Sexual dysfunction in men and women with diabetes: a mirror of their complications?

Background Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality. Objective To investigate and report current evidence in regards to the association between sexual dysfunction and diabetes. Methods A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to study topic. Results Female and male sexual dysfunction often occur in the context of diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects on both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease - a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and beneficial effects for cardiovascular health being reported for pro-erectile drugs. Conclusion Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessment are therefore needed to provide the best chances for adequate treatment.