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Try out PMC Labs and tell us what you think. Learn More. Sexual dysfunction is a prevalent problem in obese women with type 2 diabetes. This study examined the effects of intensive lifestyle intervention ILI in these women. Participation in ILI appeared to have beneficial effects on sexual functioning among obese women with diabetes, particularly in those who had FSD at baseline.

Sexual dysfunction is associated with chronic diseases in women, including cancer, heart disease, and diabetes 1 , 2. Recent studies have reported high rates of sexual problems in women with type 1 and type 2 diabetes, including loss of sexual desire, difficulties with arousal and orgasm, and dyspareunia painful intercourse 3 — 6. Despite these reports, it is unclear to what extent sexual dysfunction in women with diabetes is related to the effects of the disease on hormonal or vascular mechanisms involved in sexual response or to indirect effects via weight gain, alterations in body image, other comorbidities, or psychosocial concomitants of the disease.

In a large study of women with type 1 diabetes, Enzlin et al. Similarly, sexual dysfunction among type 2 diabetic women has been associated with comorbid depression in a large population-representative study 7. Obesity also has been strongly associated with increased risk of sexual dysfunction in women 8 , 9 , with more obese women reporting increased frequency and severity of sexual problems Higher rates of sexual problems have been reported in women seeking bariatric surgery compared with nonobese women or women in a residential obesity treatment program Improvements in female sexual function have been reported after bariatric surgery 12 and in participants randomized to a Mediterranean diet However, to date, there have been no studies examining whether a lifestyle intervention focused on producing modest weight losses will improve sexual function in overweight and obese women with type 2 diabetes.

Look AHEAD is a randomized trial evaluating the long-term effects on cardiovascular morbidity and mortality of an intensive lifestyle intervention ILI deed to produce weight loss and increases in physical activity in overweight and obese participants with type 2 diabetes compared with a control group This ancillary study assessed the baseline prevalence and risk factors for sexual dysfunction among women participating in Look AHEAD and examined the changes in sexual function of participants in the ILI group compared with the control group over the course of 1 year of intervention.

A detailed description of other eligibility criteria has been published ly 15 , These sites were selected on the basis of geographic and ethnic diversity of the study participants and the willingness of the project staff to participate in the ancillary study. Separate Institutional Review Board approval for the ancillary study was obtained for each of the participating sites. Those in the ILI group were offered group and individual sessions with weekly meeting for the first 6 months, followed by 3 meetings per month between months 7 and The DSE group attended three meetings focused on education about diet and activity and social support but was given no behavioral strategies.

All measures were completed at baseline before randomization and at 1 year by staff who were trained and certified and masked to treatment asment. Sexual function in women was assessed using the FSFI, a widely used self-report measure of sexual function in females This questionnaire was deed as an assessment tool for use in clinical trials and recognizes the multidimensional nature of female sexual dysfunction FSD. The questionnaire has been validated in several studies by comparison with clinical interviews 14 , 18 , The questionnaire assesses sexual function over the past 4 weeks; it includes 19 items and provides scale scores in six separate domains sexual desire, arousal, lubrication, orgasm, satisfaction, and pain , as well as an overall index of sexual function.

Participants must complete all questions within a specific domain to analyze that domain, resulting in inconsistent sample sizes across domains, and must answer all 19 questions to calculate the total FSFI score. FSFI total scores range from 2 to 36, with higher scores indicating better sexual function. The questionnaire asks women whether they are sexually active, and an additional question was added to determine whether the participant had a partner.

Because of the sensitive nature of the questions, staff did not review questionnaires with participants or ask about missing information. Body weight was recorded to the nearest 0. Height was recorded to the nearest 0.

BMI was calculated as weight kg divided by height m 2. Systolic blood pressure and diastolic blood pressure readings were measured in duplicate using a Dinamap Monitor Pro automated blood pressure device GE Medical Systems, Tampa, FL and averaged. Total scores on the BDI range from 0 to 63, with higher scores indicating more symptoms of depression.

Self-reported data also were collected regarding medical history, employment, education, family income, smoking, prescription medications, alcohol use, and family medical history. Descriptive statistics were used to characterize the ancillary study sample and to compare our sample with the main Look AHEAD trial with respect to relevant demographic and medical history variables. Logistic regression analyses were used to examine potential factors associated with having FSD at baseline and differences between the ILI and DSE groups regarding odds of experiencing remission or development of FSD from baseline to 1 year.

Analyses were performed using SPSS version 20 software. These participants averaged They reported having had diabetes for 6. Participants in the substudy were comparable with women in the main trial regarding baseline variables, such as BMI and duration of diabetes Supplementary Table 1. However, women in the substudy were older Of the participants, 37 9. Fifty-five percent of the sexually inactive women indicated that they had no partner. Table 1 presents the baseline FSFI scores of the sexually active women in this study and compares their scores with those of a control group of healthy United States women of similar age The control group, drawn from a study 14 , is shown here to provide a context for considering the scores of women in the current study.

Using the ly established cutoff of Logistic regression analyses were conducted to determine whether any of the physical, demographic, or self-reported measures were associated with having FSD at baseline. The only ificant predictor was baseline score on the BDI odds ratio, 1. Baseline sexual function was not related to subsequent weight loss or changes in depression, with similar changes in those who reported being inactive at baseline and those who were active, with or without FSD. Women in the ILI group in this ancillary study lost, on average, 7. A total of women Subsequent analyses were performed separately for sexually active women with FSD at baseline and for those who did not have FSD at baseline.

Percent of women in each category at 1 year. Table 2 shows changes in FSFI total and domain scores from baseline to 1 year, retaining women who became sexually inactive at 1 year and providing scores of zero on the relevant FSFI items. However, if we focus only on women who reported FSD at baseline and remained sexually active Table 2 , second panel , almost all sexual function domains show ificantly greater improvements in ILI group women than in DSE group women. Changes in weight, depressive symptoms, and sexual domain scores from baseline to 1 year.

After controlling for the baseline variables, we found that greater weight loss from baseline to 1 year was the only variable associated with increased odds odds ratio, 0. However, among those women who remained sexually active, decreases in depression were related to greater odds of remission of FSD odds ratio, 1. In contrast, there was little evidence that participation in the ILI group helped to prevent the development of FSD in those who did not have such problems at baseline. At entry into the trial, sexually active women in this ancillary study had ificant impairments across all major domains of sexual function compared with normative controls studies have shown that obesity and diabetes are both associated with increased risk of FSD 4 , 8 , 9.

Thus, prevalence of FSD may increase with severity of obesity. The age of the participants and menopause also may have contributed to their FSD. In addition, we found that one-third of the women in our trial reported not being sexually active at baseline. For half of these women, this was likely related to their lack of a sexual partner; however, for the other half, it may reflect either sexual problems in the partner or a response to their own sexual problems. Excluding women who reported being sexually inactive from the estimates of the with FSD may underestimate the rates of FSD in this population.

Moreover, the FSFI does not define sexual activity, so women may differ on whether they include masturbation as sexual activity. This study also found that scores on the BDI were the only ificant correlate of FSD at baseline; none of the other baseline variables, including those related to diabetes duration and glycemic control, were related to sexual function in these diabetic women. This finding, which confirms studies of women with type 1 and type 2 diabetes 4 , 7 , suggests that sexual dysfunction in women with diabetes is more closely related to psychosocial variables than to the physiological consequences of diabetes.

However, given that our baseline data are cross-sectional, it is not clear whether sexual dysfunction predisposes diabetic women to depression or vice versa. Although male subjects showed similarly high rates of erectile dysfunction ED at baseline, loss of sexual function in Look AHEAD men was related strongly to diminished exercise capacity and increased cardiovascular risk factors.

Although men with ED were more likely to report symptoms of depression at baseline than men with normal sexual function, mood was a less ificant predictor of ED in these obese diabetic men than exercise capacity and cardiovascular risk. Based on similar findings from multiple studies of diabetic and nondiabetic men, ED has been proposed as an early or harbinger of coronary artery disease in men 22 , In contrast, psychosocial factors and depressed mood are more frequently associated with sexual dysfunction in diabetic 4 and nondiabetic women 24 , This study also suggests that becoming sexually inactive may be one response to worsening in sexual function in women with diabetes.

This difference was not attributable to loss of partner being more common in DSE group women. Consequently, becoming sexually inactive may be an important outcome in this study, and excluding women who become inactive may result in misleading conclusions. Therefore, we chose not to remove women who reported becoming sexually inactive at 1 year from certain analyses of the FSFI, and we used their zero scores indicating no sexual activity as actual data. Although the current study suggests benefits of weight loss on sexual dysfunction in obese diabetic women, the magnitude of these benefits was modest in comparison with those reported ly.

For example, Esposito et al. Bond et al.

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