Abstract
Purpose
The aim of this study was to evaluate the prevalence and risk factors associated with female sexual dysfunction (FSD) in young women with type 1 diabetes treated with different intensive insulin regimens.
Methods
Type 1 diabetic women aged 18–35 years were included in this study if they had stable couple relationship and no oral contraceptive use. All women were asked to complete the Female Sexual Function Index (FSFI) and other validated multiple-choice questionnaires assessing sexual-related distress (Female Sexual Distress Scale, FSDS), quality of life (SF-36 Health Survey), physical activity (International Physical Activity Questionnaire), depressive symptoms (Zung Self-Rating Depression Scale, SRDS) and diabetes-related problems (Diabetes Integration Scale ATT-19). FSD was diagnosed according to a FSFI score higher than 26.55 and a FSDS score lower than 15.
Results
The overall prevalence of FSD in diabetic and control women was 20 and 15 %, respectively (P = 0.446). Compared with the continuous subcutaneous insulin infusion group and control women, diabetic women on multiple daily injections (MDI) had lower global FSFI score (P = 0.007), FSDS score (P = 0.045) and domains such as arousal (P = 0.006), lubrication and satisfaction scores (P < 0.001 for both). In the multiple regression analysis, only the mental component summary (P = 0.047) and the SRDS score (P = 0.042) were independent predictors of FSFI score in the overall diabetic women.
Conclusion
Young women with type 1 diabetes wearing an insulin pump show a prevalence of sexual dysfunction similar to that of healthy age-matched women, but sexual function was significantly impaired in diabetic women on MDI therapy. Depression and the mental health status were independent predictors for FSD in diabetic women.
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References
Maiorino MI, Bellastella G, Esposito K (2014) Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes 7:95–105
Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB (2008) Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 112:970–978
Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357:762–774
Abu Ali RM, Al Hajeri RM, Khader YS, Shegem NS, Ajlouni KM (2008) Sexual dysfunction in Jordanian diabetic women. Diabetes Care 31:1580–1581
Enzlin P, Rosen R, Wiegel M, Brown J, Wessells H, Gatcomb P, DCCT/EDIC Research Group et al (2009) Sexual dysfunction in women with type 1 diabetes: long-term findings from the DCCT/EDIC study cohort. Diabetes Care 32:780–785
Esposito K, Maiorino MI, Bellastella G, Giugliano F, Romano M, Giugliano D (2010) Determinants of female sexual dysfunction in type 2 diabetes. Int J Impot Res 22:179–184
Enzlin P, Mathieu C, Van Den Bruel A, Vanderschueren D, Demyttenaere K (2003) Prevalence and predictors of sexual dysfunction in patients with type 1 diabetes. Diabetes Care 26:409–414
Bultrini A, Carosa E, Colpi EM, Poccia G, Iannarelli R, Lembo D et al (2004) Possible correlation between type 1 diabetes mellitus and female sexual dysfunction: case report and literature review. J Sex Med 1:337–340
Salonia A, Lanzi R, Scavini M, Pontillo M, Gatti E, Petrella G et al (2006) Sexual function and endocrine profile in fertile women with type 1 diabetes. Diabetes Care 29:312–316
Cortelazzi D, Marconi A, Guazzi M, Cristina M, Zecchini B, Veronelli A et al (2013) Sexual dysfunction in pre-menopausal diabetic women: clinical, metabolic, psychological, cardiovascular, and neurophysiologic correlates. Acta Diabetol 50:911–917
Tagliabue M, Gottero C, Zuffranieri M, Negro M, Carletto S, Picci RL et al (2011) Sexual function in women with type 1 diabetes matched with a control group: depressive and psychosocial aspects. J Sex Med 8:1694–1700
American Diabetes Association (2016) 7. Approaches to glycemic treatment. Diabetes Care 39:S52–S59
Nicolucci A, Maione A, Franciosi M, Amoretti R, Busetto E, Capani F, EQuality1 Study Group–Evaluation of QUALITY of Life and Costs in Diabetes Type 1 et al (2008) Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections. Diabet Med 25:213–220
Cherubini V, Gesuita R, Bonfanti R, Franzese A, Frongia AP, Iafusco D, VIPKIDS Study Group et al (2014) Health-related quality of life and treatment preferences in adolescents with type 1 diabetes. The VIPKIDS study. Acta Diabetol 51:43–51
Maiorino MI, Bellastella G, Petrizzo M, Improta MR, Brancario C, Castaldo F et al (2014) Treatment satisfaction and glycemic control in young Type 1 diabetic patients in transition from pediatric health care: CSII versus MDI. Endocrine 46:256–262
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208
Derogatis LR, Rosen R, Leiblum S, Burnett A, Heiman J (2002) The Female Sexual Distress Scale (FSDS): initial validation of a standardized scale for assessment of sexually related personal distress in women. J Sex Marital Ther 28:317–330
Baser RE, Li Y, Carter J (2012) Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer 15(118):4606–4618
Meston CM, Derogatis LR (2002) Validated instruments for assessing female sexual function. J Sex Marital Ther 28(Suppl 1):155
Zung WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70
Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
IPAQ Research Committee. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ). International Physical Activity Questionnaire. www.ipaq.ki.se
Welch G, Dunn SM, Beeney LJ (1994) The ATT39: a measure of psychological adjustment to diabetes. In: Bradley C (ed) Handbook of psychology and diabetes. Harwood Academic Publishers, Switzerland, pp 223–246
The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986
McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E et al (2016) Definitions of sexual dysfunctions in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med 13:135–143
Esposito K, Ciotola M, Giugliano F, Bisogni C, Schisano B, Autorino R et al (2007) Association of body weight with sexual function in women. Int J Impot Res 19:353–357
Esposito K, Giugliano F, Ciotola M, De Sio M, D’Armiento M, Giugliano D (2008) Obesity and sexual dysfunction, male and female. Int J Impot Res 20:358–365
Pontiroli AE, Cortelazzi D, Morabito A (2013) Female sexual dysfunction and diabetes: a systematic review and meta-analysis. J Sex Med 10:1044–1051
Isidori AM, Pozza C, Esposito K, Giugliano D, Morano S, Vignozzi L et al (2010) Development and validation of a 6-item version of the female sexual function index (FSFI) as a diagnostic tool for female sexual dysfunction. J Sex Med. 7:1139–1146
Maseroli E, Fanni E, Fambrini M, Ragghianti B, Limoncin E, Mannucci E et al (2016) Bringing the body of the iceberg to the surface: the Female Sexual Dysfunction Index-6 (FSDI-6) in the screening of female sexual dysfunction. J Endocrinol Invest 39:401–409
Ciocca G, Limoncin E, Mollaioli D, Gravina GL, Carosa E, Di Sante S et al (2016) SIAMS survey on sexological screening during the assisted reproductive technologies in Italy. J Endocrinol Invest 38:999–1005
Peters A, L Laffel, American Diabetes Association Transitions Working Group (2011) Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care 34:2477–2485
Ciocca G, Carosa E, Stornelli M, Limoncin E, Gravina GL, Iannarelli R et al (2015) Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L’Aquila earthquake. Acta Diabetol 52:513–521
Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544
Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, GSSAB Investigators’ Group et al (2005) Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 17:39–57
Kokkonen ER (1995) Mental health and social adaptation in young adults with juvenile onset diabetes. Nordic J Psychiatry 49:175–181
Dimitropoulos K, Bargiota A, Mouzas O, Melekos M, Tzortzis V, Koukoulis G (2012) Sexual functioning and distress among premenopausal women with uncomplicated type 1 diabetes. J Sex Med 9:1374–1381
Acknowledgments
The authors thank Paolo Cirillo, Elisabetta Della Volpe, Maria Rosaria Improta and Marella Solimeno for data collection and technical support, and Concetta Verazzo for nursing assistance.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Maiorino, M.I., Bellastella, G., Castaldo, F. et al. Sexual function in young women with type 1 diabetes: the METRO study. J Endocrinol Invest 40, 169–177 (2017). https://doi.org/10.1007/s40618-016-0542-5
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DOI: https://doi.org/10.1007/s40618-016-0542-5