Women on the Other Side of War and Poverty : Its Effect on the Health of Reproduction

Sexual function is a fundamental component of a woman’s healthy life (1-3). Still, female sexual dysfunction (SD) is largely unexplored in the literature and, specifically among diabetic women compared with men, infrequently questioned during evaluation of chronic diabetic complications (1-5). In fact, fewer than 10% of the physicians question their female patients about sexual function, despite 72% of these patients reporting that they would like to discuss this subject (1,3). Between 40%–45% of the women are estimated to present SD (3). In the few studies investigating female SD in Brazil, the frequency increased to 49% with age, multiparity, and menopause, with approximate prevalence of 26% for lack of desire, 23% for pain, and 21% for orgasmic dysfunction (6,7). The female sexual health undergoes several changes throughout life and varies according to age, hormonal variations, and chronic diseases, which may contribute to the development of SD. Menopause is associated with SD by imposing changes in lifestyle and vaginal physiology, while some studies also suggest an increased risk of female SD associated with a progression to diabetes mellitus (8). The first link between female SD and diabetes was established by Kolodny in 1971(9). However, the data related to the prevalence of this condition is still conflicting and reported to range between 25% and 71%, according to Pontiroli et al (5). This variation reflects differences in ethnicity and culture of the population under evaluation, criteria for study inclusion (such as age and type/duration of diabetes), and tools used to assess SD (5,10-12). Enzlin et al have found the occurrence of SD in 25% and 27% of diabetic men and women, respectively, although the correlation among women was only associated with depression (13). Duman studied patients with types 1 (T1D) and 2 diabetes (T2D) and found that in both groups, SD correlated significantly with diabetes type and duration, in addition to glycosylated hemoglobin (HbA1C) levels, but not with age, schooling, overall monthly income, status of employment, duration of marriage, and childbearing (14). Taloyan et al studied only patients with T2D and reported that age, civil status, and the presence of diseases other than diabetes also affected sexual satisfaction (15). Based on the considerations above, this study aimed at analyzing for the first time the impact of diabetes on the Abstract Objectives: This study analyzed for the first time the effects of diabetes mellitus on the sexual function of Brazilian postmenopausal women. Materials and Methods: In total, 184 postmenopausal participants were selected after meeting the inclusion criteria of occurrence of menopause, diagnosis of type 2 diabetes (T2D), ≥1 year stable heterosexual relationship, active sexual life for >6 months, controlled associated chronic diseases, and absence of recent acute illness or psychiatric diseases. The participants were categorized into two groups, with and without T2D (control group). The control group comprised 84 women without diabetes, with mean 55 years of age, whereas the diabetes group comprised 100 women with T2D with a mean 59 years of age. Each participant filled out the nine-item Female Sexual Function Index (FSFI) questionnaire. The analyzed domains included desire, arousal, lubrication, orgasm, satisfaction, and pain. An FSFI score ≤26.5 determined the occurrence of sexual dysfunction (SD). Results: The prevalence of SD was significantly increased in women with T2D (85%) compared with controls (69%; P = 0.001). Women in the T2D group had lower mean total FSFI score when compared with those in the control group (P = 0.004). As for specific questionnaire items, we found significant differences in regards to decreased arousal (P = 0.004), desire (P = 0.001), lubrication (P = 0.015), orgasm (P = 0.019), satisfaction (P = 0.002), and pain (P = 0.002) in the T2D group. SD was associated with diabetes duration in the T2D group and with age (P = 0.001) and menopause duration (P = 0.001) in both groups. Conclusions: Among postmenopausal women in Brazil, a diagnosis of diabetes increased SD prevalence and had an impact on arousal, desire, lubrication, orgasm, satisfaction, and pain.