The majority of women with diabetes—type 1 or type 2—face issues related to sexual health and function, according to endocrinologist Alice Cheng, MD, FRCPC, and more than 7 in 10 female patients would like their doctors to initiate conversations about sexual dysfunction.

Dr. Cheng and Sharon Parish, MD, presented Female Sexual Dysfunction in Diabetes—Therapeutic Interventions on Friday, June 12, during this year’s Scientific Sessions. The presentation can be viewed by registered meeting attendees at ADA2020.org through September 10, 2020. If you haven’t registered for the Virtual 80th Scientific Sessions, register today to access all of the valuable meeting content.

Dr. Cheng reviewed the mechanisms of female sexual dysfunction and discussed pharmacological interventions that can be used at various stages of the sexual response cycle—desire, arousal, and climax. Issues can arise at any of these points, she said, and need to be addressed when they continue for six months or more and cause distress to the patient.

“Why are we talking about this at ADA? Because female sexual dysfunction is common in diabetes, but providers don’t ask,” said Dr. Cheng, Associate Professor at the University of Toronto, Ontario, Canada.

Data show that up to 71% of women with type 1 diabetes and 69% of women with type 2 diabetes report issues with sexual dysfunction, Dr. Cheng said. Meanwhile, 72% of women say they want to talk to their doctor about sexual dysfunction and 73% of women prefer the doctor to initiate the conversation.

“I think these last two points are important,” Dr. Cheng said. “This sort of harkens back to about 30 years ago when we all started to learn more about erectile dysfunction in men and there was quite an awareness campaign to teach us to get comfortable with asking men about sexual dysfunction. I think we’re behind with female sexual dysfunction, but it’s a similar concept. Patients want to talk about it, but they wish for us to initiate the conversation.”

There are several potential causes of female sexual dysfunction in diabetes, including atherosclerosis and neuropathy, which can reduce circulation and sensation. High sugar levels can decrease lubrication and increase yeast infections. Patients with diabetes also deal with issues such as fear of hypoglycemia, depression, and anxiety.

Testosterone therapy may help in postmenopausal women, Dr. Cheng said. For premenopausal women, agents that increase dopamine and norepinephrine may help, including flibaserin, which is the only therapy approved by the U.S. Food and Drug Administration for sexual dysfunction in premenopausal women. Off-label options include bupropion and buspirone, Dr. Cheng said.

Dr. Parish, Professor of Medicine in Clinical Psychiatry at Weill Cornell Medicine, provided strategies to help providers discuss sexual health with female patients and reviewed non-pharmacological interventions. The strategies she discussed are backed by evidence, including data from the International Society for the Study of Women’s Sexual Health.

Dr. Parish suggested beginning conversations about sexual health with a ubiquitous statement followed by an open-ended question. For example, a provider might say, “Many women with diabetes have issues with sexual desire, arousal, or orgasm. How about you?”

Open-ended questions can also help screen for distress and the impact of sexual dysfunction.

“It’s very important to normalize and universalize the conversation. It’s also important to be explicit and open, so patients know what is OK to discuss,” she said.

Dr. Parish shared several other strategies that nonspecialists can employ, including interventions such as psychoeducation and behavioral recommendations, lifestyle modification, vaginal lubricants and moisturizers, dilators, and therapies for vulva vaginal atrophy. She also discussed strategies to effectively refer patients to sex, psychological, and physical therapists.

“Screening for sexual problems improves detection and patient satisfaction,” she said. “Following clinical practice guidelines can help with executing sexual health counseling, and patient-centered communication skills facilitate permission to discuss and address sexual health concerns.”