Abstrak

SEXUAL DYSFUNCTION
IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Rudi Putranto*, Pradana Soewondo**

*Div. Psychosomatic Medicine ** Div. Endocrinology and Metabolism
Department of Internal Medicine, Faculty of Medicine
University of Indonesia

Introduction
Diabetes is known to cause multiple medical (1), psychological (2), and sexual (3) dysfunctions. Impaired sexual function in men is a well documented complication of diabetes. Sexual dysfunction refers to the persistent impairment of the normal patterns of sexual interest or response (4). Several studies have shown that men with diabetes are at increased risk for erectile dysfunction, that it occurs at an earlier age (5–9), and that it is related to longer duration of diabetes, poor metabolic control, and the presence and number of diabetic complications (10). Moreover, in a recent controlled study, comparing women with diabetes and control subjects, we demonstrated that significantly more women with diabetes (27%) than control subjects (15%) reported sexual dysfunction and that a significant difference was found only for decreased lubrication (12,13).
Up to now, it has been hypothesized that the etiology of sexual dysfunction in men with diabetes is linked with somatic factors and that, in women with diabetes, sexual dysfunction is linked with psychological factors (3).
Objective of this study are to 1) study the prevalence of sexual dysfunction in men and women with type 2 diabetes; 2) describe how descriptive variables, psychological variables, diabetic complications, duration of diabetes and sexual dysfunction relate in women and men with type 2 diabetes.

Methods
This was a cross-sectional comparative study. The study conducted at the outpatient endocrinology and metabolism clinic, Department of Internal Medicine, Cipto Mangunkusumo National Central Hospital. The study was conducted between January and April 2004.
Sample for this study were chosen using non probability sampling on type 2 diabetes patients visiting endocrinology and metabolism clinic Cipto Mangunkusumo National Central Hospital, Jakarta. The inclusion criteria were type diabetes patients aged 18 years old or older and able to communicate with mild complication or not. The exclusion criteria were refusal to participate in the study and incomplete questionnaire, have severe complications. Data analysis was using univariate and bivariate methods, then collected data processed using the SPSS version 13 computer program. Patients have sexual dysfunction if they answer yes for the question number 21 of Beck Depression Inventory (1. I am less interested in sex that I used to be or 2. I am much less interested in sex now or 3. I have lost interest in sex completely). Psychological variables measured by Beck Depression Inventory for depression. We called depression if the answer rate ≥ 10.

Results
During the course of study, which was done between January and April 2004, we consecutively obtained 80 patients. All subject included the study.The subject in this study consisted of 32 (40%) males, 48 (60%) females. There were 5 (6,3%) aged 18-34, 23 (28,8%) aged 35-49, 42 (52,5%) aged 50-65 and 10 (12,5%) aged 0ver 65. Number and proportional of sexual dysfunction was 33 ( 41,3%). We found sexual dysfunction in males were 13 (39,4%) and females were 20 (60,6%). Age of the patients with and without sexual dysfunction were 55,82 vs 51,94 years of age. There was no difference between male and female (p=0,865). We found depression in patients with sexual dysfunction was 18 (54,5%). There was association between depression and sexual dysfunction (p=0,018). Sexual dysfunction in patient with complication of diabetes found in 14 (42,4%) patients. There was no difference sexual dysfunction in patients with complication of diabetes or not (p=0,698). Duration of diabetes patients with sexual dysfunction were 16 (48,5%) for < 5 years and 17 (51,5%) for ≥ 5 years. There was no associated.

Conclusions
Number and proportional of sexual dysfunction was 33 (41,3%). Sexual dysfunction and patient type 2 diabetes reported sexual dysfunction were not significantly different for sex, duration of diabetes, or complication of diabetes compared with those not reporting sexual dysfunction. We found patients type 2 diabetes with sexual dysfunction more depressive symptoms.