I'm a guy, so I think a lot about sex. I'm also older, so I don't think about sex as much as I once did in my youth, say only once every 5 minutes these days. Given my predilection towards posts on male sexual function, one might think that I'm a misogynist. Far from it (I hope!) as I think I'm more a typical physician: we address issues for which we have (easy) solutions. We never really talked about depression until the SSRIs hit the market. We never spoke about urge incontinence & overactive bladder until we developed viable antimuscarinics. And we never asked about erectile dysfunction until the PDE-5 inhibitors arrived.
Luckily, we now have validated questionnaires with which to assess female sexual function, for instance the Female Sexual Function Index, which was used in a study published in next month's Obstetrics & Gynecology, commonly referred to as the Green Book. The authors concluded that women w/diabetes are more likely to report lower overall sexual satisfaction. In fact, insulin use was associated w/difficulty w/lubrication & orgasm.
Bottom line: because this was an observational study and clearly not a randomized controlled trial, we can only develop hypotheses from the conclusions, rather than draw causal relationships. However, given that diabetes has a cause & effect relationship w/heart disease, stroke, kidney disease & peripheral neuropathy, it's not a big stretch of the imagination to add female sexual function to the list of reasons why women need better glycemic control. And while we wait for such a randomized, double-blind, placebo-controlled trial, we can still advocate for better control on the basis of better health outcomes plus the possibility of an added bonus.
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