Assessment of sexual dysfunction in patients with diabetes mellitus in the general outpatient clinic of Dalhatu Araf Specialist Hospital Lafia
Background: Sexual dysfunction is a known complication of diabetes mellitus that negatively affects the life of the patient. Most times physicians do not consider it during consultation with diabetics. Its prevalence, types and pattern as well as risk factors have been reported elsewhere including some parts of Nigeria but these have not been reported in Nasarawa State. This study was carried out to determine the prevalence of sexual dysfunction, its types and risk factors among diabetic patients with a view to raising awareness among family physicians to routinely inquire about it in order to provide holistic care to the diabetic patients. It was a hospital-based descriptive cross-sectional study, which was conducted at the General Outpatient Clinic of Dalhatu Araf Specialist Hospital Lafia, Nasarawa State, Nigeria.
Method: Systematic random sampling technique was used to enroll 178 odd-numbered adult diabetic participants. Data about participants' socio-demographic characteristics, duration of DM and self-reported risk factors for sexual dysfunction was collected using a validated semi-structured questionnaire. Physical examination, which included their weight, height and external genitalia, was conducted and their body mass index (BMI) was calculated by dividing their weight in kilograms over the square of their height in meters. Their laboratory indices, which included fasting blood glucose (FBG) and lipid profile, were also assessed. The total cholesterol (TC), high-density lipoprotein (HDL) and triglyceride (TG) were measured directly from the laboratory, while lowdensity lipoprotein (LDL) was calculated using the Friedewald's formula: LDL = TC – [HDL + TG/2.2] in mmol/L. The data was analyzed using EPI Info version 3.5.3 (2011). Bivariate analysis by use of chi square was done to determine the strength of association between risk factors and sexual dysfunction. Logistic regression analysis by stepwise backward elimination of risk factors was carried out to determine the predictors of sexual dysfunction. A p-value of less than 0.05 was considered statistically significant for sexual dysfunction throughout the analysis.
Results: There were 178 participants that comprised 71 males (39.9%) and 107 females (60.1%). Their ages ranged from 25-75 years with a mean age of 49.8 ± 11.2 years. The mean age of males was 51.3 ± 12.6 years while that of females was 48.9 ± 10.1 years. One hundred and thirty-eight (77.5%) participants had sexual dysfunction while 40 (22.5%) did not. The prevalence of male sexual dysfunction was 77.46% while it was 77.57% in the females. The types of sexual dysfunction seen in this study were reduced desire for sex in 70 (39.3%) participants, 68 (38.2%) had anorgasmia, 59 (33.1%) had aversion for sex, 52 (29.2%) had sexual dissatisfaction. Erectile dysfunction was seen in 32 (45.1%) males while 28 (39.4%) males had premature ejaculation. Seventy females (65.4%) experienced dyspareunia while 49 (45.8%) and 26 (24.3%) had vaginal dryness and vaginismus respectively. The risk factors seen in this study were stress, high glycemic level, negative feelings about sex, being overweight or obese, low educational status, increasing age and high serum level of low-density lipoprotein cholesterol. However, FBG and stress appeared to be the strongest risk factors for sexual dysfunction among the participants following logistic regression analysis in this study.
Conclusion: The 77.5% prevalence of sexual dysfunction in this study showed that sexual dysfunction is common in patients with diabetes mellitus. Family Physicians are encouraged to routinely ask diabetic patients about sexual dysfunction so as to provide holistic care to their patients. Proper education of diabetic patients about their disease should be carried out at every encounter with them. The management plan and complications as well as the possible preventive measures like lifestyle and dietary modification should also be communicated to them appropriately.
Keywords: Sexual dysfunction, diabetes mellitus, blood lipids, fasting blood glucose, prevalence of sexual dysfunction