Sexual Dysfunction in Women With Type 1 Diabetes

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.