Assessment of Sexual Dysfunction and Its Correlates in Females Living with Type 2 Diabetes Mellitus

Abstract

Background:

Type 2 diabetes mellitus (T2DM) is highly prevalent in India and affects many aspects of health, including sexual well-being. While male sexual problems are well documented, female sexual dysfunction (FSD) in women with diabetes often remains overlooked. This study explored the prevalence of FSD and its links with age, diabetes duration, and glycemic control.

Methods:

In this cross-sectional study, 90 women with T2DM attending a tertiary hospital outpatient clinic were recruited through convenience sampling. Postmenopausal and non-sexually active women, or those with major comorbidities, were excluded. Data were collected using a sociodemographic pro-forma and the Female Sexual Function Index (FSFI). Glycemic control was defined by hemoglobin A1c (HbA1c) (<7% = good control). Statistical tests included descriptive analysis and correlation.

Results:

FSD was identified in 77% of participants. Desire, arousal, and lubrication difficulties were most common (each affecting 97%), followed by orgasm and satisfaction problems (95%). Women with poor glycemic control were nearly seven times more likely to report FSD (OR = 6.89, P = .007). Older age (r = −0.224, P = .033) and longer diabetes duration (r = −0.402, P = .001) were both linked with lower FSFI scores.

Conclusion:

FSD is common among women with T2DM and is closely tied to age, duration of illness, and poor glycemic control. Addressing sexual health in diabetes care can improve both well-being and quality of life, highlighting the need for routine screening and supportive interventions.

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by impaired insulin secretion and resistance, leading to long-term complications affecting multiple organ systems. ¹ The global burden of T2DM continues to rise, with India contributing a substantial proportion of cases. Alongside cardiovascular, renal, and neurological complications, diabetes significantly impacts quality of life through its effect on sexual health. ²

Sexual dysfunction in men with diabetes, particularly erectile dysfunction, has been extensively studied, with prevalence estimates reaching nearly 50%. ³ In contrast, female sexual dysfunction (FSD) remains an underexplored area, despite similar vascular, neurological, and hormonal mechanisms contributing to impaired sexual response in women with diabetes. ⁴ FSD is a multidimensional disorder that may involve decreased desire, impaired arousal and lubrication, difficulties achieving orgasm, reduced satisfaction, and pain during intercourse. Recent studies suggest that women with T2DM are at significantly higher risk of FSD compared to the general population, with reported prevalence ranging between 55% and 75% worldwide. ⁵ A recent meta-analysis reported a pooled prevalence of 68.6% among diabetic women, underscoring the global significance of this problem. ⁶

Beyond physical mechanisms, psychological factors such as depression, anxiety, and relationship distress also contribute to FSD in women with diabetes.^7,8 Importantly, sexual health is closely tied to overall well-being and self-perception. Failure to recognize and address FSD can therefore worsen quality of life and negatively influence diabetes management. However, due to sociocultural stigma, embarrassment, and lack of awareness, female patients rarely report sexual concerns, and healthcare providers often overlook this domain during consultations.

In India, where discussions around female sexuality remain limited, data on FSD among women with T2DM are scarce. Most available studies are small, and few have systematically examined clinical correlates such as glycemic control, age, and duration of diabetes. Understanding these associations is critical for early detection and appropriate intervention.

The present study was conducted to estimate the prevalence and specific types of FSD in women with T2DM attending a tertiary care hospital. Additionally, it aimed to examine the relationship of sexual dysfunction with glycemic control, age, and duration of illness. These findings may provide insights into an often-neglected aspect of diabetes care and highlight the importance of incorporating sexual health into routine clinical practice.

Aims and Objectives

This study aims to investigate the prevalence of sexual dysfunction in females with T2DM and to identify specific types of sexual dysfunction commonly observed in this population. Additionally, the study seeks to examine the impact of various factors, such as glycemic control, age, and duration of diabetes, on FSD.

Materials and Methods

Study Design and Ethical Approval

It was a cross-sectional, analytical study conducted in an outpatient department of a tertiary care hospital. Approval of the Ethics and Scientific Committee was obtained before the start of the study.

Participants of the Study and Sample Size Calculation

The inclusion criteria consist of adult females in the reproductive age group who have been diagnosed with diabetes and are willing to provide informed consent. Exclusion criteria were postmenopausal women, those who are not sexually active, and patients with other major medical comorbidities known to affect sexual function (e.g., advanced cardiovascular disease, end-stage renal disease, active major depressive disorder requiring treatment), and those on medications known to influence sexual function. In addition to medical screening, each participant underwent a brief structured psychiatric interview conducted by the investigator to rule out major psychiatric illnesses, including depressive and anxiety disorders that could independently affect sexual functioning.

Participants were recruited using convenience sampling: All eligible women attending the diabetes outpatient clinic during the study period were approached by the investigator, provided with an information sheet in their preferred language, and invited to participate.

The sample size was calculated using the single-proportion formula:

$\begin{array}{l}n=Z²\times p\left(\text{1 }-p\right)/d²,\text{ where}Z=\text{ 1}.\text{96 }\left(\text{for 95}\%\text{ confidence}\right),\\ \begin{array}{cc}& \end{array}p=\text{ anticipated prevalence of FSD among women with }\\ \begin{array}{cc}& \end{array}\text{T2DM and}d=\text{ allowable margin of error}.\end{array}$

We used P = .686 based on a meta-analysis reporting a pooled prevalence of approximately 68.6% in diabetic women Rahmanian et al. ⁶ With a margin of error of d = 0.10, the calculation yielded n = 83. To account for potential non-response or incomplete questionnaires, we inflated this by 10%, giving a target of 90 participants.

Tools Used in Study

Sociodemographic and clinical data were collected using a semi-structured pro-forma designed for the study (age, education, occupation, Body Mass Index (BMI), duration of diabetes, current medications, and most recent hemoglobin A1c [HbA1c]). Sexual function was assessed using the Female Sexual Function Index (FSFI), a validated 19-item self-report instrument that covers six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain). A total FSFI score < 26.55 was used to define FSD. ⁹ During the study, patients satisfying the inclusion and exclusion criteria were informed about the aims and objectives of the study and assured of confidentiality, and those females diagnosed with T2DM who provided informed consent were selected. The FSFI was administered to participants by an investigator in the outpatient department of a tertiary health care center in participants’ preferred language (English, Hindi, and Marathi). Where necessary, the investigator provided standardized verbal translation with care to preserve item meaning. ¹⁰

Definition of Glycemic Control

Glycemic control was defined by the most recent glycosylated HbA1c measured within three months of the interview: HbA1c < 7.0% was classified as good glycemic control and HbA1c ≥ 7.0% as poor glycemic control, in accordance with contemporary clinical guidelines.

Statistical Analysis

The data thus collected were tabulated using Microsoft Excel 2007 and were subjected to analysis using SPSS version 30. The data were summarized using mean, standard deviation, frequency, and percentage. The Fisher’s exact test was used as a test of significance at a 5% level of significance. The odds ratio was used to assess the association between sexual dysfunction and glycemic control, whereas, as these variables were approximately normally distributed, Pearson’s correlation coefficient was used to examine pairwise linear relationships between FSFI scores and continuous predictors (age and duration of diabetes).

Results

Table 1 shows sociodemographic data and related details of a total of 90 participants diagnosed with T2DM included in our study, with a mean age of 39 ± 7 years. Out of which the majority of them were housewives (82.2%), followed by self-employed (10%) and salaried (7.8%).

Table 1.

Sociodemographic Pro Forma.

Age (Years)	39 ± 7
Education
Uneducated	18 (20%)
Primary	30 (33.3%)
Secondary	35 (38.9%)
Graduate	2 (2.2%)
Postgraduate	5 (5.6%)
Occupation
Housewife	74 (82.2%)
Self-employed	9 (10%)
Salaried	7 (7.8%)
Diabetic control
Controlled	59 (66%)
Uncontrolled	31 (34%)
Duration of DM (years)	4 ± 4.5

Two-thirds of our participants had controlled diabetes (66%) while the rest had uncontrolled diabetes (34%). The average duration of T2DM among the participants was 4 ± 4.5 years.

Figure 1 shows that FSD is prevalent in females with T2DM, with a prevalence of 77%, indicated by an FSFI score less than 26.55. FSFI cutoff scores indicating difficulties are: Desire < 4.28, arousal < 5.08, lubrication < 5.45, orgasm < 5.05, satisfaction < 5.04, and pain < 5.51. ¹¹ Based on these cutoff scores, Figure 2 shows a high prevalence among these domains: Reduced desire (97%), lack of arousal (97%), difficulties in lubrication (97%), problems related to orgasm (95%) and satisfaction (95%). However, a far smaller number of our patients experienced pain during sexual activity nearing (36%).

Figure 1.

Prevalence of Female Sexual Dysfunction.

Figure 2.

Comparison of Domain-wise Prevalence of FSD with Existing Literature.

Association of Glycemic Control with Sexual Dysfunction

As shown in Table 2, sexual dysfunction was more prevalent in females with poor glycemic control, affecting 29 out of 31 participants, compared to 40 out of 69 participants with good glycemic control. Women with poor glycemic control were nearly seven times more likely to experience sexual dysfunction, as indicated by the odds ratio of 6.89. This association was statistically significant, with a P value of .007 (Fischer’s exact test).

Table 2.

Association of Glycemic Control with Sexual Dysfunction.

	Sexual Dysfunction	No Sexual Dysfunction	Total
Poor glycemic control	29	2	31	Odds ratio −6.89 P value −.007 (Fischer’s exact test)
Good glycemic control	40	19	69
	69	21	90

Correlation of Age with FSFI Score

Both age and FSFI total scores were continuous variables and were normally distributed; therefore, Pearson’s correlation was applied. A significant negative correlation was observed between age and FSFI scores, indicating a decline in sexual function with advancing age (r = −0.224, P = .033).

Correlation of Duration of T2DM with FSFI Score

Similarly, the duration of T2DM and FSFI scores was continuous and normally distributed. Pearson’s correlation showed a significant negative association, with longer duration of diabetes being linked to poorer sexual function (r = −0.402, P = .001).

Discussion

FSD remains a largely under-recognized and underreported issue, particularly in conservative societies in India, where discussions surrounding female sexuality are often discouraged and stigmatized. Many women hesitate to seek medical help due to embarrassment, cultural taboos, and lack of awareness, leading to significant distress and deterioration in intimate relationships. Unlike male sexual dysfunction, which has received considerable attention in both research and clinical practice, FSD is often overlooked, leaving many women without proper diagnosis and management. A recent systematic review and meta-analysis by Pasaribu et al. (2023), which synthesized global data, reported a pooled prevalence of approximately 52% for FSD in women with T2DM, reflecting a substantial burden across diverse populations. ¹² Consistent with our results, a case-control study by Li et al. (2016) in the Chinese population found that nearly 75% of women with T2DM reported sexual dysfunction. ¹³

Among the domains of sexual dysfunction, the present study found that the domains of FSD that were most affected were reduced desire (97%), lack of arousal (97%), difficulties with lubrication (97%), orgasmic problems (95%), and decreased satisfaction (95%). In contrast, a significantly smaller proportion of participants (36%) reported experiencing pain during sexual activity. As depicted in Figure 2, findings in our study closely align with a study conducted on female diabetics in Bangladesh by Kamrul-Hasan et al. in most domains of FSD, with slight variations. ¹⁴ In our study, the prevalence of reduced desire, lack of arousal, and difficulties in lubrication were all 97%, compared to 93%, 94% and 97%, respectively, in their study. Similarly, problems related to orgasm were reported by 95% of participants in our study versus 89% in their study. The prevalence of dissatisfaction was notably higher in our study, around 95% compared to theirs, 85%. However, a marked difference was observed in the pain domain, where only 36% of our participants reported experiencing pain during sexual activity, in contrast to 82% in their study. While all the above-mentioned studies identified desire, arousal, and lubrication as commonly affected domains, the present study also found satisfaction and orgasm to be significantly impacted, highlighting a broader range of sexual dysfunction in females with T2DM.

We also found that poor glycemic control was strongly associated with FSD, with women having HbA1c ≥ 7% nearly seven times more likely to experience dysfunction. This association is consistent with earlier studies that demonstrated worse FSFI scores in women with poor glycemic control. The pathophysiological mechanisms likely include chronic hyperglycemia leading to endothelial dysfunction, impaired genital blood flow, neuropathy, and hormonal imbalances, all of which contribute to impaired arousal, lubrication, and orgasmic response. ¹⁵

Our study demonstrated a significant negative correlation between age and FSFI scores (r = −0.224, P = .033), suggesting that sexual function declines with advancing age. Similar associations have been reported in recent studies, which found lower FSFI scores in older women, particularly in domains such as desire and arousal. ¹⁶ This supports the conclusion that aging is an important factor influencing sexual health in women with T2DM and underscores the need for early screening and intervention.

We also observed a significant negative correlation between duration of diabetes and FSFI scores (r = −0.402, P = .001), indicating that longer disease duration was associated with poorer sexual function. This finding is consistent with previous reviews and meta-analyses showing that chronic hyperglycemia and its vascular and neuropathic complications contribute to progressive deterioration in sexual functioning.^8,16,17 Together, these results highlight that both advancing age and longer duration of diabetes independently worsen sexual health outcomes in women with T2DM. In contrast, a meta-regression by Pontiroli et al. (2013) did not identify significant associations between FSD and these clinical variables, underscoring variability across populations and study designs. ¹⁸

The increased risk of sexual dysfunction in poorly controlled diabetics and longer duration of illness may be attributed to multiple pathophysiological mechanisms. Chronic hyperglycaemia leads to endothelial dysfunction, neuropathy, and vascular impairment, which can negatively impact sexual arousal and lubrication due to reduced genital blood flow. ¹⁹ Although biological mechanisms play a key role, psychological factors such as depression, anxiety, and relationship distress are also important contributors to FSD in women with diabetes.^7,12,20 In our study, a short structured psychiatric interview was conducted for all participants to exclude major psychiatric disorders. Nevertheless, sub-threshold mood or anxiety symptoms may still have influenced sexual function, which remains a consideration in clinical interpretation.

Taken together, these findings reinforce the need for routine assessment of sexual health in women with T2DM. FSD can impair quality of life, self-esteem, and even adherence to diabetes treatment, yet remains rarely addressed in clinical practice, particularly in conservative societies where discussions about sexuality are often stigmatized. Proactive inquiry and culturally sensitive counseling should therefore be integrated into diabetes care.

Conclusion

A total of 90 diabetic females were recruited in this study, of whom 77% of participants had sexual dysfunction. It has been observed that desire, arousal, lubrication, orgasm, and satisfaction domains were most commonly affected, while pain was the least commonly affected domain. Factors such as poor glycemic control, increasing age, and longer duration of diabetes were significantly associated with worsened sexual functioning. This emphasizes the need for routine screening and targeted interventions to improve sexual health and quality of life in diabetic women. Our findings reinforce the importance of achieving optimal glycemic control not only for overall metabolic health but also for maintaining sexual well-being. Future studies should explore whether improved diabetes management, including lifestyle interventions and glycemic optimization, can effectively reduce the prevalence and severity of sexual dysfunction in this population.

Limitations

The study did not include a control group of non-diabetic women, which limits the ability to directly compare prevalence figures with the general population. This single-center design may also reduce the generalizability of the findings. Various confounding factors, such as age, obesity, and psychological stressors, were not taken into consideration.