Evaluation of factors affecting sexual dysfunction in female patients with diabetes mellitus

Sexual Dysfunction in Diabetic Patients: Τhe Role of Advanced Glycation End Products

Sexual dysfunction is a common but underestimated disorder of diabetic patients of both genders, entailing specific and complex pathogenesis and severely affecting reproductive health and quality of life. Hyperglycemia, dyslipidemia, hypertension, obesity, aging, and psychological factors underlie its pathogenesis. A large body of evidence indicates that advanced glycation end products and oxidative stress have a distinct impact on the pathogenesis of diabetes and its complications, including hypogonadism, which is closely related to sexual dysfunction. Advanced glycation end products seem to affect sexual function either directly by accumulation in various regions of the reproductive system and/or correlation or indirectly through oxidative stress induction via several mechanisms. They are also involved in the pathogenesis of diabetic complications, which are related to sexual dysfunction. Herein, we review the issue of sexual dysfunction in diabetic males and females, with special emphasis on the impact of advanced glycation end products in the pathogenesis of sexual dysfunction, the relationship of advanced glycation end products with low testosterone levels in diabetic subjects, which account for the proportion of disorder and the available therapeutic interventions.

Sexual life experiences of women with diabetes: A systematic review and synthesis of qualitative studies

This study aims to systematically interpret and synthesize the data obtained from qualitative research about the sexual lives of women with diabetes. A thorough literature review was conducted between May and July 2023 across five electronic databases: PubMed, Web of Science, CINAHL, EBSCO, and Science Direct Embase. Eight studies published in English since 2000, which explored the sexual experiences of women with diabetes, were included in this assessment. The sexual experiences of women with diabetes were summarized under five main themes: perception of sexuality, changes in sexual life, adapting to the new normal, unmet care needs, and expectations. This review underlines the intricate nature of diabetic women's sexual experiences, acknowledging the substantial impact of diabetes-related complications and the associated emotional stress on their quality of life and intimate relationships. The study finds that awareness varies among women, with some adapting to the changes brought on by diabetes, while others remain uninformed about its impact on their sexual health. There is a pronounced need for integrating sexual health into diabetes care routines. Many women face unaddressed sexual health concerns and require education and empathetic care from knowledgeable health professionals.

Do We Care Enough About the Presence of Sexual Problems in Diabetic Patients?

Purpose

Sexual health is not only the absence of sexual dysfunction or disability, but also the presence of physical, emotional, mental, and social well-being related to sexuality. The current study aims to determine whether all adult patients who have applied for their regular health check-ups due to diabetes mellitus had ever voluntarily expressed their sexual problems to a specialist and whether they were asked about the presence of sexual dysfunction. It also aims to determine how the physicians attach importance to the issue.

Patients and Methods

All patients aged 18-65 years with type 1 and type 2 diabetes mellitus, who applied to our hospital between the years of January 2021 and 2022, were questioned by filling out a questionnaire for the presence of sexual problems in addition to screening for chronic complications of diabetes mellitus (retinopathy, nephropathy, and neuropathy) and routine history and physical examination.

Results

The association between the presence of sexual problems and whether patients were questioned about the relevant issue in their previous controls and gender and age factors, educational background, presence of comorbidities, duration of marriage, and microvascular complications of diabetes mellitus were examined. In a population of 595 patients, 53.78% of the patients stated that they had sexual problems; however, 9.91% had been questioned about this issue by the physician. It was observed that 6.3% of female and 15.3% of male patients had previously consulted a doctor voluntarily due to their sexual problems.

Conclusion

This study presents empirical findings that shed light on the inadequacies in healthcare providers' approach to addressing sexual health concerns among individuals diagnosed with diabetes, as well as the shortcomings in patients' effective communication of these concerns.

What I felt as a diabetes fatigue survivor: a phenomenology study

Purpose

Diabetes has resulted in an increase in diabetic fatigue syndrome, which has a negative influence on health, particularly the risk of worsening quality of life (QoL) due to physical and mental limitations. The purpose of this study was to evaluate the experiences of patients with unregulated type 2 diabetes mellitus (T2DM) and diabetes fatigue syndrome.

Methods

This study used a qualitative phenomenological design and focused on patients from four primary health centers (PHCs) in Surabaya, Indonesia with higher incidents of unregulated T2DM. Thirty participants were recruited using purposive sampling with the following inclusion criteria: adult T2DM patients, willing to participate in the study, and able to recount experiences associated with their illness. Data collection took place between April and June 2020 across 36 interview sessions. Semi-structured interviews were carried out face-to-face with each participant with the principles of social distancing applied due to the COVID-19 pandemic.

Results

Analysis identified five themes and thirteen subthemes. The first theme was participants’ experiences during blood glucose imbalance. Other themes included experiences of boredom with diet, physical and psychological distress, financial problems during treatment, and sexual problems.

Conclusion

Participants with T2DM who experienced diabetes fatigue reported negative effects on their life, especially on health, functional daily activity, and finances. The results of this study can provide information for nurses and other healthcare providers to promote interventions for patients with T2DM, such as modifying lifestyle, self-acceptance, and self-efficacy.

Assisted reproduction technology outcomes in women with infertility and preexisting diabetes mellitus: a systematic review

OBJECTIVE

To assess maternal and neonatal outcomes in women with or without preexisting diabetes mellitus (DM) undergoing assisted reproduction technology (ART) treatment.

METHODS

Prospective or retrospective controlled trials reporting on women with or without preexisting DM undergoing ART treatment were considered eligible. Twelve electronic databases were systematically searched up to December 2020. The risk of bias was assessed by the Cochrane Risk OF Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Each primary outcome was extracted and pooled as maternal- or neonatal-related.

RESULTS

Two studies were included in the systematic review, reporting on both maternal- and neonatal-related parameters after ART treatment. Due to the limited data, no meta-analysis was conducted. Preterm birth, placenta previa, and excessive bleeding during pregnancy were observed more often in pregnancies complicated by preexisting DM conceived by ART compared with pregnancies without DM. There was no difference in the risk for placental abruption between the groups. Regarding the neonatal outcomes, large-for-gestational-age (LGA) embryos and neonatal intensive care unit (NICU) admission were more commonly reported for women with preexisting DM. In one study, preexisting DM was marginally associated with infant mortality.

CONCLUSIONS

Despite the scarce data, preexisting DM in pregnancies conceived by ART is associated with increased risk for maternal and neonatal complications.

TRIAL REGISTRATION

Registered in PROSPERO (registration number: 143187).

Sexual Dysfunction in Men and Women with Diabetes: A Reflection of their Complications?

BACKGROUND

Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality.

OBJECTIVE

The study aimed to investigate and report current evidence with regard to the association between sexual dysfunction and diabetes.

METHODS

A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to the study topic.

RESULTS

Female and male sexual dysfunction often occurs in diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet they should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects in both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease, a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and exerting beneficial effects for cardiovascular health being reported for pro-erectile drugs.

CONCLUSION

Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessments are therefore needed to provide the best chances for adequate treatment.

Sexual Function and Sexual Quality of Life in Premenopausal Women with Controlled Type 1 and 2 Diabetes-Preliminary Study

Sexual dysfunction is more common in women with diabetes than in women without diabetes. The aim of the study was to determine sexual function and the level of the quality of sex life in premenopausal women with controlled, uncomplicated type 1 and type 2 diabetes taking into account the stages of the menstrual cycle and mood level. The study included 163 women with type 1 and type 2 diabetes and 115 controls without diabetes. Questionnaire studies were conducted using the following surveys: Demographic and Clinical Data Survey, Female Sexual Function Index, Sexual Quality of Life—Female, and Beck Depression Inventory. Both phases of the menstrual cycle—follicular and luteal—were included. It was shown that, in women with type 1 diabetes, sexual function decreased during the luteal phase in comparison with the follicular phase (p < 0.001). In the women with type 2 diabetes and in the controls, sexual function was comparable during both phases of the cycle (p > 0.05). In the women with uncomplicated controlled type 1 diabetes, sexual function and the sexual and relationship satisfaction changed depending on the phase of the menstrual cycle with a decrease during the luteal phase. Sexual function and the quality of the sex life of premenopausal women with controlled type 2 diabetes were comparable during both the follicular and the luteal phases. Sexual function in menstruating women with controlled type 2 diabetes decreased with age and a worsening mood.

Vitamin E and ginseng supplementation to enhance female sexual function: a randomized, double-blind, placebo-controlled, clinical trial

Female sexual disorders (FSD) are a spectrum of disorders common among women, especially in their middle age, which can reduce the female quality of life substantially. We aimed to evaluate the effects of a combined vitamin E and ginseng supplement on amelioration of female sexual dysfunction. In a 6-week, double-blind, randomized, placebo-controlled clinical trial, participants, suffering from sexual dysfunction based on the female sexual function index (FSFI) questionnaire, were randomly allocated to receive the supplement (100 IU vitamin E, 67 mg Korean ginseng, and 40 mg Siberian ginseng) or placebo daily. The primary outcome in our trial was the change in the FSFI total score. Sixty-nine participants were enrolled, but only 31 in each group completed the trial. Changes in the FSFI total score and its domain scores were significant during the trial course within each group. However, the supplement only ameliorated desire and satisfaction domains superior to the placebo. In case of the total score and other domains, the changes were insignificantly different between the treatment groups. Although our study could not find additional benefits for the vitamin E and ginseng supplement over placebo in enhancing sexual function overall, the supplement worked better in enhancing sexual desire and satisfaction.