Sexual Dysfunction Prevalent in Patients with Diabetes

Although there are both evidence-based medical and psychological treatments available, health care professionals may not actively discuss sexual dysfunction in patients with diabetes, leading to underdiagnosis and undertreatment.

As a result, a recent study focused on the prevalence of sexual dysfunction in both men and women with type 1 diabetes (T1D) or type 2 diabetes (T2D) and the associations between clinical and psychological variables.

A team of investigators, led by Jolijn Van Cauwenberghe, Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, observed sexual dysfunction in men was related to clinical factors, while women reported low emotional well-being and symptoms of anxiety compared to women without sexual dysfunction.

Study

The study was performed as part of the Diabetes Management and Impact for Long-term Empowerment and Success (MILES), an observational study investigating the psychosocial aspects of diabetes. Enrolled patients completed an online survey that included questions on sociodemographic, clinical and health care use, as well as validated psychological questionnaires.

Investigators measured sexual functioning in patients using questions obtained from the Short Sexual Functioning Scale (SSFS). It included 13-items covering different difficulties and amounts of distress caused by the dysfunction.

Participants would rate their sexual dysfunction and stress they experienced on a scale of mild, moderate, or severe. Then, investigators would determine sexual dysfunction if moderate or severe dysfunction caused moderate or severe distress.

In addition, the WHO-5 well being index (WHO-5) collected information on general emotional well-being, with a score <13 showing impaired well-being. Further, the Generalized Anxiety Disorder 7-item scale (GAD-7) screened for symptoms of anxiety, with a score ≥10 indicating moderate to severe symptoms of anxiety.

The Problem Areas in Diabetes (PAID) scale was used to assess diabetes distress, with a score ≥40 as cut-off for elevated diabetes distress.

Results

Of the 1935 participants in the study, the analysis included those who were sexually active in the past 4 weeks and completed the SSF (n = 756). Overall, 140 of 411 men (36%) and 114 of 345 women (33%) reported sexual dysfunction.

For men, the most reported sexual dysfunctions were erectile dysfunction (T1D: 20%, T2D: 33%), and orgasmic dysfunction (T1D: 22%, T2D: 27%).

Data show sexual dysfunction in men had associations with older age (OR = 1.05, P = .022), higher waist circumference (OR = 1.04; P <.001) and longer duration of diabetes (OR = 1.04; P = .007). In addition, more men with sexual dysfunction reported diabetes distress (20% versus 12%, P = .026).

Further, women reported decreased sexual desire (T1D:22%, T2D:15%), lubrication problems (T1D:19%, T2D:14%), and orgasmic dysfunction (T1D:16%, T2D:15%).

Data also show women with sexual dysfunction reported impaired emotional well-being (36% versus 25%, P = .036), diabetes distress (36% versus 21%, P = .003), and anxiety symptoms (20% versus 11%, P = .026).

Conclusion

Investigators concluded that diabetes patients commonly experience sexual dysfunction, with significantly more men and women with sexual dysfunction reporting high levels of diabetes distress.

They noted further research is needed to understand the biological, psychological and social mechanisms behind sexual dysfunction in these patients, as well as objectively measured clinical data.

“Protocols should further include validated instruments that do not only measure the presence of SD’s but that also take into account the distress they create,” investigators wrote. “By combining these elements in large studies, more high quality information about the link between diabetes and various sexual dysfunctions could be obtained.

The study, “Prevalence of and risk factors for sexual dysfunctions in adults with type 1 or type 2 diabetes: Results from Diabetes MILES - Flanders,” was published online in Diabetic Medicine.