Sexual health is defined by WHO as a physical, emotional, psychological, and social well-being in terms of sexual desire, it goes beyond sexual dysfunction, or disability.
Sexual dysfunction is a combination of disorders that is characterized as a major disorder in one’s ability to respond to sexual response or sexual pleasure. Desire, arousal and orgasm are three principle stages of sexual response cycle. Female Sexual Dysfunction is characterized by:
- lack or loss of desire/libido/sex drive
- sexual aversion – avoidance of any touching or communication that might lead to sex
- lack of sexual enjoyment
- vaginal dryness
- markedly delayed or non-existent orgasm
- vaginismus – spasm or squeezing of the muscles of the vagina during penetration
- dyspareunia – difficult or painful sexual intercourse.
- Non-coital sexual pain disorder (recurrent or persistent genital pain induced by non-coital sexual stimulation)
It may be as a result of problems with biological origin or intra-psychological or interpersonal conflicts (psychogenic) or a combination of these factors, and any type of stress, emotional disturbances, or lack of knowledge about physiology and sexual function.
Although various studies have reported high prevalence of sexual dysfunction in women with diabetes compared with non-diabetic women, the sexual problems of diabetic women and its related risk factors are not well defined and highlighted. There are also fewer studies on diabetic women than diabetic men, and it is often a neglected health issue in women with diabetes.
Personal taboos regarding sex, confidentiality issues, worries about potential humiliation, time constraints, even the doctor’s limited experience in the management of sexual problems, are a few of the factors that can impede the uncovering of possible sexual difficulties or disorders.
However, it affects the overall quality of life, physical and emotional health, and deserves more attention in clinical practice as well as in clinical research.
Causes of sexual dysfunction in women with Diabetes
Female Sexual Dysfunction is multifactorial disorder involving subjective and objective aspects of sexual function, with numerous contributing factors (hormonal, psychological, interpersonal, and social). DM is known to cause different medical, psychological, and sexual complications.
- Women with DM may have less sexual desire which can be due to depression or changes in blood glucose levels that can leave them feeling tired or irritable.
- Hyperglycemia as well as vascular and neuropathic complications of diabetes may contribute to sexual dysfunction in women. Exposure to chronic hyperglycemia can decrease hydration of the vaginal mucous membranes, leading to decreased lubrication and painful intercourse.
- Genitourinary and fungal infections related to hyperglycemia can also contribute to difficult or painful sexual intercourse.
- Atherosclerosis and diabetes-related endothelial dysfunction in women can cause decreased labial engorgement (due to insufficient blood flow to the labia) and clitoral insufficiency (clitoris stops responding to sexual arousal due to decreased blood flow) both of which are crucial for female sexual arousal and function.
- Diabetic neuropathy can affect the nerves that supply the female genitals, causing decreased response and impaired reaction to sexual stimuli
- Female sexual dysfunction can also be a side effect of medications such as certain blood pressure treatments (beta-blockers), antihistamines, antipsychotics, antidepressants (SSRIs) and benzodiazepines.
The table below summarizes the mechanisms leading to Female Sexual Dysfunction
Treatment for female sexual dysfunction in Diabetes
At present, no specific guidelines are currently available for the treatment of FSD in diabetes; therefore, therapeutic possibilities for sexual dysfunction in diabetic women refer to lifestyle changes, optimal diabetic control, psychotherapy, and selected medications when appropriate. In summary
- Achieving adequate glycemic control is of paramount importance for diabetic women, in order to help reduce the risk of genitourinary infections and avoid complications that negatively affect sexual function.
- Modification of risk factors (weight control, healthy diet, regular exercise)
- Manage stress effectively & address psychological issues
- Cognitive behavioral psychotherapy for desire disorders or vaginismus
- Clitoral therapy device for arousal or orgasm disorders
- Treatment of depression, if present