Sexual dysfunction, an invisible complication of diabetes – an exploratory study of the experiences of premenopausal women with Type 1 diabetes

Abstract

Background: Survey data suggest that women with Type 1 diabetes mellitus have a higher prevalence of sexual dysfunction (SD) compared with women with Type 2 diabetes or without diabetes. However, little is known about how women with Type 1 diabetes experience SD or its impact on their lives. This exploratory study sought to elicit women with Type 1 diabetes’s experiences of SD and identify their ideas on how SD could be better addressed in diabetes care. Method: A qualitative study using semi-structured interviews was conducted at a diabetes centre in South West of England hospital. A purposeful sample of six women with Type 1 diabetes (<50 years of age) and experience of SD were interviewed. The interviews lasted 20–30 min and were analysed using Interpretive Phenomenological Analysis. Findings: The study identified four superordinate themes: barriers to sex, impact of SD, personal support and ideas for improving support with SD. The majority of the themes were underpinned by diabetes specific factor such as hypoglycaemia, body image and diabetes management (technology and glucose regulation). This study found that women’s perspectives on their sexual identities and behaviours were mediated by emotional and interpersonal issues. This study also highlighted the lack of support provided by healthcare professionals (HCPs) in addressing SD. Conclusion: The findings indicate that SD is a complex issue that needs to be given more attention by HCPs, so that the women can approach sex positively in their lives. HCPs need to be enabled to initiate conversations around SD in their consultations.

Prevalence and associated factors of sexual dysfunction in premenopausal women with type 1 diabetes: A systematic review and meta‐analysis

“…While this review has shown that the prevalence of SD is much higher in women with type 1 diabetes, this estimate is based on generic SD measure. Previous qualitative studies have shown that women with type 1 diabetes experienced SD in multiple ways 13,35,36 that are not captured by these generic measures. Hence, the studies included in the review may have underestimated women with type 1 diabetes experiences of SD.…”

“…The prevalence of SD in this population raises an important question about the extent to which it is considered in clinical care. SD can have a significant detrimental impact on quality of life and relationships 1,11,13 . However, while SD is commonly considered and addressed in men with diabetes, it is not routinely explored in women 11,31 .…”

“…Previous research has highlighted additional psychological phenomena which may be related to SD in women with type 1 diabetes and were not considered in these studies, such as reduced self‐esteem and body image issues due to the impact of injection sites on their bodies (i.e. lipohypertrophy) and wearable diabetes devices 13,36,38 . Again, studies assessing these associations may be useful in determining factors that might underpin SD in this population so that the women can be supported in addressing or compensating for them.…”

“…In a previous qualitative study we conducted, women with type 1 diabetes reported a number of additional diabetes specific factors that impacted on their engagement in and enjoyment of intimacy with partners. The factors mentioned included: visible tissue damage related to insulin injection sites; a fear of hypoglycaemia during intercourse; and the impact of wearable diabetes technologies such as glucose sensors and insulin pumps 13 . SD has also been negatively associated with quality of life and personal relationships, and increased depression and anxiety in women with type 1 diabetes 1,11 .…”

“…The factors mentioned included: visible tissue damage related to insulin injection sites; a fear of hypoglycaemia during intercourse; and the impact of wearable diabetes technologies such as glucose sensors and insulin pumps. 13 SD has also been negatively associated with quality of life and personal relationships, and increased depression and anxiety in women with type 1 diabetes. 1,11 The commonly reported features of SD in women with type 1 diabetes are deficits in sexual desire, arousal or the ability to orgasm.…”