Jolijn Van Cauwenberghe, Paul Enzlin, Giesje Nefs, Johannes Ruige, Christel Hendrieckx, Christophe De Block, Frans Pouwer

Prevalence of and risk factors for sexual dysfunctions in adults with type 1 or type 2 diabetes: Results from Diabetes MILES -Flanders. Diabet Med . 2022 Jan;39(1):e14676. Epub 2021 Sep 1.

Sexual dysfunction is relatively common among people with diabetes. More than half of men with diabetes report sexual dysfunction. Most studies on this topic focus on erectile dysfunction, although decreased desire, decreased arousal and orgasmic dysfunction have also been reported. Demographic and clinical risk factors include older age, smoking, longer diabetes duration, higher HbA1c, untreated hypertension, sedentary lifestyle, microvascular complications and cardiovascular disease, but psychological risk factors (depression,  emotional and cognitive adjustment to diabetes) also play a role. Although this topic has been studied less extensively in women than in men, women with diabetes are more than twice as likely to experience sexual dysfunction than women without diabetes. Compared with men, psychological factors seem to play a more important role in sexual dysfunction than clinical factors in women. Despite the fact that about one in five adults with diabetes would like their health care professional to touch on the topic of how diabetes is affecting their sex life, in most cases the topic is only discussed when the person with diabetes initiates the discussion, resulting in underdiagnosis and undertreatment of sexual dysfunction in people with diabetes.

 

Because most studies so far have looked at men or women only, type 1 diabetes or type 2 diabetes only and clinical or psychological factors only, this study aimed to assess all these variables simultaneously. This study was part of the Diabetes ‘Management and Impact for Long-term Empowerment and Success’ (MILES) Study International Collaborative, in which Giesje Nefs of Diabeter was involved.

Key findings:

• About a third of people reported a sexual dysfunction
• Men mostly reported erectile dysfunction (more in men with type 2 diabetes) and orgasmic dysfunction
• Women mostly reported decreased sexual desire, lubrication problems and orgasmic dysfunction
• Men with sexual dysfunction :
  • Were older
  • Had higher BMI and waist circumference
  • Had a longer diabetes duration
  • Showed a higher prevalence of retinopathy and neuropathy
• Women with sexual dysfuntion reported:
  • Impaired well-being
  • Elevated diabetes distress
  • Moderate to severe anxiety symptoms

 

In addition to the strengths of this study (large sample, validated questionnaires, DSM-5-defined sexual distress, inclusion of psychological factors), limitations include:

• Underestimation of sexual dysfunction: only people who were sexually active in the past four weeks
• Selection bias: people with access to internet and younger people more engaged with their diabetes
• No conclusions on causal relationships (observational study)
• Underestimation of medical conditions (self-reported data)

 

Concluding, the authors state

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