Sexual Dysfunction in Female Patients with Type 2 Diabetes Mellitus—Sneak Peek on an Important Quality of Life Determinant

Clinical inertia in sexual medicine practice

Clinical inertia (CI) is common in clinical practice. Sexual health issues are common in society, and CI is ubiquitous in sexual medicine practice. CI influences all aspects of healthcare, including prevention, diagnosis, and treatment. In this short review, we briefly describe the various aspects of CI in sexual medicine practice and ways to tackle them

The impact of overactive bladder on sexual health in women with diabetes

BACKGROUND

The prevalence of overactive bladder symptoms and sexual dysfunction is increased in women with type 2 diabetes, and this can negatively impact their quality of life.

AIM

To evaluate the effects of overactive bladder on sexual function and the quality of sexual life in women with and without type 2 diabetes.

METHODS

This cross-sectional study included 168 women who were assigned to 4 groups: healthy women (n = 42), women with overactive bladder (n = 42), women with diabetes but without overactive bladder (n = 42), and women with both diabetes and overactive bladder (n = 42). Data were collected using the Overactive Bladder 8-Question Awareness Tool, the Female Sexual Function Index, and the Sexual Quality of Life-Female questionnaire. The variables assessed with these tools were analyzed using the Kruskal-Wallis test.

OUTCOMES

The levels of overactive bladder symptoms, sexual function, and sexual quality of life in women were evaluated.

RESULTS

The overactive bladder and sexual function scores of women with overactive bladder and women with both diabetes and overactive bladder were significantly worse compared to those of healthy women (P ˂ .001). In particular, women with both diabetes and overactive bladder had lower levels of sexual quality of life compared to women with overactive bladder and healthy women (P ˂ .001).

CLINICAL IMPLICATIONS

The study reveals that overactive bladder symptoms and diabetes severely affect women's quality of sexual life, emphasizing that these problems should be a routine part of clinical assessment.

STRENGTHS AND LIMITATIONS

The strength of the study lies in its unique approach as the first to comprehensively examine the effect of diabetes and overactive bladder on sexuality through a comparison of 4 distinct groups of women. Collecting data using valid and reliable scales and applying the STROBE checklist increases methodological rigor. However, the limited sample size restricts generalizability, and causal relationships cannot be established due to the cross-sectional design. In addition, self-reported data may increase the risk of bias.

CONCLUSION

This study highlights that diabetes and overactive bladder symptoms negatively affect women's sexual function and sexual quality of life and that comprehensive and individualized treatment plans should be developed.

Global prevalence of sexual dysfunction in women with skin diseases: a systematic review and meta-analysis

BACKGROUND

Skin diseases are a category of chronic conditions that often impact patients' appearance, potentially leading to psychological issues, including sexual dysfunction. The present study is an attempt to determine the global prevalence of female sexual dysfunction (FSD) in women with skin diseases.

METHODS

For this systematic review and meta-analysis, databases including PubMed, Web of Science, Scopus, Science Direct, Embase, and Google Scholar were systematically searched for relevant studies. All published research up to April 2024 imported into EndNote for further analysis. A random-effects model was applied for the analysis, and the I² statistic was used to assess study heterogeneity.

RESULTS

Analysis of 24 studies (45 datasets) indicated that the overall prevalence of FSD in women with skin diseases was estimated at 61.3% (95% CI: 53.9-68.2%). Additionally, subgroup analysis based on skin disease type revealed an FSD prevalence of 69.8% (95% CI: 56.7-80.2%) in women with vitiligo, 59.2% (95% CI: 49.1-68.5%) in those with psoriasis, and 56.5% (95% CI: 47.8-64.8%) in women with hidradenitis suppurativa.

CONCLUSION

There was a high prevalence of FSD in women with skin diseases. There is a need for policy makers and healthcare providers to prioritize the well-being of these patients.

Investigating factors affecting the quality of life of women with gestational diabetes: a systematic review and meta-analysis

BACKGROUND

Gestational diabetes mellitus (GDM) affects a significant proportion of pregnant women, impacting both physical and psychological well-being. This study aimed to investigate the factors influencing quality of life (QoL) in women with GDM.

METHODS

This systematic review followed PRISMA guidelines and was registered in PROSPERO (ID: CRD42024612587). A comprehensive search was conducted in PubMed, Scopus, ProQuest, Web of Science, and CINAHL, using MeSH terms related to gestational diabetes and quality of life. Eligible studies included adult women with gestational diabetes and assessed factors influencing their quality of life. The included studies were related to various stages including antenatal, during pregnancy or postpartum. Data extraction was performed independently by two authors, and study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted in STATA, including meta-analysis with a random-effects model.

FINDINGS

The findings reveal that women with GDM experience significantly lower QoL compared to healthy pregnant women, with sexual dysfunction being a notable contributor. Women with GDM reported lower sexual desire, satisfaction, and higher pain levels, which were significantly associated with poorer QoL, particularly in mental health and pain domains. Socio-demographic factors such as age, education, income, and marital status were significantly linked to QoL, with younger women and those with lower education or income reporting poorer outcomes. Psychological factors, including stress, depression, and anxiety, negatively impacted QoL, while social support, self-efficacy, and illness acceptance were positively correlated with better QoL outcomes. Additionally, stress was found to be the main predictor of QoL for women over 30, while social relationships were more important for younger women. Treatment with insulin or a combination of insulin and oral hypoglycemic agents was associated with lower QoL compared to dietary management alone.

CONCLUSION

This systematic review identified key psychosocial and medical factors influencing the quality of life in women with gestational diabetes. The findings emphasize the importance of addressing psychological well-being, social support, and treatment approaches to enhance QoL in these women. Further research is needed to explore interventions targeting mental health and stress management to improve outcomes for women with gestational diabetes.

Sexual dysfunction, anxiety, depression and reduced quality of life in women with non-radiographic axial spondyloarthritis- a cross-sectional analysis

Axial spondyloarthritis (ax-SpA) is a chronic inflammatory disease which causes a major deterioration of both physical and mental health. This research aimed to assess the prevalence of sexual dysfunction (SD), decreased quality of life (QoL), and depressive and anxiety symptoms in women with non-radiographic axial spondyloarthritis (nr-axSpA). A cross-sectional study was performed, involving 60 sexually active women with nr-axSpA and an age-matched group of 60 healthy women. Data were gathered through patient records and three standardized tools: the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 (SF-36). Sexual dysfunction was found to be more prevalent in the nr-axSpA group (65% vs. 40%, p < 0.01). The mean FSFI result was substantially lower in patients than in healthy controls (19.71 ± 11.32 vs. 24.75 ± 8.36, p < 0.01) with significant differences of the scores in desire, arousal, lubrication and pain caused during intercourse. Women with nr-axSpA also experienced higher levels of anxiety (HADS-A: 8.52 ± 3.62 vs. 5.88 ± 3.83, p < 0.01) and depression (HADS-D: 6.27 ± 3.38 vs. 3.28 ± 2.77, p < 0.01). They also had lower physical (171.0 ± 72.9 vs. 301.5 ± 81.2, p < 0.01) and mental (204.9 ± 83.9 vs. 277.1 ± 74.5, p < 0.01) QoL scores. Women diagnosed with nr-axSpA are more prone to sexual dysfunction, increased anxiety and depression, and have a significantly worsened quality of life. The obtained results accentuate the necessity of addressing the patients' physical as well as their emotional issues through a comprehensive approach.

Impact of gestational diabetes mellitus on women's sexual function: a systematic review and meta-analysis

BACKGROUND

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication with well-established adverse effects on maternal and fetal health. However, research on its impact on sexual health is inconsistent. Currently, there is no comprehensive review on sexual function in pregnant women with GDM. The purpose of this study is to systematically gather and synthesize the available evidence, addressing this important research gap.

METHODS

This systematic review and meta-analysis utilized a comprehensive literature search strategy and incorporated the following databases: the Cochrane Library, Scopus, PubMed, Web of Science, SID, and Google Scholar. The search was conducted until February 21, 2024. The quality of the cross-sectional and case‒control studies included in the current study was evaluated via the modified and standard Newcastle‒Ottawa scale. The certainty of the evidence was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-regression was conducted to examine the variables that influence total sexual function. Additionally, sequential analysis was performed to determine the required information size for the meta-analysis.

RESULTS

The systematic search process yielded a total of 370 studies. The final analysis included six studies. The meta-analysis findings revealed that compared with controls, women with GDM had significantly lower total scores for sexual function (SMD - 1.80, 95% CI -3.44 to -0.15, p = 0.03), sexual desire (SMD - 5.14, 95% CI -8.14 to -2.14, p < 0.001), arousal (SMD - 0.58, 95% CI -0.95 to -0.21, p = 0.002), lubrication (MD -0.41, 95% CI -0.59 to -0.22, p < 0.001) and satisfaction (SMD - 3.82, 95% CI -6.08 to -1.57, p < 0.001). However, the analysis did not reveal statistically significant differences in sexual pain, or orgasm between the GDM and control groups. The meta-regression analysis revealed that older age in the control group was associated with poorer sexual function.

CONCLUSION

Compared with control women, pregnant women diagnosed with GDM have lower sexual function. Further research with larger sample sizes is necessary to enhance the robustness of the evidence, given the low level of certainty. Healthcare providers should focus on the sexual well-being of women with GDM and create tailored interventions to address their specific needs.

Sexual function of overweight pregnant women with gestational diabetes mellitus: A cross-sectional study

Background and Aims

Overweight and obesity are on the rise worldwide and may affect female sexual function. The aim of this study was to investigate the relationship between sexual function in normal and overweight pregnant women with gestational diabetes mellitus (GDM).

Methods

This cross-sectional study was conducted in overweight and normal-weight pregnant women with GDM in Sari, Iran. Data were collected from 2018 to 2021. The demographic data collected from the participants included age, educational level, occupation, gestational age, duration of marriage, number of births, place of residence (city or village), private house, private bedroom, and insurance status. The General Health Questionnaire, Female Sexual Function Index (FSFI), and Enriched Marital Satisfaction questionnaires were used to assess mental health, sexual functioning, and marital satisfaction, respectively.

Results

The study included 200 women with GDM. The mean age of the participants was 29.75 (SD = 4.40) years. Among pregnant women with GDM, 56.50% of them had sexual dysfunction based on FSFI. The mean FSFI score in pregnant women with GDM was 25.60 (SD = 3.61). Among the participants, 50.00% had normal body mass index (BMI). There was no significant difference between BMI status and total sexual function score (p > 0.05). The multivariate analysis revealed that marital satisfaction (β = 0.41, p < 0.001) and BMI status (β = -0.15, p = 0.002) were the only factors significantly associated with overall sexual function, explaining 27% of the variance in the total FSFI score.

Conclusion

The results of this study showed that there was no significant relationship between sexual dysfunction and obesity in GDM. Considering that the research in this area is very limited and the negative effects of obesity and GDM have been confirmed in many areas, including sexual desire disorder, necessary planning should be done to control these factors.