Risky sexual behaviors in adolescents and young adult women with type 1 diabetes: An overlooked problem

Abstract

The presence of unprotected sex activity in women living with type 1 diabetes (T1D) who have insufficient glycemic control should be considered as a specific risky behavior. To evaluate risky behaviors, including unprotected sexual activity, sources of information and knowledge related to reproductive health in adolescents and young adult women with T1D (PwT1D) compared to a group of adolescents and young adult women without diabetes (Comparison group). PwT1D and the Comparison group completed a questionnaire with validated measures that assessed reproductive health. PwT1D (n = 115, age = 17.7 ± 3.2 years) and Comparison group (n = 386, age = 18.3 ± 2.9) were recruited. The proportion of women reporting having sex without any contraceptive was similar in both groups (57.1% and 50%, in PwT1D and Comparison group, respectively). The use of non‐effective contraceptive was reported in 63.2% and 63.6% of the PwT1D and Comparison group, respectively. Among PwT1D, parents, formal sex education, and friends were the primary source of information on reproductive health. Low levels of knowledge about diabetes and pregnancy were observed in PwT1D. HbA1c level was associated with having at least one sexual activity without any contraception (OR = 1.63, p = 0.039). PwT1D have similar rates of risky behaviors compared to a Comparison group. Sexual risky behaviors should be especially considered in PwT1D with glycemic control above the optimal level. Parents are an important source of reproductive health information for PwT1D. Use of effective contraception should be reinforced in sexually active PwT1D.

Sexual Risk Behaviors of Adolescents with Type 1 Diabetes in Comparison with Their Peers

“…Similarly, girls in both groups of our study were more cautious about risky behaviors than boys were, and adolescents with T1D were more cautious compared to their peers without T1D, possibly due to the consequences of risky behaviors (alcohol and tobacco consumption, unprotected sex) and oral contraceptive use on diabetes management and complications [ 35 , 36 , 37 ]. Furthermore, in agreement with our study, in the study by Giraudo et al [ 27 ] on 115 adolescents and young women with T1D and 386 peers without T1D it was found that fewer adolescents with T1D than controls had sexual activity. Thus, adolescents and young women with T1D were more cautious than their peers in terms of risky sexual behaviors.…”

“…Consistent with our findings, previous U.S. studies [ 20 , 21 , 26 ] and Giraudo et al [ 27 ] have shown a lower prevalence of sexual activity among T1D adolescents compared to peers without T1D, suggesting increased cautiousness and hesitance regarding sex. Of note, the overall prevalence of sexual activity in our study was higher than that reported in the above studies (18–24%), probably due to population differences.…”

“…This may be attributed to diabetes management education, delayed personal social development and initiation of risk-taking behaviors. To the contrary, similar sexual risky behaviors were found in a study of adolescents and young women with T1D [ 27 ].…”

“…However, in the latter study a significant proportion of adolescents and young women with T1D smoked or used illicit substances, which did not occur in our study, and a significantly higher proportion of participants had unprotected sex in comparison with those of our study. These differences could be attributed to the older age range of the study population in the Giraudo et al study [ 27 ].…”

“…A significantly higher rate of poor glycemic control among adolescents engaged in risky behaviors has been previously reported [ 33 ]. Moreover, in the Giraudo et al study [ 27 ], poor glycemic control was associated with high risk sexual behaviors.…”