title: Sexual dysfunction in pre-menopausal diabetic women: clinical, metabolic, psychological, cardiovascular, and neurophysiologic correlates.
abstract: An increased prevalence of female sexual dysfunction (FSD) has been reported in women with diabetes mellitus (DM). Our aim was to evaluate correlates (psychological, cardiovascular, and neurophysiologic) of FSD in DM women without chronic diabetic complications. Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI), Michigan Diabetic Neuropathy Index (DNI), and the symptoms of diabetic neuropathy (SDN) questionnaires, metabolic variables, endothelial vascular function (flow-mediated dilation, FMD), echocardiography, and electromyography were studied. 109 pre-menopausal women (18-50 years) [48 with DM (14 type 1 DM, 34 type 2 DM, duration 12.6 ± 1.91 years), and 61 healthy women] received the above questionnaires; physical activity, smoking habits, parity, BMI, waist circumference, HOMA-IR index, fibrinogen, cholesterol (total, HDL, LDL), triglycerides, HbA1c, high-sensitivity C-reactive protein, total testosterone, and estradiol were measured; echocardiography, assessment of intima-media thickness (IMT), FMD, ECG (heart rate and Qtc, indexes of sympathetic activity), and electromyography were performed. FSFI total score and score for arousal, lubrication, and orgasm domains were lower in DM women than in controls (P < 0.05); DM women had higher BDI, Doppler A wave peak velocity, DNI, and SDN score (P < 0.001 to P < 0.04). Doppler E wave peak velocity, peroneal, posterior tibial and sural nerves conduction velocity and amplitude were lower in diabetic women than in controls (P < 0.05 to P < 0.001). FSFI score was positively correlated with physical activity, Doppler E wave peak velocity, and peroneal nerve amplitude and negatively with BDI, parity, IMT, SDN, and HbA1c (P < 0.05 to P < 0.001). At stepwise regression, SDN score (negatively) and Doppler E wave peak velocity (positively) predicted FSFI score (r = 507, P < 0.001). In conclusion, cardiovascular and neurological impairments are associated with FSD in diabetic women. Follow-up studies are required to evaluate sexual dysfunction as a risk factor for future cardiovascular or neurological events.
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Ospedale San Paolo, via Antonio Di Rudinì 8, 20142, Milan, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Cortelazzi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Marconi
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cristina
authors.forename: Barbara
authors.initials: B
authors.lastname: Zecchini
authors.forename: Annamaria
authors.initials: A
authors.lastname: Veronelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Cattalini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Innocenti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Bosco
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Pontiroli
mesh_terms: D000293:Adolescent; D000328:Adult; D002319:Cardiovascular System / Q000503:physiopathology; D003863:Depression / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D017697:Premenopause; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000378:metabolism / Q000523:psychology; D011795:Surveys and Questionnaires; D014664:Vasodilation / Q000502:physiology; D055815:Young Adult