This study aimed to investigate the prevalence and risk factors associated with sexual dysfunction in a well-characterized cohort of women with type 1 diabetes.  The study was conducted in women enrolled in the long-term Epidemiology of Diabetes Interventions and Complications (EDIC) study, a North American study of men and women with type 1 diabetes. At year 10 of the EDIC study, 652 female participants were invited to complete a validated self-report measure of sexual function, standardized history and physical examinations, laboratory testing, and mood assessment.

RESULTS Of the sexually active women with type 1 diabetes in the EDIC study, 35% met criteria for female sexual dysfunction (FSD). Women with FSD reported loss of libido (57%); problems with orgasm (51%), lubrication (47%), and arousal (38%); and pain (21%). Univariate analyses revealed a positive association between FSD and age (P = 0.0041), marital status (P = 0.0016), menopausal status (P = 0.0019), microvasculopathy (P = 0.0092), and depression (P = 0.0022). However, in a multivariate analysis, only depression (P = 0.004) and marital status (P = 0.003) were significant predictors of FSD.

CONCLUSIONS FSD is common in women with type 1 diabetes and affects all aspects of sexual function and satisfaction. Depression is the major predictor of sexual dysfunction in women with type 1 diabetes. These findings suggest that women with type 1 diabetes should be routinely queried about the presence of sexual dysfunction and possible co-association with depression.

Diabetes has long been considered a major cause of impaired sexual function. Both men with type 1 and type 2 diabetes have been shown to have substantially increased risk of erectile dysfunction (ED). Beyond the effects of comorbidities, such as older age, use of antihypertensive medication, high BMI, and smoking, the severity and duration of diabetes and its vascular and neurological complications, which cause abnormalities in the endothelium or nitric oxide–related mechanisms in the corpora cavernosa, have been strongly linked with the development of sexual dysfunction in men.

Women with diabetes have similar rates of cardiovascular and neurological complications, and therefore similar rates of sexual dysfunction might be anticipated. Sexual functioning of women with diabetes, however, has received far less attention in research, and results are less conclusive than those of studies in men. In general, studies of sexual dysfunction in women have lagged behind those in men, likely due to several factors, including a lack of standardized definitions of sexual dysfunction in women, absence of well-validated scales, and societal taboos regarding female sexuality. Previous studies of sexual dysfunction in women with diabetes are small in number and have significant methodological drawbacks, including small sample sizes and lack of adequate characterization of diabetes, particularly with regard to glycemic control, neurovascular complications, psychological adjustment to diabetes, and presence or absence of comorbid depression.

Nevertheless, preliminary reports have noted a high prevalence of sexual dysfunction in women with diabetes. In particular, a mixed pattern of sexual symptoms has been found, including loss of sexual interest or desire, arousal or lubrication difficulties, painful intercourse (dyspareunia), and loss of the ability to reach orgasm. In a recent study, women with type 1 diabetes had increased rates of sexual dysfunction compared with age-matched control subjects. In contrast to studies in men, no association was found between sexual dysfunction and cardiovascular, metabolic (i.e., glycemic control, diabetes duration), or other risk factors (i.e., age, BMI, menopause, use of hormone replacement therapy). Another study further revealed that sexual dysfunction in women with diabetes is related more directly to psychological factors, i.e., the presence of depression was found to be the major predictor of female sexual dysfunction (FSD). This latter finding is consistent with other studies showing depression to be a major risk and comorbid factor of FSD.

To summarize, there are few data available that have systematically evaluated the effect of diabetes and/or the role of specific diabetes therapies on female sexual functioning. The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study is unique in providing the opportunity to assess female sexual function in the context of a large, multicenter, controlled trial of long-term therapy for type 1 diabetes. Accordingly, this study aimed to evaluate the prevalence, type, risk factors, and predictors of FSD in a prospective observational study examining the risk factors associated with long-term complications of type 1 diabetes in women.

Prevalence and characteristics of sexual dysfunction

Based on the FSFI-R cutoff score for sexual dysfunction of 22.75, the overall prevalence of FSD among sexually active women in this study was found to be 35.4%. Univariate analyses revealed that women meeting criteria for FSD were on average older than women without FSD (P = 0.0041), were more likely to be married (P = 0.0016), be (post)menopausal (P = 0.0019), have evidence of microvasculopathy (composite diabetes complications variable, P = 0.0092), and be depressed (P = 0.0022) than women without FSD (Table 2). Among those women who met the criteria for FSD, 57% reported a problem with decreased desire, 51% had problems with orgasm, 47% had inadequate lubrication, 38% had problems with sexual arousal, and 21% reported pain during intercourse. Additionally, 25% of sexually active women reported low overall sexual satisfaction. For all sexual domains, study participants without FSD scored higher (i.e., had better function) than women with FSD (P

< 0.001).

# Paul Enzlin, PHD
# Raymond Rosen, PHD
# Markus Wiegel, PHD
# Jeanette Brown, MD
# Hunter Wessells, MD
# Patricia Gatcomb, RN
# Brandy Rutledge, PHD
# Ka-Ling Chan, MS
# Patricia A. Cleary, MS and
# the DCCT/EDIC Research Group

For Full article Abstract/FREE Full Text