Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease

Katerina Stechova; Lenka Mastikova; Krzysztof Urbaniec; Miroslav Vanis; Simona Hylmarova; Milan Kvapil; Zlatko Pastor

doi:10.1016/j.esxm.2019.03.001

Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease

Sex Med. 2019 Jun;7(2):217-226. doi: 10.1016/j.esxm.2019.03.001. Epub 2019 Apr 4.

Authors

Katerina Stechova¹, Lenka Mastikova², Krzysztof Urbaniec³, Miroslav Vanis³, Simona Hylmarova⁴, Milan Kvapil⁴, Zlatko Pastor⁵

Affiliations

¹ Department of Internal Medicine, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic. Electronic address: katerina.stechova@fnmotol.cz.
² Department of Internal Medicine, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic; Department of Clinical Hematology, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic.
³ Department of Internal Medicine, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic; Czech Technical University in Prague, Czech Republic.
⁴ Department of Internal Medicine, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic.
⁵ Department of Gynecology and Obstetrics, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic.

Abstract

Introduction: More sexual problems are reported among people treated for diabetes; however, this situation is less explored in women than in men.

Aim: To analyze the presence and causal links of female sexual dysfunction (FSD) among Czech women treated for type 1 diabetes.

Methods: 40 women completed a national version of the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-revised (FSDS-R), and Beck's Depression Inventory-II (BDI-II). A metabolic and endocrine analysis was done using blood samples. Data were statistically analyzed using SPSS v.24 and the R environment.

Main outcome measures: Patient details (personal information, diabetes-related data, and sex history), sexual performance (the FSFI and FSDS-R scores), and level of depression (the BDI-II score) were measured.

Results: FSD was present in 58% of the participants (based on the FSFI score), and 38% women declared significant sexual distress (according to their FSDS-R score). Even though only 4 women fulfilled the criteria for depression, we observed a strong association between BDI-II and FSFI (for total FSFI score P = .012, ρ = -0.394) resp. FSDS-R scores (P < .001, ρ = 0.552). Although we were not able to establish a clear direct connection between FSD and metabolic control, BDI-II scores were closely correlated with glycosylated hemoglobin (P = .009, ρ = 0.407). The duration of diabetes (based on FSDS-R: P = .046) but neither age nor the presence of chronic diabetic microvascular complications was associated with a higher FSD occurrence. We also observed an association between FSD and the presence of autoimmune hypothyroidism, even when successfully treated (FSDS-R: P = .009; FSFI: P = .067).

Conclusion: FSD is more common in women with type 1 diabetes than in healthy women, and coexisting thyroid autoimmune disease seems to exacerbate FSD. Women suffering from type 1 diabetes, and particularly those with additional endocrinopathies, should be actively screened for FSD. Stechova K, Mastikova L, Urbaniec K, et al. Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease. Sex Med 2019;7:217-226.

Keywords: Autoimmune Thyroid Disease; BDI-II; Diabetes; FSDS-R; FSFI; Female Sexual Dysfunction; Insulin; Insulin Pump; Life Quality; Sexarche.