第1型糖尿病婦女常見性功能障礙

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　May 4, 2009 — 根據5月份糖尿病照護期刊上一項「Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC)」世代研究的長期研究結果，第1型糖尿病婦女常見性功能障礙，且影響各方面的性功能與滿意度。
　　
　　比利時Katholieke Universiteit Leuven & University Hospitals Gasthuisberg的Paul Enzlin博士等人寫道，糖尿病一直被視為性功能不佳的主要原因。不過，糖尿病婦女的性功能不佳在研究上少有著墨，研究結果也比男性的研究更無定論。一般來說，女性性功能不佳的研究遠不及男性，可能因素包括，缺乏女性性功能不佳的標準定義、缺少有效度的指標、有關女性性慾的社會印象。
　　
　　這項研究的目標，在確認有第1型糖尿病的一個北美婦女世代中，預測性功能不佳的風險因素以及盛行率。在EDIC研究第10年時，652名女性參與者被要求完成一個有效的自我報告性功能測量，以及接受標準的病史及生理檢查、實驗室評估、情緒評估等。
　　
　　在EDIC研究中，有性行為的第1型糖尿病婦女，有35%符合女性性功能不佳(FSD)標準。在FSD中，婦女指出的特定問題包括，失去性慾(57%)；性高潮 (51%)、潤滑(47%)、喚起情慾(38%)的問題；疼痛(21%)。
　　
　　單一變項分析中，FSD與年紀(P = .0041)、婚姻狀態(P = .0016)、停經狀態(P = .0019)、微血管病變(P = .0092)、憂鬱(P = .0022)直接相關。根據多變項分析，FSD的唯一顯著預測因子是憂鬱(P = .004)以及婚姻狀態(P = .003)。
　　
　　研究作者寫道，FSD常見於第1型糖尿病婦女，且影響各方面的性功能和滿意度。憂鬱是第1型糖尿病婦女的主要預測因子。這些發現認為，第1型糖尿病婦女應定期檢查有無出現性功能不佳，以及可能同時發生的憂鬱症狀。
　　
　　研究限制包括，從追蹤10年的資料進行橫斷面分析；研究發現僅可運用於白人、較年輕的第1型糖尿病婦女；分析中未納入無性生活的婦女；缺乏無糖尿病婦女作為對照阻。
　　
　　研究作者結論表示，相較於男性的發現，我們的結果顯示，第1型糖尿病婦女中，憂鬱以及婚姻狀態是FSD的主要預測因子，至於血糖控制和併發症則與FSD無關。需要後續研究以闡明這些差異之中的機轉。因為FSD可能是影響生活品質以及伴侶之間關係的一個重要負面因子，糖尿病婦女的性困難應該要有更多研究實務。
　　
　　國家糖尿病與腎病研究中心(NIDDK)糖尿病內分泌與代謝症小組；國家眼科研究中心；國家神經異常與中風研究中心；一般臨床研究中心計畫暨臨床與翻譯科學中心計畫；國家研究資源中心，以及透過與NIDDK合作研究發展協議的Genentech等，支持DCCT/EDIC計畫。研究作者宣告沒有相關財務關係。
　　
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Sexual Dysfunction Is Prevalent in Women With Type 1 Diabetes

By Laurie Barclay, MD
Medscape Medical News

May 4, 2009 — Sexual dysfunction is prevalent in women with type 1 diabetes and affects all aspects of sexual function and satisfaction, according to the results of long-term findings from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study cohort reported in the May issue of Diabetes Care.

"Diabetes has long been considered a major cause of impaired sexual function," write Paul Enzlin, PhD, from Katholieke Universiteit Leuven & University Hospitals Gasthuisberg in Leuven, Belgium, and colleagues. "Sexual functioning of women with diabetes, however, has received far less attention in research, and results are less conclusive than those of studies in men. In general, studies of sexual dysfunction in women have lagged behind those in men, likely due to several factors, including a lack of standardized definitions of sexual dysfunction in women, absence of well-validated scales, and societal taboos regarding female sexuality."

The goal of this study was to determine the prevalence of and risk factors predicting sexual dysfunction in a well-characterized North American cohort of women with type 1 diabetes. At year 10 of the EDIC study, 652 female participants were asked to complete a validated self-report measure of sexual function and to undergo standardized history and physical examinations, laboratory evaluation, and assessment of mood.

Criteria for female sexual dysfunction (FSD) were met by 35% of sexually active women with type 1 diabetes in the EDIC study. Specific problems noted by women with FSD were loss of libido (57%); problems with orgasm (51%), lubrication (47%), and arousal (38%); and pain (21%).

In univariate analyses, FSD was directly associated with age (P = .0041), marital status (P = .0016), menopausal status (P = .0019), microvasculopathy (P = .0092), and depression (P = .0022). The only significant predictors of FSD, based on multivariate analysis, were depression (P = .004) and marital status (P = .003).

"FSD is common in women with type 1 diabetes and affects all aspects of sexual function and satisfaction," the study authors write. "Depression is the major predictor of sexual dysfunction in women with type 1 diabetes. These findings suggest that women with type 1 diabetes should be routinely queried about the presence of sexual dysfunction andpossible co-association with depression."

Limitations of this study include analyses presented from a cross-sectional analysis of data obtained at 10-year follow-up; applicability of findings only to white, relatively young women with type 1 diabetes; exclusion of sexually inactive women from the analyses; and lack of a nondiabetic control group of women.

"In contrast to findings in men, our results showed that in women with type 1 diabetes, depression and marital status are the main predictors of FSD, whereas glycemic control and complications were not associated with FSD," the study authors conclude. "Further studies are needed to elucidate the mechanisms underlying these differences. Considering that FSD can have an important negative effect on quality of life and partner relationships, the sexual difficulties of women with diabetes warrant more attention in both research and practice."

The DCCT/EDIC project is supported by contracts with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Eye Institute; National Institute of Neurological Disorders and Stroke; the General Clinical Research Centers Program and the Clinical and Translation Science Centers Program; and National Center for Research Resources and by Genentech through a Cooperative Research and Development Agreement with the NIDDK. The study authors have disclosed no relevant financial relationships.

Contributors of free or discounted supplies and/or equipment were LifeScan, Roche, Aventis, Eli Lilly, OmniPod, Can-Am, BD, Animas, Medtronic, Medtronic MiniMed, Bayer, and OMRON. The costs of publication of this article were defrayed in part by the payment of page charges, mandating that it must therefore be marked "advertisement" solely to indicate this fact.

Diabetes Care. 2009;32:780-785.