Diabetes Affects Female Sexual Function

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.

And so it is w/women.  We've only barely started looking into female sexual dysfunction.  Heck, we haven't even agreed upon ICD-9 terminology where it currently overlaps w/erectile dysfunction (302.72).  I mean, how can we treat something if we can't describe it enough to research it, much less develop treatment (protocols).

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.

2,270 women 40-80yo (avg 55yo) participated in this study with only 2 out of 5 non-Latina white.  In other words, there was a good bit of racial diversity in this group of women.  1 out of 5 women had diabetes, and of those, 1 out of 4 used insulin to control their diabetes.  Those women w/end-organ damage due to their diabetes, eg heart disease, stroke, kidney disease & peripheral neuropathy, reported decreased sexual function in at least one domain, sexual desire/interest, sexual arousal/lubrication/orgasm/pain, and sexual satisfaction.

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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