title: Sexual dysfunction and symptom impact in men with long-standing type 1 diabetes in the DCCT/EDIC cohort.
abstract: BACKGROUND
  Male sexual dysfunction is a common complication of diabetes (DM), but the relative impact of erectile dysfunction (ED), orgasmic dysfunction (OD), and/or decreased libido (DL) on global sexual bother has not been assessed.
  
  
  OBJECTIVE
  To assess the relationship between ED, OD, and DL and overall sexual satisfaction in men with type 1 DM, and determine which form of dysfunction causes the most bother.
  
  
  METHODS
  The study cohort consisted of 713 men with type 1 DM who completed the Diabetes Control and Complication Trial and then participated in the follow-up Epidemiology of Diabetes Interventions and Complications Study. In year 10 of EDIC, 583 (83%) completed a validated instrument assessing ED, OD, and DL and the bother these conditions cause. Statistical tests determined the concordance of function and bother in each domain, and the impact of each domain on overall sexual satisfaction.
  
  
  METHODS
  Patient-reported outcomes using responses to individual items of the International Index of Erectile Function (IIEF).
  
  
  RESULTS
  ED was present in 34%, OD in 20%, and DL in 55%. When correlated with overall sexual satisfaction, ED had the highest weighted kappa (0.84, 95% confidence interval [CI] = 0.80-0.87), while OD (0.57, 95% CI = 0.51-0.63) and DL (0.55, 95%CI = 0.48-0.62) were considerably lower. Furthermore, the single item assessing confidence in getting and keeping an erection had the strongest correlation with overall sexual bother as well as specific erectile bother.
  
  
  CONCLUSIONS
  ED, OD, and DL are highly prevalent in men with long-standing type I diabetes. All three sexual dysfunctions cause bother in men with DM, but ED causes more general sexual bother and likely has a greater overall impact on quality of life. Our data underscore the importance of asking men with DM about their sexual function and point to the need for further research to investigate disorders of orgasm and desire.
authors.affiliation: Department of Urology, Keck School of Medicine, USC/Norris Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90089, USA. penson@usc.edu
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.forename: Patricia
authors.initials: P
authors.lastname: Cleary
authors.forename: Brandy N
authors.initials: BN
authors.lastname: Rutledge
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D016001:Confidence Intervals; D048909:Diabetes Complications / Q000150:complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D006305:Health Status Indicators; D006801:Humans; D018783:Impotence, Vasculogenic / Q000209:etiology* / Q000503:physiopathology; D007989:Libido; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013315:Stress, Psychological; D011795:Surveys and Questionnaires