Risk Factors For Sexual Dysfuncion In Chinese Women With Type 2 Diabetes

BackgroundFemale sexual dysfunction, a kind of relatively high incidence of common disease,can influence women’s quality of life, especially in Chinese, because women were affected by long-term feudal traditional concepts, and it involves the individual patient privacy. Therefore,even if the patient has the disease, did not receive timely treatment, not only delay the timing of treatment, but also for a long time has not received sufficient attention.Therefore, the relevant Chinese female sexual dysfunction is rarely reported, it is necessary to carry out further research on this aspect.The incidence of female sexual dysfunction is mainly influenced by age, menopause, chronic diseases such as diabetes, psychological factors.With the development of society economy,and the improvement of living standards and change of lifestyle in China. The incidence of diabetes is increasing year by year, especially in type 2 diabetes mellitus.And the onset of diabetes is the trend of younger, has become one of the main diseases affecting human health, can cause many problems of medical, psychological and sexual function.Diabetes is a achronic, systemic disease with more serious complications such as blindness, kidney failure, amputations, cardiovascular and cerebrovascular disease, sexual dysfunction, gastrointestinal disorders and other disease. Erectile dysfunction is a well-established complication of diabetes. Although women with diabetes have the same risk, but whether in research or clinical practice, sexual function in women with diabetes have received little attention.Nowadays,246 million people in the world are affected by diabetes and it is expected to affect 380 million by 2025. Moreover, the largest increases in prevalence of diabetes will occur in developing countries by 2025. Among diabetic patients, hyperglycemia can cause several complications from short to long term effects. Sexual problems are common complications of diabetic disease in both men and women. Sexual health is an important, but often neglected. According to the World Health Organization, term "sexual dysfunction" is defined as various ways in which an individual is unable to participate in a sexual relationship as he/she would wish.Diabetic FSD is a common and multiple disease, mainly manifest as decreased libido, sexual arousal disorder, orgasmic disorder, pain during intercourse and vaginal lubrication drop problems, seriously affects the life quality of patients with women, but often is neglected. FSD is a "hidden" complications of diabetes, it is also an important part of diabetes treatment. There are large differences in the epidemiology investigation, such as survey of the population, study design, sample quantity and homogeneity, the lack of credible evidence exsits.The pathogenesis of diabetic FSD is unclear, but certainly vascular system disease, neuropathy, endocrine factors are thought to contribute to this problem. And so for better diagnosis and treatment of diabetic FSD, the risk factors for more in-depth research is needed.At present, the diagnosis of FSD is lack of an objective "gold standard" diagnostic tool, with the female sexual function index epidemiological screening for FSD, because it is influenced by subjective factors, race, scoring standards and sample size and other factors, the reported results are inconsistent.The aim of this study was designed to evaluate the incidence of Chinese female sexual dysfunction in patients with type 2 diabetes and associated risk factors.Objective:1.To explore the difference of 6 dimensions of sexual function between type 2 diabetic women and non-diabetic women with Female Sexual Function Index(FSFI).2.To explore the prevalence of sexual dysfunction of women patients with type 2 diabetes mellitus in Tai’an.3.To explore related risk factors of female sexual function in patients with type 2 diabetes mellitus in Tai’an.Methods:1.Subject:The study sample was drawn from female patients with type 2 diabetes for treatment in Tai’an Central Hospital, aged 20-60 years old, married adults,a total of 342.Non-diabetic patients are from the hospital’s nurses, relatives of patients and healthy people to the hospital for physical examination, a total of 279 people. All subjects signed a written informed consent,the questionnaire was conducted by hand.2.Methods:Compared the incidence rate and the various dimensions of sexual function between 342 diabetic patients and 279 non-diabetic control; According to the presence or absence of FSD,342 diabetic patients were divided into the FSD group and the no FSD group, the differences between the two groups were compared in age, BMI, duration of diabetes, blood pressure, HbAlc, TC, TG, sex hormone, menopausal symptoms (or no), depression (with or without), complications (macrovascular disease, microvascular disease and peripheral neuropathy), blood glucose control, antidiabetic drugs and lipid drug.Age, BMI, duration of diabetes, blood pressure, HbAlc, TC, TG, sex hormone, menopause, depression, complications (macrovascular disease, microvascular disease and peripheral neuropathy), blood glucose, antidiabetic drugs, drug to lipid as independent variables, and FSD (or no) as the dependent variable, we perform binary logistic regression analysis.According to BMI, diabetic patients were divided into normal weight group (BMI<24kg/m2) and overweight group (BMI^ 24kg/m2); According to the BDI score, there were no depression group and depression group. According to the symptoms of menopausal symptoms were divided into menopause symptoms group and no menopausal group.The differences of sexual function between the two groups were compared.Fasting blood glucose was determinated by glucose oxidase method. Total cholesterol and triglyceride were detected enzyme coupled colorimetric/double test dosage forms, and hemoglobin Alc were detected by immune turbidity method.Follicle stimulating hormone, Luteinizing hormone, Estradiol and Testosterone were assessed by radioimmunoassay. All the monitoring indexes were completed in the Department of Laboratory of Tai’an Central Hospital.3.Statistic analysis:Using Excel to establish a database, using SPSS20.0 software for data analysis. Measurement data were expressed by mean±standard deviation, and the data were tested by t-test or single factor analysis of variance (ANOVA) after the normal distribution test. Count data using frequency (percentage) by using chi square (2) test were compared between the two groups. In patients with diabetes, the FSD related factors (variables) were univariate analysis, and then use the two classification Logistic regression analysis of the impact of FSD on the role of variables. P<0.05.The difference was statistically significant.Results:1.The characteristics of the participantsPatients with diabetes survey (n=342). The average age was 49.12±9.32, the 24 years old, the biggest 60 years old, normal control group (n=279,48.23±8.56, the minimum 23, maximum 60 years), there was no significant difference; body mass index (23.41±1.78 vs 22.64±1.97), menopausal status (46.2% vs 44.6%), BMI (23.41±1.78 kg/m2 vs 23.21±1.96 kg/m2),total cholesterol (4.75±2.56 mmol/L vs 4.38±2.29 mmol/L) and triglyceride (1.17±0.70 mmol/L vs 1.09±0.91 mmol/L) had no significant difference. In diabetic patients and non-diabetic group, depression (8.91 ±4.93 vs 6.15±3.21) P<0.050, there is statistical difference. The incidence rates of diabetic marovascular vessel, microvascular vessel and peripheral nerve were 13.4%,8.2% and 24.2%.2. The score of each dimension and the prevalence rate of FSD in diabetic group and non-diabetic group2.1 Scores of sexual function and prevalence of FSD in diabetic group and non-diabetic groupCompared with the non-diabetic group, the various dimensions of the sexual function of diabetic women were significantly reduced, sexual desire (2.55±0.61 vs 2.99±0.87 P=0.000), sexual arousal (3.99±0.79 vs 4.65±0.65 P=0.000), vaginal lubrication(4.49±1.06 vs 5.14±0.93 P=0.000), orgasm (3.40±0.88 vs 4.27±0.74 P=0.000), satisfaction (4.21±0.94 vs 4.93±0.89 P=0.000), pain (4.15±1.16 vs 4.89 ±0.92 P=0.000) had statistical significanceThe dimension prevalence of FSFI among the two groups was compared, low sexual desire (75.1% vs 65.5%), sexual arousal disorder (59.3% vs 51.2%), vaginal lubrication (55.2% vs 39.8%), orgasmic dysfunction (62.5% vs 56.3%), satisfaction disorder (61.3% vs 47.3%), sexual pain disorder (68.4% vs 51.6%). total prevalence rate(69.2% vs 45.8% P=0.000), so sexual dysfunction of diabetic group was significantly higher than the non-diabetic group.There is statistical difference.2.2 Comparison of the prevalence of FSD in diabetic group and non-diabetic group before menopauseComparison of the prevalence of FSD in the two groups, low sexual desire (76.1% vs 54.4%), sexual arousal disorder (56.5% vs 36.5%), vagina moist barrier (53.2% vs 35.1%), orgasmic disorder (67.4% vs 38.1%), satisfaction disorder(58.6% vs.30.5%), sexual pain disorders (65.8% vs 28.3%). the total prevalence rate (60.8% vs 34.3%, P=0.000), the FSD prevalence rate of diabetic group was significantly higher than that in the non-diabetic group, there was statistically significant difference.2.3 Comparison of the prevalence of FSD in diabetic group and non-diabetic group after menopauseComparison of the prevalence of FSD in the two groups, low sexual desire (74.1% vs 60.0%), sexual arousal disorder (62.7% vs 55.8%), vagina moist barrier (68.3% vs 57.2%), orgasmic disorder (74.1% vs 62.7%), satisfaction (70.2% vs 64.8%) disorder, sexual pain disorders (71.5% vs 66.8%). The total prevalence rate (72.7% vs. 60.6%, P=0.025), the FSD prevalence rate of diabetic group was significantly higher than that in the non-diabetic group, there was statistically significant difference.3. FSD risk factors in female patients with type 2 diabetes mellitus3.1 Single factor analysis of the influencing factors of sexual dysfunction in female patients with type 2 diabetes mellitusThe age of FSD patients was 47.61±8.97 years old, the age of the patients with non FSD was 42.69±9.26 years old, the difference was statistically significant between the two groups, P<0.05. BMI of patients with FSD was 23.54±1.78 kg/m2, non FSD patients with BMI was 23.08±1.73 kg/m2, the difference between the two groups was statistically significant, P<0.05. Menopause and depression compared with FSD, P<0.05, the difference was statistically significant. But there is no significant in blood pressure, HbA1C, TC, TG, duration, complications, sex hormones, blood glucose control and hypoglycemic drugs (P>0.05).3.2 Logistic regression analysis of the influencing factors of sexual dysfunction in female patients with type 2 diabetes mellitusWhether or the occurrence of sexual dysfunction (FSD) as dependent variable, the age, BMI, course of disease, blood pressure, HbAlC, TC, TG, sex hormone, menopause, depression, complications, blood sugar control, hypoglycemic drugs as the independent variables. Binary variable logistic regression analysis. There were 3 factors associated with sexual dysfunction, namely, BMI, menopause and depression. BMI of FSD effect ORvalue was 1.836 (95%CI:1.119-3.011), menopause of FSD effect or value of 2.160 (95%CI:1.282-3.637), depression of FSD effect or value of 2.922 (95%CI:1.282-3.637). Three factors are risk factors for the occurrence of FSD, and the depression of FSD have the highest effect.3.3 Effect of BMI on the sexual function of patients with diabetesWe divided diabetic patients into overweight and normal weight group according to BMI.Compared with sexual desire, sexual arousal, vaginal wetness, sexual satisfaction and sexual pain of two groups, P were (0.002; 0.007; 0.031; 0.003; 0.037), there was statistical difference;Compared with sexual arousal of two groups, P values was 0.111, there is no statistical difference.3.4 Effect of menopause on sexual function in patients with diabetes mellitusThe difference of sex function dimension was mainly vaginal lubrication degree and pain, P value respectively (0.003; 0.002),there is statistical difference; Comparison of sexual desire, sexual arousal, orgasm and sexual satisfaction of two groups, P value respectively (0.071; 0.240; 0.072; 0.083), no significant difference.3.5 Effects of depression on sexual function in patients with diabetes mellitusWe divided diabetic patients into depression group and non-depression group. Compared two groups of sexual desire, sexual arousal, vaginal moist, orgasm, sexual satisfaction and sexual pain, P value (0.017 0.045 0.002,0.017 0.001; 0.012), respectively.There is significant difference.Conclusion:1. The prevalence of sexual dysfunction in women with diabetes was 69.2%, higher than that of non-diabetic group,45.8% in Tai’an city.2. In this study, BMI, menopause and depression were the related factors of sexual dysfunction in women with diabetes,namely, the three risk factors of FSD were BMI, menopause and depression.Depression had the strongest effect on the occurrence of FSD. Diabetes complications, disease duration, blood glucose control, hypertension, blood lipid had no significant correlation with diabetic sexual dysfunction.3. Female diabetic dysfunction is an important part of the evaluation of diabetic complications.