SEXUAL AND REPRODUCTIVE DISORDERS IN DIABETIC WOMEN

Diabetes mellitus (OM) affects women's norma/life in many ways. The main infertility risk factors related to OM are: menstrual abnormalities, shortening of reproductive period (late menarche and premature menopause), poor glycemic control and presence of chronic complications, hyperandrogenism and polycystic ovary syndrome, autoimmunity, sexual dysfunction. Female sexual dysfunction (FSD) include few elements: active sexual desire disorder; female arousal disorder (inability to achieve arousal); female orgasmic disorder; sexual pain disorders (dyspareunia). The etiology of FSD is multifactorial and combines interpersonal, social, psychological and biological factors. The treatment of FSD is less clear-cut than in men. It seems as though an association between female sexual health and vascular risk factors (hypertension, hyperlipidemia, obesity, diabetes, CAD) exists; however, at the present time, there are new data supporting the idea that FSD can be a predictor of future cardiovascular events. A study published in 2002 confirms that women with type 1 OM are clearly at risk for decreased desire and dyspareunia and that especially the arousal phase can be affected. The results also suggest that psychological and not diabetes related somatic factors are important. The sexual problems of women with type 1 OM deserve more attention in practice and research. Esposito et al. (2010) consider that studies assessing sexual dysfunction in type 2 diabetic women are scanty. They noticed that glycemic control was not associated with FSD risk; independent predictors were age, metabolic syndrome and atherogenic dyslipidemia. Higher level of physical activity was protective. Evaluation of female sexuality should become a routine evaluation in type 2 diabetic women, such as other diabetic complications. Few studies were dedicated to the alterations of sexual function in women with diabetes and chronic kidney disease (CKD). Hypoactive sexual desire disorder is the most common problem reported by these patients. It is important for the physician to incorporate assessment of sexual function into routine evaluation protocol.