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The topic of sexual problems among women with diabetes has been highly underreported, says Lois Jovanovic, MD, from the Sansum Medical Research Institute in Santa Barbara, California. While nearly 2,000 studies addressing sexual dysfunction among men with diabetes have been published in the past five years, Jovanovic observes that a "paltry" 13 articles about sexual dysfunction among women with diabetes appeared during that same period.
Now a group of researchers in Belgium has conducted a new study focused on women. The researchers asked 120 women with type 1 diabetes to complete a questionnaire evaluating their psychological adjustment to having diabetes, marital satisfaction, depression and sexual function. The women's medical records were reviewed for A1C levels, use of medications, body mass index and premature heart complications. An age-matched control group of 180 healthy women without diabetes was used for comparison.
Women with type 1 diabetes were more likely to suffer from decreased vaginal lubrication, and those with diabetes-related complications were even more likely to report sexual problems. Women in both the diabetes group and the control group who suffered from sexual problems reported depression and lower satisfaction with their marriages.
"Sexual problems are frequent in women with diabetes," the researchers conclude. "They affect overall quality of life and deserve more attention in clinical practice and research."
Jovanovic, citing past research, notes that "women suffer from depression twice as frequently as men. It has been reported that women with diabetes suffer an even greater prevalence of depression than women without diabetes." Since "depression can result in loss of libido," she adds, it is one of many factors that might contribute to sexual dysfunction.
Jovanovic also cites evidence that the duration of marriage, the woman's hormonal state, fear of unwanted pregnancy, infection, the partner's fear of the woman's diabetes, and preoccupation with her diabetes are all factors that can lead to poor sexual function.
"Now that there is evidence-based medicine to suggest that arousal is the problem," she writes, "intervention can be designed to treat the problem."
She recommends taking a medical history and conducting a physical examination to determine the "most likely cause" of a woman's sexual problems. She offers a spate of suggestions for treatment, including anti-depression medication, advice about birth control, and individual and marriage counseling.
—Diabetes Care, April 2002
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