Type 2 diabetes affects vaginal physiology in postmenopausal women, according to a recent report in The Journal of Sexual Medicine.
Such changes can lead to sexual dysfunction, especially poor lubrication.
In the past, animal studies have found an association between diabetes and structural changes in the vagina. It is thought that diabetes reduces the expression of sex steroid receptors. However, similar studies had not been performed on human vaginal tissue.
A team of Italian scientists decided to take a closer look. Their study included 21 postmenopausal women who were, on average, in their sixties or seventies. The women were scheduled for gynecological surgery and consented to have two vaginal tissue samples collected during their procedures.
Ten of the women had diabetes; the remaining eleven did not.
After analyzing the biopsies, the researchers noted the following:
• Diabetic women had “significantly increased vessel density” which might explain vaginal dryness.
• Diabetic women also had reduced androgen receptor expression, along with reduced endothelial and neuronal nitric oxide synthase isoform gene expressions. These issues could be connected to problems with vaginal smooth muscle tone and blood flow
• Lower aquaporin-2 expression in diabetic women could interfere with the movement of fluid through the vaginal walls, which is needed for good lubrication.
“These changes in the vagina of women with diabetes may at least partially contribute to the sexual problems they report,” the authors wrote.
Several limitations were acknowledged. The study population was small and obtaining vaginal biopsies can be difficult. Also, the participants were postmenopausal; results could be different in premenopausal women. In addition, it was unclear whether medications taken for diabetes could be involved with vaginal tissue changes.
Still, clinicians might consider diabetes when treating women with sexual dysfunction.
“Prevention of diabetes as well as the restoration of good glycemic control in subjects with diabetes should be the first-line intervention aimed also at improving sexual activity in these women,” the authors explained.
The Journal of Sexual Medicine
Baldassarre, Maurizio, PhD, et al.
“Changes in Vaginal Physiology of Menopausal Women with Type 2 Diabetes”
(Full-text. First published online: May 14, 2015)