İYABET HASTALIĞI OLAN KADINLARDA CİNSEL İŞLEVBOZUKLUKLARININ SIKLIĞI VE DİYABETİK VE DEMOGRAFİKFAKTÖRLERLE İLİŞKİSİ: BİR META-ANALİZ VE META REGRESYON ÇALIŞMAS

Amaç: Diyabet hastalarında cinsel işlev bozukluklarının (CİB) sıklığına dair çalışmalar, cinsel psikofizyoloji çok sayıda değişkenden etkilenebildiği için, oldukça farklı sonuçlar üretmektedir. Bu farklı sonuçları konsolide edecek yöntemlerle yapılmış bölgesel çalışmalara ihtiyaç vardır. Bu meta-analiz çalışmasının amacı diyabet hastalığı olan kadınlarda CİB yaygınlığını ortaya koymak ve CİB yaygınlığı üzerine olası diyabetik ve demografik değişkenlerin etkilerini incelemektir. Materyal ve Metot: Bu meta-analiz çalışması için literatür “Google Akademik” veri tabanı ile taranmıştır. Ocak 2000 ile Ağustos 2020 tarihleri arasında Türkiye’de yapılmış diyabet hastalığı olan kadınlarda CİB araştıran gözlemsel çalışmalar dahil edilmiştir.Bulgular: Diyabetik kadınlarda CİB yaygınlığı rastgele etkiler modeline göre %58,95 bulunmuştur. Uyarılma, istek, ağrı, doyum, lubrikasyon ve orgazm bozuklukları ise sırasıyla %57,75, %56,63, %45,63, %40,22, %38,61 ve %49,25 olarak saptanmıştır. Meta-regresyon sonuçlarına göre CİB üzerine HbA1c, diyabet hastalığının süresi, yaş ve vücut kitle indeksinin etkisi saptanmamıştır. Sonuç: Türkiye’de diyabet hastalığı olan kadınlarda CİB’in yaygınlığı genel popülasyondan yüksektir. Tanı koymada yaşanan olası sorunlar da dikkate alındığında bu hastaların mutlaka CİB bakımından sorgulanmaları ve gerekli hastaların özelleşmiş kliniklere yönlendirilmeleri gereklidir.

THE PREVALENCE OF SEXUAL DYSFUNCTIONS IN WOMEN WITH DIABETES AND ITS RELATIONSHIP WITH DIABETIC AND DEMOGRAPHIC FACTORS: A META-ANALYSIS AND META REGRESSION STUDY

Objectives: Since sexual psychophysiology can be affected by many variables, studies on the frequency ofsexual dysfunction (SD) in diabetic patients produce quite different results. There is a need for regional studiesconducted with methods to consolidate these different results. The purpose of this meta-analysis study is toreveal the combined prevalence of SD in women with diabetes and to examine the effects of possible diabeticand demographic variables on the prevalence of SD. Materials and Methods: For this meta-analysis study, the literature was searched with the "Google Scholar"database. Observational studies investigating SD in women with diabetes in Turkey between January 2000 andAugust 2020 were included in the meta-analysis. Results: The prevalence of SD in diabetic women was 58.95% according to the random-effects model. Arousal,desire, pain, satisfaction, lubrication and orgasm disorders were found as 57.75%, 56.63%, 45.63%, 40.22%,38.61% and 49.25%, respectively. According to meta-regression results, the effects of HbA1c, diabetesduration, age, and body mass index on SD were not determined. Conclusion: SD is higher than the general population of women with diabetes in Turkey. Considering thepossible problems encountered in diagnosis, these patients should be questioned for SD and the necessarypatients should be directed to specialized clinics.

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1. Hatch JP. Psychophysiological aspects of sexual dysfunction. Arch Sex Behav. 1981;10(1):49-64.
2. Woodard TL, Diamond MP. Physiologic measures of sexual function in women: a review. Fertility and sterility. 2009;92(1):19-34. (doi:10.1016/j.fertnstert.2008.04.041).
3. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.
4. Nappi RE, Cucinella L, Martella S, Rossi M, Tiranini L, Martini E. Female sexual dysfunction (FSD): Prevalence and impact on quality of life (QoL). Maturitas. 2016;94:87-91.
5. van Lankveld JJ, Grotjohann Y. Psychiatric comorbidity in heterosexual couples with sexual dysfunction assessed with the composite international diagnostic interview. Archives of Sexual Behavior. 2000;29(5):479-98.
6. Tan HM, Tong SF, Ho CC. Men's health: sexual dysfunction, physical, and psychological health—is there a link? The journal of sexual medicine. 2012;9(3):663-71.
7. Basson R, Rees P, Wang R, Montejo AL, Incrocci L. Sexual function in chronic illness. The journal of sexual medicine. 2010;7(1):374-88.
8. Lue TF, Brant WO, Shindel A, Bella AJ. Sexual dysfunction in diabetes. Endotext [Internet],(ed.). MDText. com, Inc.; 2017.
9. Laurent SM, Simons AD. Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical psychology review. 2009;29(7):573-85.
10. Winder K, Linker RA, Seifert F, ve ark. Neuroanatomic correlates of female sexual dysfunction in multiple sclerosis. Annals of neurology. 2016;80(4):490-8.
11. Sramkova T, Skrivanova K, Dolan I, ve ark. Women's sex life after spinal cord injury. Sexual medicine. 2017;5(4):e255-e9.
12. Esfahani SB, Pal S. Obesity, mental health, and sexual dysfunction: A critical review. Health psychology open. 2018;5(2):2055102918786867.
13. Rockliffe-Fidler C, Kiemle G. Sexual function in diabetic women: A psychological perspective. Sexual and Relationship Therapy. 2003;18(2):143-59.
14. Giraldi A, Kristensen E. Sexual Dysfunction in Women with Diabetes Mellitus. The Journal of Sex Research. 2010;47(2-3):199-211. (doi:10.1080/00224491003632834).
15. Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes, metabolic syndrome and obesity: targets and therapy. 2014;7:95.
16. Pontiroli AE, Cortelazzi D, Morabito A. Female Sexual Dysfunction and Diabetes: A Systematic Review and Meta‐Analysis. The Journal of Sexual Medicine. 2013;10(4):1044-51. (doi:https://doi.org/10.1111/jsm.12065).
17. West SL, Vinikoor LC, Zolnoun D. A systematic review of the literature on female sexual dysfunction prevalence and predictors. Annual Review of Sex Research. 2004;15(1):40-172.
18. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. Annals of internal medicine. 2009;151(4):264-9.
19. 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):1-20. (doi:10.1080/00926230590475206).
20. Rosen RC. Assessment of female sexual dysfunction: review of validated methods. Fertility and sterility. 2002;77:89-93.
21. McGahuey AJG, Cindi A. Laukes, Francisco A. Moreno, Pedro L. Delgado, Kathy M. McKnight, Rachel Manber, Cynthia. The Arizona sexual experience scale (ASEX): reliability and validity. Journal of Sex &Marital Therapy. 2000;26(1):25-40.
22. Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. International Journal of Impotence Research. 2004;16(6):531.
23. Peng Y-S, Chiang C-K, Kao T-W, ve ark. Sexual dysfunction in female hemodialysis patients: a multicenter study. Kidney international. 2005;68(2):760-5.
24. Kaplan SA, Reis RB, Kohn IJ, ve ark. Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction. Urology. 1999;53(3):481-6.
25. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.
26. Duval S, Tweedie R. A nonparametric “trim and fill” method of accounting for publication bias in metaanalysis. Journal of the american statistical association. 2000;95(449):89-98.
27. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis. John Wiley & Sons; 2011.
28. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557-60. (doi:10.1136/bmj.327.7414.557).
29. R: A language and environment for statistical computing. [computer program]. Vienna, Austria.: R Foundation for Statistical Computing.; 2020.
30. Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. EvidenceBased Mental Health. 2019;22(4):153-60.
31. Viechtbauer W. Conducting meta-analyses in R with the metafor package. Journal of statistical software. 2010;36(3):1-48.
32. Öztürk ÜA, Atasoy N, Kurçer MA, Karaahmet E, Saraçli Ö. Zonguldak il merkezinde kadin cinsel sorunlarinin yayginligi ve cinsel sorunlarla ilgili etkenler/Prevalence of female sexual problems and effecting factors in Zonguldak province. Anadolu Psikiyatri Dergisi. 2012;13(3):191.
33. Rahmanian E, Salari N, Mohammadi M, Jalali R. Evaluation of sexual dysfunction and female sexual dysfunction indicators in women with type 2 diabetes: a systematic review and meta-analysis. Diabetology & metabolic syndrome. 2019;11(1):73.
34. Olarinoye J, Olarinoye A. Determinants of sexual function among women with type 2 diabetes in a Nigerian population. The journal of sexual medicine. 2008;5(4):878-86.
35. Enzlin P, Rosen R, Wiegel M, ve ark. Sexual dysfunction in women with type 1 diabetes: long-term findings from the DCCT/EDIC study cohort. Diabetes care. 2009;32(5):780-5.
36. Enzlin P, Mathieu C, Van den Bruel A, Bosteels J, Vanderschueren D, Demyttenaere K. Sexual dysfunction in women with type 1 diabetes: a controlled study. Diabetes care. 2002;25(4):672-7.
37. Eeg‐Olofsson K, Cederholm J, Nilsson P, ve ark. New aspects of HbA1c as a risk factor for cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register (NDR). Journal of internal medicine. 2010;268(5):471-82.
38. Arredondo A. Diabetes duration, HbA1c, and cause-specific mortality in Mexico. The Lancet Diabetes & Endocrinology. 2018;6(6):429-31.
39. Nisar MU, Asad A, Waqas A, ve ark. Association of Diabetic Neuropathy with Duration of Type 2 Diabetes and Glycemic Control. Cureus. 2015;7(8):e302-e. (doi:10.7759/cureus.302).
40. Vafaeimanesh J, Raei M, Hosseinzadeh F, Parham M. Evaluation of sexual dysfunction in women with type 2 diabetes. Indian journal of endocrinology and metabolism. 2014;18(2):175.
41. Rane K, Wajngot A, Wändell P, Gåfvels C. Psychosocial problems in patients with newly diagnosed diabetes: number and characteristics. Diabetes research and clinical practice. 2011;93(3):371-8.
42. Graziottin A, Leiblum SR. Biological and psychosocial pathophysiology of female sexual dysfunction during the menopausal transition. The Journal of Sexual Medicine. 2005;2:133-45.
43. Günzler C, Berner MM. Efficacy of psychosocial interventions in men and women with sexual dysfunctions—a systematic review of controlled clinical trials. The journal of sexual medicine. 2012;9(12):3108-25.
44. Phillips Jr RL, Slaughter JR. Depression and sexual desire. American Family Physician. 2000;62(4):782-6.
45. Peleg-Sagy T, Shahar G. The prospective associations between depression and sexual satisfaction among female medical students. The journal of sexual medicine. 2013;10(7):1737-43.
46. De Lucena B, Abdo C. Personal factors that contribute to or impair women’s ability to achieve orgasm. International journal of impotence research. 2014;26(5):177-81