Women with type 1 diabetes experience a three times greater risk of sexual dysfunction than women without diabetes.
The likelihood of experiencing sexual dysfunction is nearly 3-fold higher in premenopausal women with type 1 diabetes (T1D), compared to women without diabetes, according to new research.1
However, the lack of available diabetes-specific tools for assessing sexual dysfunction in T1D women, with most diabetes professionals using generic tools, suggests more emphasis is needed in approaching sexual issues in this patient population.
“These findings should encourage diabetes professionals and policymakers to give more attention to female sexual dysfunction by incorporating it into care pathways and clinical guidelines,” wrote the investigative team, led by Rahab Hashim, RN, MSc, a diabetes specialist nurse at University Hospital Bristol and Weston National Health Service Trust.
Sexual dysfunction is common in individuals with both T1D and type 2 diabetes (T2D). According to prior literature, its prevalence is higher in women with T1D compared to both women with T2D and women without diabetes.2 The experience of women with T1D and sexual dysfunction is linked to both physical damages caused by hyperglycemia, as well as psychosocial challenges related to the disease.
However, the prevalence estimates of sexual dysfunction in women with T1D remain variable, due to the heterogeneity of the conducted studies and various confounding factors associated with the dysfunction. Hasim and colleagues conducted a systematic review to better understand the current prevalence estimates of sexual dysfunction, the methods used to measure sexual dysfunction, and the factors associated with sexual dysfunction in women with T1D.
The investigative team searched 4 electronic databases (Embase, MEDLINE, CINAHL, and PsycINFO) between March - April 2022. The search was updated in February 2023 to identify studies that assessed sexual dysfunction in women with T1D. Exclusions were made for studies that included pregnant women, those with post-menopausal women, and studies that were not available in English.
Lacking diabetes-specific measures, investigators considered generic measures of sexual dysfunction in the review. The most used measure of sexual dysfunction included the Female Sexual Function Index with 6 subdomains (desire, arousal, orgasm, lubrication, pain, and satisfaction; a cut-off of ≤26.55 suggesting sexual dysfunction) and the Female Sexual Distress Scale (12 questions: score of ≥15 indicating sexual distress).
Investigators conducting the review search identified 1,104 articles, reviewed the abstracts of 941, and identified 181 studies as eligible for full review. After excluding 170 of the reviewed studies, a total of 11 case-control studies from 2005 - 2021 were included in the review. The total number of women with T1D participating in studies was 926, with an age range from 28 - 43 years (median age, 35 years).
Based on the study data, the median reported prevalence of sexual dysfunction in women with T1D was 36%, compared to 13% in women without diabetes. Pooled estimates reported in the meta-analysis suggested the odds of women with T1D experiencing sexual dysfunction were three-and-a-half times higher (odds ratio [OR], 3.8; 95% CI, 1.8 - 8.0; P <.001), than women without diabetes, based on the Female Sexual Function Index scores alone.
Hasim and colleagues performed a sub-analysis to examine study heterogeneity and excluded 1 outlying study. After exclusions, the pooled estimate rose to nearly a 5-fold increased risk of sexual dysfunction compared to women without diabetes (OR, 4.9; 95% CI, 2.7 - 8.9; P <.001).
In order to identify which domains of sexual dysfunction were more strongly reported in women with T1D, the team conducted an additional meta-analysis comparing Female Sexual Function Index scores. Of 6 studies reporting the mean standard deviation scores in each of the domains, the total scores for each were significantly lower in women with T1D, indicating greater sexual dysfunction. An analysis of psychological factors, including depression, anxiety, and duration of diabetes, revealed a significant association between these factors and sexual dysfunction.
Although the review showed a higher prevalence of sexual dysfunction in women with T1D, the investigative team noted the estimate was based on generic measures. As such, these studies may have underestimated the experiences of women with T1D and sexual dysfunction.
“It also indicates that more comprehensive sexual dysfunction measures specifically for assessing sexual dysfunction in women with T1D are needed if a true understanding of the interception between living with diabetes and sexual dysfunction is to be properly considered,” investigators wrote.