Table 2.
Studies of sexual dysfunction in diabetes
| Authors (Year) | Population | Definition of Autonomic Neuropathy |
Definition of Sexual Dysfunction |
Findings |
|---|---|---|---|---|
| Men and Women | ||||
| Wessells et al. (2018) | 1059 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | ED: IIEF single item FSD: FSFI-R | Majority with complication at UroEDIC I had persistence of the complication at UroEDIC II. In men, age associated with persistence of ED, OD, and LD. HbA1C associated with persistence of OD and ED. In women, age associated with with emergence of FSD, persistence of FSD. HbA1C in women associated with emergence of LUTS and persistent UI |
| Bak et al. (2017) | 215 T2DM | Medical history | ED: IIEF FSD: FSFI | Sexual dysfunction correlated with age and duration of diabetes. Sexual disorders correlated with occurrence of depression and acceptance of illness. |
| Bjerggaard et al. (2015) | 1170 T2DM | n/a | ED: IIEF FSD: FSFI-R | 54% of men and 12% of women had sexual dysfunction |
| Pavy-Le Traon et al. (2010) | 684 T1DM | CAN severity Ewing Score (0-5): deep breathing, Valsalva, stand test, HRV, SBS | Erectile dysfunction symptoms (erection frequency and maintenance) | Erectile dysfunction independently associated with CAN severity (p=0.0005) |
| Low et al. (2004) | 231 T1DM/T2DM | Autonomic Symptom Profile (ASP) Composite Autonomic Severity Score (CASS) | ASP: Sexual dysfunction | Men with T1DM and T2DM had significantly worse sexual function scores compared to controls (p<0.05 for both) |
| Men | ||||
| Corona et al. (2016) | 449 T2DM | Medical interviews | ED: IIEF | The combination of phosphodiesterase 5 inhibitor therapy and an integrated approach to achieving metabolic targets in men with T2DM can improve sexual function and depressive symptoms. |
| Ghafoor et al. (2015) | 200 Diabetes patients with ED* | Composite Autonomic Severity Score (CASS) | ED: IIEF | Autonomic Neuropathy prevalence: 86 (43%) |
| Pop-Busui et al. (2015) | 635 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | ED: IIEF single item | ED prevalence: 290 (46%) Odds of ED+LUTS: 2.65 (1.47-4.79) |
| Bansal et al (2011) | 52 Diabetes* | Sympathetic skin response: Medtronic electromyographic system | ED: 5-item score <21 | Diabetic neuropathy not associated with ED |
| Penson et al. (2009) | 713 T1DM | IIEF | ED, OD, DL | ED was present in 34%, OD in 20%, and DL in 55%. All cause bother, though ED causes more general sexual bother. |
| Hamdan et al. (2008) | 56 T2DM, 30 controls | R-R variation <10, Valsalva ratio ≤1.2 | Ultrasound penile vasculature assessment PSV≤30 cm/sec and EDV≥5 cm/sec | Diabetic ED group had higher HbA1c and oxidative stress levels (p=0.001), lower R-R ratio (p<0.002) and neurophysiological parameters compared to controls |
| Debono et al. (2008) | 22 T2DM | CAN: Age specific Inspiration Ratio (E/I from R-R variation), Valsalva ratio ≤1.2, standing 30:15 ratio ≤1.031 | ED: IIEF≤21 | No significant associations observed between CAN measures and ED |
| Burke et al. (2007) | 53 Diabetes* | n/a | Previously validated Male sexual function index | Men with diabetes at baseline has greater dysfunction in all 5 sexual domains (sexual drive, erectile function, ejaculatory function, sexual problem assessment, and sexual satisfaction). |
| Pegge et al. (2006) | 33 ED (20 T1DM/T2DM), 30 controls (15 T1DM/T2DM) | Inspiration Ratio (E/I from R-R variation), Valsalva ratio | ED: IIEF | E/I ratios of diabetic men significantly lower than controls (p<0.02). No difference in CAN measures by ED status. |
| Bleustein et al. (2002) | 73 (53 ED, 20 No ED) | Index finger and glans penis vibration, pressure, spatial perception, warm/cold thermal thresholds | ED: IIEF≤25 | Neuropathic measures of the glans penis significantly associated with ED |
| De Angelis et al. (2001) | 60 T2DM | CAN: Deep breathing, Squatting vagal test, Squatting sympathetic test, Heat-pain threshold, Warm threshold, Vibratory threshold | ED: IIEF≤25 | Heat-pain, warm perception thresholds, cardiovascular reflex tests abnormal in men with ED (p<0.05) |
| Sairam et al. (2001) | 129 n/a | n/a | ED: men were already diagnosed | The prevalence of undiagnosed DM was higher in men with ED than in the general population. |
| Hecht et al. (2001) | 49 ED | 15-item Autonomic Symptom questionnaire, Nerve Condition studies, Sphincter ani electromyography, Vibratory thresholds, Temperature Perception thresholds, CAN: Heart rate variability | ED: physician referral based on diagnosis | Frequency of abnormal nerve conduction studies, heart rate variability higher in men with diabetic ED |
| Fedele et al. (2001) | 1010 T1DM/T2DM | Ewing Score ≥2 positive responses | ED: failure to achieve and maintain erection sufficient for satisfactory sexual performance | Erectile dysfunction associated with autonomic neuropathy (RR=1.16) |
| Wellmer et al. (1999) | 79 T1DM/T2DM | Thermal thresholds, Vibration thresholds, Light touch thresholds, Axon reflex vasodilation, Axon reflec sweating, Sural and peroneal nerve conduction studies | ED: erection insufficient for intercourse and erection could not be sustained for duration of intercourse | Neuropathic pain (p<0.05), abnormal sensory axon-reflex vasodilation (p<0.001), and decreased sural nerve action potential (p<0.01) significantly greater in men with ED |
| Women | ||||
| Hotaling et al. (2016) | 371 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | FSD: FSFI-R | FSD prevalence: 153 (41%) |
| Maiorino et al. (2016) | 145 | Diabetic neuropathy index | FSD: FSFI Sexual activity-related distress: FSDS | Depression and mental health were independent predictors of FSD. Sexual function was significant impaired in women on multiple daily injection. |
| Elyasi et al. (2015) | 150 | Medical record history | FSD: FSFI | High prevalence of sexual dysfunction (79%), especially among those with depression. |
| Enzlin et al. (2009) | 424 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | FSD: FSFI-R | 35% of women had FSD. Depression and marital status were significant predictors of FSD. |
| Fatemi et al. (2009) | 50 T2DM | n/a | FSD: Arizona Sexual Experience Scale (ASEX) form | Diabetes significantly impaired the sexual performance of diabetic women. Determinants of sexual function included age and duration of diabetes |
| Abu Ali et al. (2008) | 1137 | Medical record history of autonomic neuropathy | FSD: FSFI | No independent association between autonomic neuropathy and FSD |
*
Type of diabetes not indicated
Note: AUASI, American Urological Association Symptom Index; CAN, cardiovascular autonomic neuropathy; DBP, diastolic blood pressure; DCCT/EDIC, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; ED, erectile dysfunction; OD, orgasmic dysfunction; LD, low sexual desire; DL, decreased libido; FSD, female sexual dysfunction; FSFI-R, Female Sexual Function Index; FSDS, Female Sexual Distress Scale; IIEF, International Index of Erectile Dysfunction; LUTS, lower urinary tract symptoms; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus