Female sexual dysfunction in type 1 diabetes: a systematic review and meta-analysis

Female sexual dysfunction (FSD) in type 1 diabetes mellitus (T1DM) is an under-appreciated complication. Despite its profound impact on female health, including reduced quality of life and psychological distress, it remains underrepresented in major diabetes guidelines. Current data synthesis is limited, often excluding older populations or failing to compare diabetes subtypes. We aimed to collate the prevalence of FSD in T1DM, pool the risk of FSD in T1DM compared to controls, compare the risk in T1DM vs. T2DM and to investigate the impact of different variables on these effects.

PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched to identify cross-sectional/cohort studies including T1DM participants. Proportion of women with FSD in T1DM versus age-matched control/T2DM population (if reported), and population characteristics were extracted.

The pooled analysis of 18 studies (N = 2476) indicated FSD prevalence of 37% in adults with T1DM (95% CI: 30%, 43%; I² = 89%; random-effects model). Analysis restricted to studies (n = 12) using standard FSFI cut-off ≤ 26.5 confirmed the summary estimate as 34% (95% CI: 26%, 41%; I² = 89%). Trim and fill analysis for publication bias found higher FSD risk in T1DM versus age-matched controls (N = 10, adjusted Risk ratio 2.10; 95% CI: 1.30, 3.39; p = 0.002; I² = 76%). The higher incidence of FSD in T1DM versus T2DM on subgroup analysis (p-interaction < 0.01) appeared to be influenced by diabetes duration (p < 0.01, R² = 70%). Depression and diabetes control indicators were among most consistent predictors of FSD, whereas continuous subcutaneous insulin infusion had a protective role.

FSD is prevalent in approximately one-third of women with T1DM, with a higher risk compared to those with T2DM, likely due to earlier onset and longer diabetes duration. Comprehensive care strategies that address both the physiological and psychological aspects of T1DM are warranted to improve sexual health and overall well-being in affected women.