroneal, posterior tibial and sural nerves conduction velocity and amplitude were lower in diabetic women than in controls (P < 0.05 to P < 0.001). FSFI score was positively correlated with physical activity, Doppler E wave peak velocity, and peroneal nerve amplitude and negatively with BDI, parity, IMT, SDN, and HbA1c (P < 0.05 to P < 0.001). At stepwise regression, SDN score (negatively) and Doppler E wave peak velocity (positively) predicted FSFI score (r = 507, P < 0.001). In conclusion, cardiovascular and neurological impairments are associated with FSD in diabetic women. Follow-up studies are required to evaluate sexual dysfunction as a risk factor for future cardiovascular or neurological events.

Menopause and Diabetes? No Sweat!

“…Although vaginal dryness and decreased libido are common symptoms of injury to blood vessels and nerves in women with diabetes, vaginal dryness and decreased libido are also common to menopause [8]. Thus, preexisting vaginal dryness and/or low libido can worsen during menopause for women with diabetes [5].…”

Sexual dysfunction among women with type 2 diabetes and its relationship with well-being, anxiety and depression

“…Interestingly, the prevalence of sexual dysfunctions among women with diabetes is under-investigated, in spite of the fact that the first report on the higher prevalence of anorgasmia among women with diabetes compared with women without diabetes (35% vs. 6%) was published as early as 1971 [3]. A literature review of Medline and PubMed revealed that the number of publications on sexual dysfunction among women with diabetes is relatively low [3][4][5][6][7][8][9]. Studies were often based on a small number of participants or had unclear methods regarding symptom identification.…”

“…A Jordanian study of 613 diabetic women reveals higher prevalence of sexual dysfunction compared with the control group, but patients had both type 1 and type 2 diabetes [4]. Only a few publications take into consideration psychopathological symptoms that also can cause sexual dysfunctions [5][6][7][8][9]. A Nigerian study of 58 women with type 2 diabetes concluded that psychological morbidity could be a determinant of sexual dysfunction [5].…”

“…One of the studies selected as partially representative included a sample of patients with type 2 diabetes [8], but participants included both genders (male and female) [8]. A second study of Italian women only included both type 1 and type 2 diabetes [7]. Turkish studies on the relationship between depression and a perception of sexuality in patients with type 2 diabetes indicated a higher prevalence of psychiatric disorders, particularly depression and anxiety, in patients with diabetes compared with the general population [8].…”

“…Of the studies reviewed, very few involved a representative group of participants and had the required psychometric qualities [7][8][9]. One of the studies selected as partially representative included a sample of patients with type 2 diabetes [8], but participants included both genders (male and female) [8].…”