4.11 Phase 1 – data collection procedure – satisfaction survey
4.11.1 Phase 1 – Basic QA parameter procedure
One hundred and ninety six out of the 311 participants had at least one form of sexual dysfunction. This constituted 63.0% of total participants.
Male sexual dysfunction was found among 81 out of the 112 male participants. This constituted 72.3% of the male participants.
One hundred and fifteen (57.8%) out of the 199 female participants were found to have female sexual dysfunction.
Figure 4 on page 82 shows the prevalence of sexual dysfunction among the participants.
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Figure 4: Prevalence of sexual dysfunction among the participants.
196(63%)
81(72.3%)
115(57.8%) 115(37%)
31(27.7%)
84(42.2%)
0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300
Combined Males Females
no. of participants (N=311)
Prevalence of sexual dysfunction Sexual dysfunction
No Sexual dysfunction
95
4.4. PATTERN OF SEXUAL DYSFUNCTION AMONG THE PARTICIPANTS.
4.4.1 Pattern of sexual dysfunction among the male participants.
4.4.1.1. Erectile dysfunction: Seventy nine (70.5%) of the 112 male participants had erectile dysfunction. Thirty three (29.5%) of the male participants had no erectile dysfunction.
4.4.1.2. Orgasmic dysfunction: Sixty seven (59.8%) of the 112 male participants had orgasmic dysfunction. Fourty five (40.2%) of the male participants had no orgasmic dysfunction.
4.4.1.3. Sexual desire dysfunction: Ninety nine (88.4%) of the 112 male participants had sexual desire dysfunction. Thirteen (11.6%) of the male participants had no sexual desire dysfunction.
4.4.1.4. Intercourse satisfaction. Ninety one (81.25%) of the 112 male participants had intercourse dissatisfaction. Twenty one (18.75%) of the male participants had intercourse satisfaction.
4.4.1.5. Overall satisfaction: Ninety male (80.4%) of the 112 participants had overall sexual dissatisfaction. Twenty two (19.6%) of the male participants had overall sexual satisfaction.
Figure 5 on page 84 shows the pattern of male sexual dysfunction.
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Figure 5: Pattern of sexual dysfunction among the male participants.
79(70.5%)
67(59.8%)
99(88.4%)
91(81.25%) 90(80.4%)
33(29.5%)
45(40.2%)
13(11.6%)
21(18.75%) 22(19.6%)
0 10 20 30 40 50 60 70 80 90 100 110
Erectile dysfunction
Orgasmic function Sexual Desire Intercourse satisfaction
Overall satisfaction
no. of par ti cipa n ts (n=1 1 2 )
Pattern of sexual dysfunction Sexual dysfunction
Normal sexual function
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4.4.2 Pattern of sexual dysfunction among the female participants.
The cut off scores to determine the presence of dysfunction on the six domains of the Female Sexual Function Index were obtained from scores less than 4.28, 5.08, 5.45, 5.05, 5.04, and 5.51 for dysfunction in the domain of desire, arousal, lubrication, orgasm, satisfaction and pain respectively.172-175
4.4.2.1. Sexual desire dysfunction: One hundred and eighty six (93.5%) of the 199 female participants had female sexual desire dysfunction. Thirteen (6.5%) of the female participants had no sexual desire dysfunction.
4.4.2.2. Arousal disorder: One hundred and twenty two (61.3%) of the 199 female participants had arousal disorder. Seventy seven (38.7%) of the female participants had no arousal disorder.
4.4.2.3. Lubrication disorder: One hundred and forty one (70.9%) of the 199 female participants had lubrication disorder. Fifty eight (29.1%) of the female participants had no lubrication disorder.
4.4.2.4. Orgasmic disorder: One hundred and forty nine (74.9%) of the 199 female participants had orgasmic disorder. Fofty (25.1%) of the female participants had no orgasmic disorder.
4.4.2.5. Sexual dissatisfaction: One hundred and forty seven (70.9%) of the 199 female participants were sexually dissatisfied. Fifty two (26.1%) of the female participants were sexually satisfied.
4.4.2.6. Pain disorder: Eighty eight (44.2%) of the 199 female participants had pain disorder.
One hundred and eleven (55.8%) of the female participants had no sexual pain disorder.
Figure 6 in page 86 shows the pattern of female sexual dysfunction.
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Figure 6: Pattern of sexual dysfunction among the female participants.
186(93.5%)
122(61.3%)
141(70.9%)
149(74.9%) 147(70.9%)
88(44.2%)
13(6.5%)
77(38.7%)
58(29.1%)
50(25.1%) 52(26.1%)
111(55.8%)
0 40 80 120 160 200
DESIRE AROUSAL LUBRICATION ORGASM SATISFACTION PAIN
no. of pa rt ici pa n ts (n=1 99 )
Pattern of sexual dysfunction Sexual dysfunction
Normal sexual function
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4.5 RELATIONSHIP BETWEEN SEXUAL DYSFUNCTION AND SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE PARTICIPANTS.
4.5.1 Relationship between sexual dysfunction and socio-demographic characteristics of the male participants.
Age: The prevalence of male sexual dysfunction was 96.6% in men aged greater than 61 years compared to 28.6% in those less than 30 years. It was found that male sexual dysfunction increases significantly with age and there was a statistically significant relationship between male sexual dysfunction and age (χ2=29.382, df=4, p=0.000).
Tribe: The Hausa and Igbo had prevalence of male sexual dysfunction of 71.4% and 80.0%
respectively. The Yoruba had a lower prevalence of 66.7%. This difference between the tribes was not statistically significant (χ2=0.558, df=3, p=0.920).
Religion: Fifty four (72%) of the 75 Muslim diabetic participants had male sexual dysfunction compared to 27 (73.0%) of the 37 participants that were Christians. This difference was not statistically significant (χ2=0.012, df=1, p=1.000).
Education: The prevalence of male sexual dysfunction reduced as the level of education increased. Men with no formal/Koranic education had the highest prevalence (86.7%) compared to those with tertiary education (61.9%). There was no statistically significant relationship between the level of education and male sexual dysfunction (χ2=5.7588, df=3, p=0.124).
Marital status: The participants who were divorced and widowers had the highest prevalence of male sexual dysfunction of 100% in both cases. The married had a prevalence of 73.3%. There
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was no participant who was single who had male sexual dysfunction. This difference was statistically significant (χ2=7.446, df=3, p=0.026).
Occupation: Male sexual dysfunction was found to be higher among retirees (100%) and the unemployed (95.5%). None of the student participants had male sexual dysfunction while 53 (65.4%) out of the 81 employed participants had male sexual dysfunction. There was a statistically significant relationship between occupation and male sexual dysfunction (χ2=17.503, df=3, p=0.000).
The relationship between sexual dysfunction and socio-demographic characteristics of the male participants is shown in Table 7 below.
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Table 7: Univariate analysis of socio-demographic factors associated with sexual dysfunction among male participants
Bold p<0.05(significant),*Fisher’s exact test, MSD male sexual dysfunction
Variables MSDpresent (n=81) MSD absent (n=31) χ2 P-value no % no %
Age(group)
18-30 2 28.6 5 71.4
29.382 0.000
31-40 3 25.0 9 75.0
41-50 16 69.6 7 30.4
51-60 32 78.0 9 22.0
>61 28 96.6 1 3.4
Tribe
Hausa 50 71.4 20 28.6
0.558 0.920*
Igbo 8 80.0 2 20.0
Yoruba 6 66.7 3 33.3
Others 17 73.9 31 26.1
Religion
Christianity 27 73.0 10 27.0
0.012 1.000
Islam 54 72.0 21 28.0
Education No
education/Koranic
26 86.7 4 13.3
5.758 0.124
Primary 11 78.6 3 21.4
Secondary 18 69.2 8 30.8
Tertiary 26 61.9 16 38.1
Marital status
Married 77 73.3 28 26.7
7.446 0.026*
Single 0 0.0 3 100.0
Divorced 1 100.0 0 0.0
Widow/widower 3 100.0 0 0.0
Occupation
Employed 53 65.4 28 34.6
17.503 0.001*
Unemployed 6 85.7 1 14.3
Student 0 0.0 2 100.0
Retiree 22 100.0 0 0.0
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4.5.2 Relationship between sexual dysfunction and socio-demographic characteristics of the female participants.
Age: The prevalence of female sexual dysfunction was 42.9% among participants aged less than 30 years. It was lower, at 32.5% among those aged between 31-40 years. Thereafter it progressively increased with age reaching 86.4% amongst those aged greater than 61 years.
There was a statistically significant relationship between female sexual dysfunction and age (χ2=27.741, df=4, p=0.000).
Tribe: Female sexual dysfunction was commoner among the Yoruba’s (60.0%) and the other tribes (62%). There was no statistically significant relationship between female sexual dysfunction and tribe (χ2=1.681, df=3, p=0.655).
Religion: Christian women had a higher prevalence of female sexual dysfunction (71.9%) compared to Muslim women with a prevalence of 51.1%. There was a statistically significant relationship between female sexual dysfunction and religion (χ2=7.674, df=1, p=0.006)
Education: The prevalence of female sexual dysfunction reduced as the level of education increased. Women with no formal/Koranic education had a prevalence of 65.4%, while those with tertiary education had a prevalence of 46.8%. There was no statistically significant relationship between female sexual dysfunction and education (χ2=5.087, df=3, p=0.166)
Marital status: One hundred and six (57.3%) of the married participants, 4 (57.1%) of the single and 4 (66.7%) of the widowed women had female sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and marital status (χ2=0.972, df=3, p=1.000)
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Occupation: Fifty two (59.1%) of the employed, 50 (53.2%) of the unemployed and 11 (84.6%) of the retirees had female sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and occupation (χ2=4.945, df=3, p=0.166).
Table 8 on page 92 shows the Univariate analysis of socio-demographic characteristics associated with female sexual dysfunction
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Table 8: Univariate analysis of socio-demographic factors associated with sexual dysfunction among female participants. (N=199)
Bold p<0.05(significant),*Fisher’s exact test, FSD female sexual dysfunction
Variables FSDpresent (n=115) FSDabsent (n=84) χ2 P-value no % no %
Age group (years)
18-30 6 42.9 8 57.1
27.741 0.000
31-40 13 32.5 27 67.5
41-50 27 49.1 28 50.9
51-60 50 73.5 18 26.5
>61 19 86.4 3 13.6
Tribe
Hausa 70 57.4 52 42.6
1.681 0.655
Igbo 5 41.7 7 58.3
Yoruba 9 60.0 6 40.0
Others 31 62.0 19 38.0
Religion
Christianity 46 71.9 18 28.1
7.674 0.006
Islam 69 51.1 66 48.9
Education No education /Koranic
51 65.4 27 34.6
5.087 0.166
Primary 23 62.2 14 37.8
Secondary 19 51.4 18 48.6
Tertiary 22 46.8 25 53.2
Marital status
Married 106 57.3 79 42.7
0.972 1.000*
Single 4 57.1 3 42.9
Divorced 1 100 0 0.0
Widow 4 66.7 2 33.3
Occupation
Employed 52 59.1 36 40.9
4.945 0.166*
Unemployed 50 53.2 44 46.8
Student 2 50.0 2 50.0
Retiree 11 84.6 2 15.4
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4.6 RELATIONSHIP BETWEEN SEXUAL DYSFUNCTION AND LIFESTYLE CHARACTERISTICS AND LABORATORY FINDINGS OF THE PARTICIPANTS.
4.6.1 Relationship between sexual dysfunction and lifestyle characteristics and laboratory findings of the male participants.
4.6.1.1 Medical history of the male participants
Tobacco use: Fourteen (77.8%) of the 18 male participants that smoked had sexual dysfunction.
Sixty seven (71.3%) of the 94 male participants that donot smoked had sexual dysfunction. There was no statistically significant relationship between male sexual dysfunction and tobacco use (χ2=0.319, df=1, p=0.775).
Alcohol use: Seventeen (80%) of the 20 male participants that imbibed alcohol had sexual dysfunction. Sixty four (69.6%) of those that did not imbibed alcohol had sexual dysfunction.
There was no statistically significant relationship between male sexual dysfunction and alcohol use (χ2=1.955, df=1, p=0.183).
Duration of diabetes: The prevalence of male sexual dysfunction increased as the duration of diabetes increased. Participants diagnosed to have Type 2 diabetes for more than 20 years had the highest prevalence of sexual dysfunction of 75.3%, while those whose duration was less than 9 years had a prevalence of 50%. However, there was no statistically significant relationship between male sexual dysfunction and duration of type 2 diabetes (χ2=3.433, df=2, p=0.191).
Hypertension: Fifty seven (83.8%) of the 68 male participants that had hypertension had sexual dysfunction. Twenty four (54.5%) of the male participants that had no hypertension had sexual dysfunction. There was a statistically significant relationship between sexual dysfunction and hypertension among the male participants (χ2=11.440, df=1, p=0.001).
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Duration of hypertension: Male sexual dysfunction was more prevalent among participants who had hypertension for less than 9 years (100%), followed by those greater than 20 years (83.6%), then those between 10-19 years (60.0%). However, there was no statistically significant relationship between male sexual dysfunction and duration of hypertension (χ2=0.574, df=2, p=1.000).
Exercise: Thirty five (58.2%) of the 55 male participants that partook in exercise had sexual dysfunction. Fourty six (80.7%) male participants that did not partook in exercise had sexual dysfunction. There was no statistically significant relationship between male sexual dysfunction and exercise (χ2=4.072, df=1, p=0.057).
4.6.1.2 Physical examination findings of the male participants
Body Mass Index (BMI): Male sexual dysfunction reduced as the BMI increased. It was 100%
amongst the underweight, 76% amongst those with normal BMI, 72.1% amongst the over weight and 58.8% amongst the obese. There was no statistically significant relationship between male sexual dysfunction and BMI (χ2=2.310, df=3, p=0.475).
Waist:Hip ratio: Five (71.4%) of the 7 participants whose waist:hip ratios were less than or equal to 0.89 had male sexual dysfunction as compared to 76 (72.4%) of the 105 participants whose waist:hip ratios were greater than or equal to 0.90. There was no statistically significant relationship between male sexual dysfunction and waist:hip ratio (χ2=0.003, df=1, p=1.000).
Blood pressure: Male sexual dysfunction increased with blood pressure. It was common among individuals with systolic (83.3%) and diastolic (83.3%) blood pressure greater than 140 mmHg and 90 mmHg respectively. It was less amongst those systolic (64.1%) and diastolic (68.3%)
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blood pressure less than 139 mmHg and 89 mmHg respective There was a statistically significant relationship between male sexual dysfunction and systolic blood pressure whereas there was no significant relationship with diastolic pressure (systolic χ2=5.089, df=1, p=0.032 and diastolic χ2=2.482, df=1, p=0.154).
4.6.1.3 Laboratory indices of the male participants
Urine glucose: Fifty (67.6%) of the 74 male participants who had at least one plus glucose in the urine had sexual dysfunction. Thirty one (81.6%) of the male participants who had no glucose in the urine had sexual dysfunction. There was no statistically significant relationship between male sexual dysfunction and urine glucose (χ2=2.462, df=1, p=0.126).
Urine protein: Ten (90.9%) of the 11 male participants that had proteinuria had sexual dysfunction. Seventy one (70.3%) of the 101 male participants that had no proteinuria had sexual dysfunction. There was no statistically significant relationship between male sexual dysfunction and urine protein (χ2=2.105, df=1, p=0.180).
Mean fasting blood glucose: Sixty seven (72.8%) of the male participants who had the mean of the last three fasting blood glucose less than or equal to 11mmol/l had sexual dysfunction while 14 (70%) of the participants who had the mean of the last three fasting blood glucose greater than or equal to 11.1mmol/l had sexual dysfunction. The difference was not statistically significant. (χ2=0.066, df=1, p=1.000).
Details of the relationship between sexual dysfunction and clinical characteristics of the male participants are shown in Table 9 below.
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Table 9. Univariate analysis of clinical characteristics associated with sexual dysfunction of the male participants. (N=112)
Variables MSDpresent (n=81) MSD absent (n=31) χ2 P-value no % no %
Tobacco use
Yes 14 77.8 4 22.2
0.319 0.775
No 67 71.3 27 28.7
Alcohol use
Yes 17 85.0 3 15.0
1.955 0.183
No 64 69.6 28 30.4
Duration of DM
<9yrs 4 50.0 4 50.0
3.433 0.191*
10-19yrs 4 57.1 3 42.9
>20yrs 73 75.3 24 24.7
HTN
yes 57 83.8 11 16.2
11.440 0.001
No 24 54.5 20 45.5
Duration of HTN
<9yrs 2 100.0 0 0.0
0.574 1.000*
10-19yrs 4 80.0 1 20.0
>20yrs 51 83.6 10 16.4
Exercise
Yes 35 63.6 20 36.4
4.072 0.057
No 46 80.7 11 19.3
BMI (kg/m2)
<18.4 2 100.0 0 0.0
2.310 0.475*
18.5-24.99 38 76.0 12 24.0
25-29.99 31 72.1 12 27.9
>30 10 58.8 7 41.2
Waist Circumference (cm)
<101 62 70.5 26 29.5
0.715 0.453
>102 19 79.2 5 20.8
Waist-Hip ratio
<0.89 5 71.4 2 28.6
0.003 1.000
>0.90 76 72.4 29 27.6
SBP (mmHg)
<139 41 64.1 23 35.9
5.089 0.032
>140 40 83.3 8 16.7
DBP (mmHg)
<89 56 68.3 26 31.7
2.482 0.154
>90 25 83.3 5 16.7
Urine glucose
Yes 50 67.6 24 32.4
2.462 0.126
No 31 81.6 7 18.4
Urine Albumin
Yes 10 90.9 1 9.1
2.105 1.000
No 71 70.3 30 29.7
Mean FBG (mmol/L)
<11.0 67 72.8 25 27.2
0.066 1.000
>11.1 14 70.0 6 30.0
MSD Male Sexual Dysfunction, BMI Body Mass Index, HTN Hypertension, DM diabetes, SBP/DBP systolic/ diastolic blood press, FBG fasting blood glucose Bold p<0.05(significant), *Fisher’s exact test
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4.6.2. Relationship between sexual dysfunction and clinical characteristics of the female participants
4.6.2.1 Medical history of the female participants
Tobacco use: Only one (33.3%) of the three female participants that used tobacco had sexual dysfunction. One hundred and fourteen (58.2%) of the female participants that donot smoked had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and tobacco use (χ2=0.747, df=1, p=0.574).
Alcohol use: Five (62.5%) of the 8 female participants that imbibed alcohol had sexual dysfunction. One hundred and ten (57.6%) of those that did not imbibed alcohol had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and alcohol use (χ2=0.077, df=1, p=1.000).
Duration of diabetes: Female sexual dysfunction increased with duration of diabetes.
Participants who had Type 2 diabetes for greater than 20 years had the highest prevalence of female sexual dysfunction (61.3%). It was 37.5% and 45% for those with duration of diabetes <9 years and 10-19 years respectively. There was no statistically significant relationship between female sexual dysfunction and duration of type 2 diabetes (χ2=4.888, df=2, p=0.087).
Hypertension: Ninety five (65.1%) of the 146 female participants that had hypertension had sexual dysfunction. Twenty (37.7%) of the female participants that had no hypertension had sexual dysfunction. There was a statistically significant relationship between female sexual dysfunction and hypertension (χ2=11.999, df=1, p=0.001).
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Duration of hypertension: Half (50%) of the female participants whose duration of hypertension was less than 9 years and between 10-19 years respectively had sexual dysfunction. Ninety (66.2%) out of the 136 female participants whose duration of hypertension was greater than 20 years had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and duration of hypertension (χ2=1.408, df=2, p=0.671).
Exercise: Twenty nine (52.7%) of the 55 female participants who partook in exercise had sexual dysfunction. Eighty six (59.7%) of the female participants that did not partook in exercise had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and exercise (χ2=0.798, df=1, p=0.432).
4.6.2.2 Physical examination findings of the female participants
Body Mass Index (BMI): Female sexual dysfunction was common among participants who were overweight (60.5%) and the obese (60.4%). Nineteen (47.5%) of the 40 female participants with normal BMI and 1 (50%) out of the 2 female participants who were underweight had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and BMI (χ2=2.262, df=3, p=0.567).
Waist circumference: Seventeen (68%) of the 25 females with waist circumference less than or equal to 87 cm had sexual dysfunction while 98 (56.3%) of the 174 females with waist circumference greater than or equal to 88 cm had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and waist circumference (χ2=1.222, df=1, p=0.269).
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Waist:Hip ratio: Four (44.4%) of the 9 females whose waist:hip ratio was less than or equal to 0.84 had sexual dysfunction while 110 (58.5%) of 188 females with waist:hip ratio greater than or equal to 0.85 had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and waist-hip ratio (χ2=0.697, df=1, p=0.404).
Systolic blood pressure: Sixty five (55.6%) of the 117 females whose systolic blood pressure was less than 139 mmHg had sexual dysfunction. This increased to 61% in 50 of 82 female participants as the systolic blood pressure increases to greater than 140 mmHg. There was no statistically significant relationship between female sexual dysfunction and systolic blood pressure (χ2=0.581, df=1, p=0.446).
Diastolic blood pressure: Seven two (57.6%) of the 125 female participants with diastolic blood pressure less than 89 mmHg had sexual dysfunction while 43 (58.1%) of the 74 females with diastolic blood pressure greater than 90 mmHg had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and diastolic blood pressure (χ2=0.050, df=1, p=0.944).
4.6.2.3 Laboratory indices of the female participants
Urine glucose: Fifty three (58.9%) of the 90 female participants who had at least one plus glucose in the urine had sexual dysfunction. Sixty two (56.9%) of the female participants who had no glucose in the urine had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and urine glucose (χ2=0.081, df=1, p=0.775).
Urine protein: Six (66.7%) of the 9 female participants that had proteinuria had sexual dysfunction. One hundred and nine (57.4%) of the 190 female participants that had no
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proteinuria had sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and urine protein (χ2=0.308, p=0.581).
Mean fasting blood glucose: Eighty seven (58.4%) of 149 and 28 (56%) of the 50 female participants whose mean of the last three fasting blood glucose was less than 11mmol/l and greater than 11.1 mmol/l respectively had female sexual dysfunction. There was no statistically significant relationship between female sexual dysfunction and mean of last three fasting blood glucose (χ2=0.088, df=1, p=0.767).
Table 10 on page 101 shows the Univariate analysis of clinical characteristics associated with female sexual dysfunction.
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Table 10: Univariate analysis of clinical characteristics associated with sexual dysfunction among female participants. (N=199)
Variables FSD present (n=115)
no %
FSD absent (n=84)
no %
χ2
P-value Tobacco use
Yes 1 33.3 2 66.7
0.747 0.574*
No 114 58.2 82 41.8
Alcohol use
Yes 5 62.5 3 37.5
0.077 1.000*
No 110 57.6 81 42.4
Duration of DM
<9yrs 6 37.5 10 62.5
4.888 0.087
10-19yrs 9 45.0 11 55.0
>20yrs 100 61.3 63 38.7
HTN
Yes 95 65.1 51 34.9
11.999 0.001
No 20 37.7 33 62.3
Duration of HTN
<9yrs 2 50.0 2 50.0
1.408 0.671*
10-19yrs 3 50.0 3 50.0
>20yrs 90 66.2 46 33.8
Exercise
Yes 29 52.7 26 47.3
0.798 0.432
No 86 59.7 58 40.3
BMI (kg/m2)
<18.4 1 50 1 50
2.262 0.567*
18.5-24.99 19 47.5 21 52.5
25-29.99 40 60.6 26 39.4
>30 55 60.4 36 39.6
Waist C (cm)
<87 17 68.0 8 32.0
1.222 0.269
>88 98 56.3 76 43.7
Waist-Hip ratio
<0.84 4 44.4 5 55.6
0.697 0.404
>0.85 110 58.5 78 41.5
SBP (mmHg)
<139 65 55.6 52 44.4
0.581 0.446
>140 50 61.0 32 39.0
DBP(mmHg)
<89 72 57.6 53 42.4
0.05 0.944
>90 43 58.1 31 41.9
Urine glucose
Yes 53 58.9 37 41.1
0.081 0.775
No 62 56.9 47 43.1
Urine Albumin
Yes 6 66.7 3 33.3
0.308 0.581
No 109 57.4 81 42.6
Mean FBG (mmol/l)
<11.0 87 58.4 62 41.6
0.088 0.767
>11.1 28 56.0 22 44.0
FSD Female Sexual Dysfunction, BMI Body Mass Index, HTN Hypertension, DM diabetes, SBP/DBP systolic/diastolic blood press, FBG fasting blood glucose Bold p<0.05(significant), *Fisher’s exact test
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4.7 BIVARIATE ANALYSIS OF THE DETERMINANTS OF SEXUAL DYSFUNCTION AMONG THE PARTICIPANTS
4.7.1 Bivariate analysis of the determinants of sexual dysfunction among the male participants
Factors with p-value less than or equal to 0.05 on univariate analysis of the relationships between sexual dysfunction and socio-demographic/clinical characteristics of the male participants were considered for bivariate logistic analysis so as to control for confounder risk factors.
The statistically significant variables observed on univariate analysis of male sexual dysfunction were age, marital status, occupation, hypertension and systolic blood pressure.
Age: Age was found to be an independent risk factor for male sexual dysfunction (p=0.001, Odds ratio=0.380, 95% CI=0.219-0.662). Participants within the age group 31-40 years were 39 times more likely to have male sexual dysfunction compared to patients aged more than 61 years.
However, the degree of uncertainty is very great because of the wide confidence interval (p=0.006, Odds ratio=38.884, df=4, 95% CI=2.821-535.880).
Marital status (p=0.525, Odds ratio=0.682, 95% CI=0.209-2.224), occupation (p=0.136, Odds ratio=0.561, 95% CI=0.263-1.200), hypertension (p=0.897, Odds ratio=0.921, 95% CI=0.266-3.190) and systolic blood pressure (p=0.872, Odds ratio=0.910, 95% CI=0.288-2.877) could not maintain statistical significance on bivariate logistic regression.
Table 11 shows the risk factors associated with male sexual dysfunction on bivariate logistic regression analysis.
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Table 11: Bivariate logistic regression analysis of risk factors for male sexual dysfunction among male participants
Variablesa Odds ratio 95% CI p-value
Age 0.380 0.219-0.662 0.001*
18-30 12.432 0.345-447.815 0.168
31-40 38.884 2.821-535.880 0.006*
41-50 5.442 0.564-52.518 0.143
51-60 4.337 0.474-39.670 0.194
>61b 1
Marital status 0.682 0.209-2.224 0.525
Married 1.67×106 0.000 0.999
Single 2.052×1025 0.000 0.999
Divorced 0.226 0.000 1.000
Widow/widower b 1
Occupation 0.561 0.263-1.200 0.136
Employed 2.920×106 0.000 0.998
Unemployed 0.968 0.000 1.000
Student 8.604×1017 0.000 0.999
Retiree b 1
Hypertension 0.921 0.266-3.190 0.897
Yes 1.318 0.363-4.784 0.675
No b 1
SBP (mmHg) 0.910 0.288-2.877 0.872
<139 1.270 1.270-0.379 0.699
>140 b 1
a statistically significant variables, b Reference group, * p<0.05(significant), CI confidence interval
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4.7.2 Bivariate analysis of the determinants of sexual dysfunction among the female participants
Any factor with p-value less than or equal to 0.05 on univariate analysis of the relationships between sexual dysfunction and socio-demographic/clinical characteristics of the female participants were considered for binary logistic regression analysis so as to control for confounder risk factors.
The statistically significant variables observed on univariate analysis of female sexual dysfunction were age, religion and hypertension.
Age: Patients age (31-50 years) was an independent predictor of female sexual dysfunction (p=0.001, Odds ratio=0.573, df=4, 95% CI=0.406-0.808). It was observed that female sexual dysfunction is more likely to occur 10.8 times in patients aged 31-40 years (p=0.002, Odds ratio=10.82, df=4, 95% CI=2.470-47.366), 6.6 times in patients aged 41-50 years (Odds ratio=6.625, df=4, 95% CI=1.658-26.474) when compared to those above 61 years. However, the degree of uncertainty is very great because of the wide confidence interval.
Religion (Odds ratio=1.867, df=1, 95% CI=0.295-11.805, p=0.507) and hypertension (Odds ratio=0.476, df=1, 95% CI=0.600-2.990, p=0.476) could not maintain statistical significance on bivariate logistic regression.
Table 12 on page 105 shows the risk factors associated with female sexual dysfunction on bivariate logistic regression analysis.
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Table 11: Bivariate logistic regression analysis of risk factors for sexual dysfunction among female participants
variablesa Odds ratio 95% CI p-value
Age 0.573 0.406-0.808 0.001*
18-30 5.010 0.855-29.366 0.074
31-40 10.816 2.470-47.366 0.002*
41-50 6.625 1.658-26.474 0.007*
51-60 2.794 0.702-11.122 0.145
>61b 1
Religion 1.867 0.295-11.805 0.507
Christianity undefined 0.000-0.000 1
Islam b 1
Hypertension 0.476 0.600-2.990 0.476
Yes 0.732 0.318-1.686 0.464
No b 1
a statistically significant variables, b Reference group, * p<0.05(significant), CI confidence interval
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CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS 5.1 Prevalence of sexual dysfunction among the participants.
The prevalence of sexual dysfunction among the male participants was found to be 72.3%
whereas the prevalence among the female participants was found to be 57.8%. Researches done among diabetics had shown that the prevalence of sexual dysfunction is slightly higher in males as compared to females.7, 16, 17, 18 The reason that has been adduced for the apparently lower prevalence of female sexual dysfunction is that discussions on sex and sexuality amongst women is still regarded as a taboo in several quarters, therefore most women may not be comfortable discussing their sexual problems for fear of being labelled promiscuous. Sexual relations especially amongst the womenfolk in the Nigerian setting are mainly for procreation.19 Ziaei-Rad et al in Iran in their study on sexual dysfunction in patients with diabetes observed a prevalence of 88% in females and 77% in males and 82.5% of the patients reported that they experienced at least one sexual dysfunction.134 The higher prevalence of sexual dysfunction among the females and the overall respondents in the Iranian study could be explained by the omission of intercourse satisfaction in the IIEF questionnaire due to cultural concerns.
The prevalence of sexual dysfunction of 72.3% among the male participants in this study was similar to the prevalence of 74% reported by Olarinoye et al in Ilorin, Nigeria.5 The similarity in the prevalence observed in these two studies could be attributed to common socio-cultural values in Zaria and Ilorin. Unadike and others in Benin, Nigeria in a similar study documented that 57.7% of adult male type 2 diabetics had sexual dysfunction.19 The lower prevalence observed in the Benin study could be attributed to the lower total set off of 59 points as against the
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off of 60 points in this study. The prevalence increases as the set total cut-off increases. Owiredu et al in their study on prevalence and determinants of sexual dysfunction among adult diabetic male patients attending an outpatient clinic in Ghana, using the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire reported a prevalence of 69.3%.7 The lower prevalence observed in the Ghana study could be attributed to the differences in the sexual assessment instrument.
In this study, the prevalence of female sexual dysfunction was 57.8%. This is slightly higher, but comparable to a report by Esposito et al in Italy in 2010 where the prevalence of female sexual dysfunction among type 2 diabetics was 54%.176 In the Italian study, the diagnostic cut-off using the FSFI was set at 23 points, whereas, in this study, it was set at the validated diagnostic cut-off of 26.66 points. Abu Ali et al in Jordan found a prevalence of 59.6% in diabetic women 50 years of age or older and the prevalence of female sexual dysfunction in the diabetic sample aged less than 50 years was around 41%.18 The slightly higher prevalence observed in the Jordanian study among women older than 50 years could be attributed higher mean age of their study when compared to this study.
Likata et al in their study among adults with diabetes mellitus attending the outpatient clinic in Kenya in 2012 reported a prevalence of female sexual dysfunction of 36.6%.57 The lower prevalence could be due to cultural reluctance to discuss problems related to sex and sexuality. In the Kenyan study, participants with hypertension (a reported risk factor for sexual dysfunction) were excluded.116,117
Ziaei-Rad et al in Iran in 2010 in their study on sexual dysfunction in female patients with diabetes reported a prevalence of 88%.134 Elyasi et al also in Iran in 2015 reported a prevalence
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of 78.7%.178 The high prevalence observed in both studies could be attributed to a higher total score of 28 set as the optimal cut off point for the Iranian version of the FSFI to distinguish between women with sexual dysfunction and those with normal sexual function.
5.2 Pattern of sexual dysfunction among the participants
Disorder of sexual desire was found to be the most prevalent male sexual disorder. This was similar to that reported by other researchers.76,86,104 The prevalence of sexual desire dysfunction of 88.4% observed in this study is higher than the 81.7% reported by Likata et al in Kenya among 186 male diabetics.57 This difference could be from the sample size, cultural differences and the exclusion criteria. The latter study excluded all chronic illnesses especially hypertension probably leading to a lower number of participants with desire dysfunction being recruited in the study.
The high prevalence of erectile dysfunction of 70.5% observed in this study agrees with findings from previous reports.5, 19 57 Olarinoye et al in Ilorin documented that 74% of type 2 diabetic males had some degree of erectile dysfunction.5 The closely similar prevalence between this two studies may be from their similar socio-cultural background. Unadike et al in Benin reported a prevalence of erectile dysfunction in the diabetic population to be 57.7%.19 The lower prevalence in the Benin study could be attributed to lower mean age of the male participants of 47±6 years as compared to 53.63±12.87 years in this study. Erectile dysfunction increases with age.43, 89, 97
Likata et al in their study in Kenya showed that the prevalence of erectile dysfunction was 68.8%.57 The mean age of male participants in the Kenyan study was 43.4±13.5 years which was lower than that in this study. There was significant disparity in the sample population size recruited by Olarinoye et al (77 participants), Likata et al (186 participants) and Unadike et al (250 participants) which may account for the variation in the prevalence.
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Orgasmic disorder was the least common of the male sexual disorders from this study with a prevalence of 59.8%. This finding agrees with previous reports.19, 56, 57 A study undertaken in Jordan, of 988 married diabetic men showed that the prevalence of orgasmic disorder was 40.5%.179 Likata et al in their study in Kenya showed that the prevalence of orgasmic disorder was 48.4%.57 The lower prevalence observed in these two studies could be attributed to socio-cultural differences (tribe, traditional practices and belief, conservative society, religion) between the study populations.
This study observed that the prevalence of intercourse dissatisfaction and overall dissatisfaction of 81.25% and 80.4% respectively was higher than previous reports by Unadike et al in Edo State, Nigeria (54.7% and 51.6%),19 and Likata et al in Kenya (86.6% and 68.4%)57 The disparity could be from the differences in sample size and the mean age of the sampled population. Diabetes mellitus has been shown to affect the various phases of male sexual circle and in turn affects intercourse satisfaction and overall sexual satisfaction.
The most common sexual complaint in women is decreased desire, followed by orgasmic dysfunction. 60, 78 The pattern of female sexual dysfunction from this study shows that disorders of desire and orgasm had the highest prevalence of 93.5% and 74.9% respectively while disorder of pain had the least prevalence of 44.2%. Arousal disorder, lubrication disorder and sexual dissatisfaction had prevalence of 61.3%, 70.9% and 70.9% respectively.
In this study, sexual desire disorder was found to be high compared to reports from Iran of 50%
by Elyasi et al178 and Kenya of 76.8% by Likata et al.57 The high prevalence of sexual arousal disorder of 61.3% observed in this study corroboates with findings among diabetics in Kenya by Likata et al who reported a prevalence of 60.4%.57However, an Iranian study reported a
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prevalence of 50%.178 Likata et al reported the prevalence of lubrication disorder of 35.4%
among female diabetics.57 A similar study in Iran reported a prevalence of 58%.178 This prevalence is high when compared to 70.9% observed in this study. Most studies have indicated orgasmic problems in women with diabetes mellitus ranging from 10-84%,18, 69 with a few studies showing no effect.95 In this study, the prevalence of orgasmic disorder of 74.9% was found to be high compared to reports from Iran of 32.7% by Elyasi et al,178 and Kenya of 43.9%
by Likata et al.57 Sexual pain disorder is the least common female sexual disorder as also observed in this study (44.2%).57, 94 This corroborates with the 44.2% reported by Elyasi et al.178 A lower value 14.6% was reported in Kenya by Likata et al.57 In this study, 70.9% of the female participants had sexual dissatisfaction which was high compared to reports from Iran of 42.7%
by Elyasi et al,178 and Kenya of 28.0% by Likata et al.57
These differences could result from the fact that in the Iranian study, the population size (150) and the mean age of the study population (42±10.1 years) were lower than that in this study (199 female participants and 48.64±11.38 years). Likewise, the Kenyan study with a population of 164 and mean age of 38.2±12.8 years. Female sexual dysfunction increases with age.18, 134 Socio-cultural factors could also be responsible for the differences. Iran has a religious and conservative society that may hinder discussion of issues of sexuality.
In a long-term Epidemiology of Diabetes Interventions and Complications (EDIC) study among women with type 1 diabetes in the United States of America, 57% of the women with female sexual dysfunction reported loss of libido, 51% had problems with orgasm, 47% had lubrication disorder, 38% had arousal disorder, 21% experienced sexual pain and 25% reported low overall sexual satisfaction.94 The higher prevalence observed in this study when compared to the EDIC study could be a true difference in the pattern of female sexual dysfunction between type 1 and