INTRODUCTION: More sexual problems are reported among people treated for diabetes; however, this situation is less explored in women than in men. AIM: To analyze the presence and causal links of female sexual dysfunction (FSD) among Czech women treated for type 1 diabetes. METHODS: 40 women completed a national version of the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-revised (FSDS-R), and Beck's Depression Inventory-II (BDI-II). A metabolic and endocrine analysis was done using blood samples. Data were statistically analyzed using SPSS v.24 and the R environment. MAIN OUTCOME MEASURES: Patient details (personal information, diabetes-related data, and sex history), sexual performance (the FSFI and FSDS-R scores), and level of depression (the BDI-II score) were measured. RESULTS: FSD was present in 58% of the participants (based on the FSFI score), and 38% women declared significant sexual distress (according to their FSDS-R score). Even though only 4 women fulfilled the criteria for depression, we observed a strong association between BDI-II and FSFI (for total FSFI score P = .012, ρ = -0.394) resp. FSDS-R scores (P < .001, ρ = 0.552). Although we were not able to establish a clear direct connection between FSD and metabolic control, BDI-II scores were closely correlated with glycosylated hemoglobin (P = .009, ρ = 0.407). The duration of diabetes (based on FSDS-R: P = .046) but neither age nor the presence of chronic diabetic microvascular complications was associated with a higher FSD occurrence. We also observed an association between FSD and the presence of autoimmune hypothyroidism, even when successfully treated (FSDS-R: P = .009; FSFI: P = .067). CONCLUSION: FSD is more common in women with type 1 diabetes than in healthy women, and coexisting thyroid autoimmune disease seems to exacerbate FSD. Women suffering from type 1 diabetes, and particularly those with additional endocrinopathies, should be actively screened for FSD. Stechova K, Mastikova L, Urbaniec K, et al. Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease. Sex Med 2019;7:217-226.

Department of Gynecology and Obstetrics University Hospital Motol and 2nd Medical Faculty of Charles University Prague Czech Republic

Department of Internal Medicine University Hospital Motol and 2nd Medical Faculty of Charles University Prague Czech Republic

Department of Internal Medicine University Hospital Motol and 2nd Medical Faculty of Charles University Prague Czech Republic; Czech Technical University Prague Czech Republic

Department of Internal Medicine University Hospital Motol and 2nd Medical Faculty of Charles University Prague Czech Republic; Department of Clinical Hematology University Hospital Motol and 2nd Medical Faculty of Charles University Prague Czech Republic

See more in PubMed

World Health Organization Sexual and reproductive health, working definitions. http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/ Available at:

Morokqff P.J., Gillilland R. Stress, sexual functioning, and marital satisfaction. J Sex Res. 1993;30:43–53.

Monga M., Alexandrescu B., Katz S.E. Impact of infertility on quality of life, marital adjustment, and sexual function. Urology. 2004;63:126–130. PubMed

Chen C.H., Lin Y.C., Chiu L.H. Female sexual dysfunction: Definition, classification, and debates. Taiwan J Obstet Gynecol. 2013;52:3–7. PubMed

Rosen R.C., Barsky J.L. Normal sexual response in women. Obstet Gynecol Clin N Am. 2006;33:515–526. PubMed

Basson R., Berman J., Burnette A. Report of the international consensus development conference on female sexual dysfunction: Definitions and classifications. J Urology. 2000;163:888–893. PubMed

World Health Organization The ICD-10 classification of mental and behavioral disorders. http://apps.who.int/classifications/icd10/browse/2016/en#/F52.0 Available at:

IsHak W.W., Tobia G. DSM-5 changes in diagnostic criteria of sexual dysfunctions. https://doi.org/10.4172/2161-038X.1000122 Reprod Sys Sexual Disorder. DOI

Holt R.I.G., Cockram C., Flyvbjerg A. 5th ed. Wiley-Blackwell; Hoboken, NJ: 2017. Textbook of diabetes.

American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2004;27(Suppl. 1):S5–S10. PubMed

World Health Organization Diabetes, fact sheet. http://www.who.int/mediacentre/factsheets/fs312/en/ Available at:

Institute of health information and statistics of the Czech Republic Care of diabetics. http://www.uzis.cz/en/catalogue/care-diabetics Available at:

Malavige L.S., Levy J.C. Erectile dysfunction in diabetes mellitus. J Sex Med. 2009;6:1232–1247. PubMed

Pontiroli A.E., Cortelazzi D., Morabito A. Female sexual dysfunction and diabetes: A systematic review and meta-analysis. J Sex Med. 2013;10:1044–1051. PubMed

Maseroli E., Scavello I., Vignozzi L. Cardiometabolic risk and female sexuality-Part I. Risk factors and potential pathophysiological underpinnings for female vasculogenic sexual dysfunction syndromes. Sex Med Rev. 2018;6:508–524. PubMed

Hotaling J.M., Sarma A.V., Patel D.P. Cardiovascular autonomic neuropathy, sexual dysfunction, and urinary incontinence in women with type 1 diabetes. Diabetes Care. 2016;39:1587–1593. PubMed PMC

Beck A.T., Ward C.H., Mendelson M. An inventory for measuring depression. Arch Gen Psychiatr. 1961;4:561–571. PubMed

Beck A.T., Steer R.A., Ball R. Comparison of Beck Depression Inventories –IA and – II in psychiatric outpatients. J Pers Assess. 1996;67:588–597. PubMed

Preiss M., Vacir K. Psychodiagnostika; Brno: 1999. BDI-II. Beckova sebeposuzovaci skala pro dospele. [in Czech]

Ptacek R., Raboch J., Vnukova M. Beckova skala deprese BDI II—standardizace a vyuziti v praxi. Ces a Slov Psychiatr. 2016;112:270–274. [in Czech]

Ociskova M., Prasko J., Kupka M. Psychometric evaluation of the Czech Beck Depression Inventory-II in a sample of depressed patients and healthy controls. Neuroendrocrinol Lett. 2017;38:98–106. PubMed

Rosen R., Brown C., Heiman J. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208. PubMed

Derogatis L.R., Rosen R., Leiblum S. The Female Sexual Distress Scale (FSDS): Initial validation of a standardized scale for assessment of sexually related personal distress in women. J Sex Marital Ther. 2002;28:317–330. PubMed

ter Kuile M.M., Brauer M., Laan E. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): Psychometric properties within a Dutch population. J Sex Marital Ther. 2006;32:289–304. PubMed

Derogatis L.R., Clayton A., Lewis-D'Agostino D. Validation of the Female Sexual Distress Scale-Revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5:357–364. PubMed

Aydin S., Onarak O.I., Topalan K. Development and validation of Turkish version of the Female Sexual Distress Scale-Revised. Sex Med-UK. 2016;4:e43–e50. PubMed PMC

Wiegel M., Meston C., Rosen R. The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20. PubMed

Meston C.M. Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther. 2003;29:39–46. PubMed PMC

Ewing D.J., Martyn C.N., Young R.J. The value of cardiovascular autonomic function tests: 10 Years’ experience in diabetes. Diabetes Care. 1985;8:491–498. PubMed

Czech Diabetological Society Recommended procedure for prevention, diagnosis and therapy of the diabetic food syndrome. http://www.diab.cz/dokumenty/standard_diab_noha.pdf Available at: [in Czech]. Accessed January 2019.

Czech Diabetological Society Recommendation for management of the diabetic retinopathy. http://www.diab.cz/dokumenty/standard_retinopatie.pdf Available at: [in Czech]. Accessed January 2019.

Czech Diabetological Society Recommended procedures for diabetic kidney disorder. http://www.diab.cz/dokumenty/standard_dmev_ledviny.pdf Available at: [in Czech]. Accessed January 2019.

R Development Core Team R: A language and environment for statistical computing. http://www.R-project.org R Foundation for Statistical Computing. Available at: Accessed June 2018.

Holla K., Jezek S., Weiss P. The prevalence and risk factors of sexual dysfunction amongst Czech women. Int J Sex Health. 2012;24:218–225.

Skrha J., Sumnik Z., Pelikanova T. Recommendation for management of the type 1 diabetes mellitus. Diabetes Metab Endocrinol Nutr. 2016;19:156–159. [in Czech]

Dimitropoulos K., Bargiota A., Mouzas O. Sexual functioning and distress among premenopausal women with uncomplicated type 1 diabetes. J Sex Med. 2012:1374–1381. PubMed

Nowosielski K., Drosdzol A., Sipinski A. Diabetes mellitus and sexuality—Does it really matter? J Sex Med. 2010;7:723–735. PubMed

Enzlin P., Mathieu C., Van Der Bruel A. Prevalence and predictors of sexual dysfunction in patients with type 1 diabetes mellitus. Diabetes Care. 2003;26:409–414. PubMed

Enzlin P., Rosen R., Wiegel M. Sexual dysfunction in women with type 1 diabetes: Long-term findings from the DCCT/EDIC study cohort. Diabetes Care. 2009;32:780–785. PubMed PMC

Salonia A., Munarriz R.M., Naspro R. Women's sexual dysfunction: A pathophysiological review. BJU Int. 2004;93:1156–1164. PubMed

Tagliabue M., Gottero C., Zuffranieri M. Sexual function in women with type 1 diabetes matched with a control group: Depressive and psychosocial aspects. J Sex Med. 2011;8:1694–1700. PubMed

Marson L., Giamberardino M.A., Costantini R. Animal models for the study of female sexual dysfunction. Sex Med Rev. 2013;1:108–122. PubMed PMC

Malone J.I. Diabetic central neuropathy: CNS damage related to hyperglycemia. Diabetes. 2016;65:355–357. PubMed

Leedom L., Feldman M., Warner P. Symptoms of sexual dysfunction and depression in diabetic women. J Diabetes Complicat. 1991;5:38–41. PubMed

Veronelli A., Mauri C., Zecchini B. Sexual dysfunction is frequent in premenopausal women with diabetes, obesity, and hypothyroidism, and correlates with markers of increased cardiovascular risk. A preliminary report. J Sex Med. 2009;6:1561–1568. PubMed

Bhasin S., Enzlin P., Coviello A. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007;369:597–611. PubMed

Cortelazzi D., Marconi A., Guazzi M. Sexual dysfunction in pre-menopausal diabetic women: clinical, metabolic, psychological, cardiovascular, and neurophysiologic correlates. Acta Diabetol. 2013;50:911–917. PubMed

Krysiak R., Drosdzol-Cop A., Skrzypulec-Plinta V. Sexual function and depressive symptoms in young women with thyroid autoimmunity and subclinical hypothyroidism. Clin Endocrinol (Oxf) 2016;84:925–931. PubMed

Maseroli E., Fanni E., Cipriani S. Cardiometabolic risk and female sexuality: Focus on clitoral vascular resistance. J Sex Med. 2016;13:1651–1661. PubMed

Ciocca G., Carosa E., Stornelli M. Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L'Aquila earthquake. Acta Diabetol. 2015;52:513–521. PubMed

Crisp C.C., Vaccaro C.M., Pancholy A. Is female sexual dysfunction related to personality and coping? An exploratory study. Sex Med. 2013;1:69–75. PubMed PMC

Jannini E.A. SM = SM: The interface of systems medicine and sexual medicine for facing non-communicable diseases in a gender-dependent manner. Sex Med Rev. 2017;5:349–364. PubMed

Jacobson A.M., Braffett B.H., Cleary P.A. The long-term effects of type 1 diabetes treatment and complications on health-related quality of life: A 23-year follow-up of the Diabetes Control and Complications/Epidemiology of Diabetes Interventions and Complications cohort. Diabetes Care. 2013;36:3131–3138. PubMed PMC