Women with Diabetes Have Diminished Sexual Function

Middle-aged women with diabetes reported lower levels of sexual desire, satisfaction, and frequency than their nondiabetic counterparts. Women with insulin-treated diabetes also reported more difficulty with lubrication, unlike women with diabetes who did not need insulin.

Lead author Kelli L. Copeland, BA, from the Women's Health Clinical Research Center and the Departments of Obstetrics, Gynecology, and Reproductive Sciences, Family and Community Medicine, University of California, San Francisco, and colleagues write, "These findings suggest that although many diabetic women are interested and engaged in sexual activity, diabetes is associated with a markedly decreased sexual quality of life in women either through complications of the disease itself or through use of treatment."

The participants were 2270 women aged 40 to 80 years (mean age, 55 ± 9.2 years) who participated in the Reproductive Risks of Incontinence Study at Kaiser 2, a cross-sectional cohort study of risk factors for urinary tract dysfunction in middle-aged and older women recruited from Kaiser Permanente Northern California between January 2003 and January 2008. The sample included 347 women with non-insulin-treated diabetes and 139 with insulin-treated diabetes. Sexual activity and function were assessed using the Female Sexual Function Index, which has been validated and used in other large studies of women's health. The participants also were asked about the frequency of sexual activity, including masturbation, within the previous 3 months.

Sexual activity less than once a month was reported by 82 (59%) of the women with insulin-treated diabetes and 199 (57%) of the women with non-insulin-treated diabetes compared with 839 (47%) of the 1784 nondiabetic women (P = .003 for insulin-treated compared with nondiabetic patients; P < .001 for non-insulin-treated compared with nondiabetic patients).

Of the women with insulin-treated diabetes, 83 (60%) reported low sexual desire compared with 928 (52%) of the nondiabetic women (P = .04). Low sexual desire was reported by 201 (58%) of the women with non-insulin-treated diabetes (P = .05 compared with the nondiabetic women). Similarly, 38 (27%) of the women with insulin-treated diabetes and 75 (22%) of the women with non-insulin-treated diabetes complained of low sexual satisfaction compared with 304 (17%) of the nondiabetic control patients (P < .001 and P = .009, respectively).

On multivariate analysis (with adjustments made for age; race; marital or relationship status; history of sex with men, women, or both; parity; menopausal status; body mass index; hysterectomy; oophorectomy; selective serotonin reuptake inhibitor use: and estrogen use), "the odds of reporting low overall sexual satisfaction were over twofold higher in insulin-treated diabetic women and over 40% higher in non-insulin-treated diabetic women compared with nondiabetic women," the authors write. Insulin-treated diabetic women also were more likely than nondiabetic women to confirm that their physical health limited their sexual activity "extremely" or "quite a bit" (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.49 - 3.51). Diabetic women not taking insulin did not differ significantly from the women without diabetes on this measure (OR, 1.29; 95% CI, 0.92 - 1.78).

End-organ complications also were associated with diminished sexual function. Compared with diabetic women without those complications, sexual activity less than once a month was more common among women with diabetes who had heart disease (OR, 2.42; 95% CI, 1.17 - 4.98; P = .02), renal dysfunction (OR, 2.06; 95% CI, 1.16 - 3.67; P = .01), and peripheral neuropathy (OR, 1.73; 95% CI, 1.08 - 2.78; P = .02). Lower sexual desire was associated with heart disease (OR, 1.96; 95% CI, 0.99 - 3.87; P = .05) and peripheral neuropathy (OR, 1.57; 95% CI, 1.00 - 2.47; P = .05). Stroke was most strongly associated with decreased sexual satisfaction (OR, 3.32; 95% CI, 1.08 - 10.21; P = .04); however, stroke was not associated with diminished sexual activity to once or less per month, nor was stroke associated with lower sexual desire.

It was concluded that treatment of women with diabetes should include a sexual history and that clinicians should counsel patients that preventing end-organ complications may help preserve their sexual function.

Obstet Gynecol. 2012;120:331-340