Sexual Dysfunction in Middle Aged and Older People with Diabetes

Context: Sexual dysfunction is an under-recognized complication of diabetes and rarely addressed.

Objective: To identify attitudes toward sex and to define the prevalence of sexual dysfunction and assess associated factors among middle-aged and older individuals with diabetes.

Dataset/Population Studied: Using data from the National Social Life, Health, and Aging Project, we identified individuals who self-reported diabetes and assessed their survey responses related to attitudes toward sex (mailed surveys) and sexual dysfunction (based on face-to-face interviews). Participants were survivors from an earlier round of the study (57-85yo in 2005-2006) and individuals recruited in 2015-2016 (50-67yo in 2015). We excluded individuals who did not answer a single question about sexual dysfunction.

Study Design and Analysis: We conducted a cross-sectional analysis and applied weights to account for complex survey design. We examined the prevalence of importance of sex and sexual dysfunction and used multivariate logistic regression to assess factors (age, sex, race/ethnicity, education, marital status, and self-reported health) associated with sexual dysfunction. A 2-sided p-value <0.05 was considered statistically significant.

Results: Overall survey response rate was 69%. Of the 4439 participants, 746 (17%) reported diabetes and 29 (4%) of them were excluded due to missing answers. Among the 717 included, 54% reported sex was somewhat to extremely important (45% among women, 62% men; 59% in 50-59yo, 50% in 60-69yo, 57% in 70-79yo, and 35% among 80+yo). Prevalence of any sexual dysfunction was 69% (73% among women, 65% men; 65% in 50-59yo, 71% in 60-69yo, 74% in 70-79yo, and 53% among 80+yo); 48% reported lack of interest, 25% inability to climax, 18% anxiety with ability to perform, 10% lacked pleasure in sex, 7% experienced painful sex. Among women, 27% reported issues with lubrication; among men, 44% reported erectile dysfunction. In a multivariate regression model, individuals were more likely to report sexual dysfunction if they were women vs men (OR 1.83 [95% CI 1.22 - 2.75]).

Conclusions: Two-thirds of middle aged/older individuals with diabetes reported sexual dysfunction and more than half reported sex was an important part of their lives. Our findings suggest sexual dysfunction is a common and important problem among patients with diabetes.