In this study, the self-reported loss of ability to have intercourse was not associated with ethnicity. On the other hand, self-reported loss of sexual desire was independently associated with ethnicity (Assyrian/Syrian vs. Swedish-born) in the fully adjusted model. In addition, loss of ability to have intercourse was independently related to older age, male sex, and living without a partner.
Advanced age is a risk factor for poor general health [17, 18] and diabetes . The sexual lives of individuals are influenced by several health and socio-demographic factors. According to studies investigating this subject, the following are risk factors for the absence of a normal sexual life in diabetic individuals: sexual dissatisfaction, lack of orgasm/erection, low sexual arousal, lack of lubrication, and sexual pain. A study of 230 married Malaysian women showed that factors such as older age, being married more than 14 years, and having less sexual intercourse were associated with a lack of lubrication . A large study of 7,243 healthy middle-aged women aged 40–59 found that the prevalence of sexual dysfunction was high but differed between different populations. The most important associated risk factor was a decrease in vaginal lubrication. Additionally, and in contrast to the study of Malaysian women, higher educational level protected against sexual dysfunction . The female participants of Assyrian/Syrian origin in the present study have a low educational level and 20% of the Assyrian/Syrian participants are illiterate [25% of women and 14.6% of men], which may highlight the need for prospective studies exploring the association between educational level and sexual life.
Sexual dysfunction in women might be related to the menopausal status and the negative impact of menopause on sexuality [21, 22]. A study in American women aged 30 to 70 years who had been in stable relationships for more than 3 months concluded that the prevalence of low sexual desire is higher in menopausal women than in premenopausal women . Another study assessing the prevalence of sexual dysfunction in premenopausal women showed that, compared to the control group, those with the metabolic syndrome had reduced sexual function . The associations between sexuality, hyperglycemia, elevated body weight, and the metabolic syndrome are also strong in menopausal women .
Relationships between hyperglycemia and higher BMI and lipid abnormalities were observed in several studies [26–28]. Despite the fact that 48% of the participants in the current study had BMI values higher than 30 kg/m2, the BMI variable was not a statistically significant confounder. Our results are based on self-reporting, and physical health and culture may have influenced the responses to sensitive questions on sexuality. It is important to note that, due to cultural and religious values, individuals with an Assyrian/Syrian ethnic background were presumed to only have a sexual life within the context of marriage .
Assyrians/Syrians are an ancient ethnic group from Mesopotamia. The Christian religion is one of the important parts of their identity . The majority of the participants in the present study accepted their diabetes as being sent by God and the separation from or loss of a life partner was not followed by another partner. “We do not do that”, said the separated woman when we asked whether she had a sexual partner or not. Perhaps this was one of the reasons for the proportion of Assyrians/Syrians who responded to this question being smaller compared to the proportion of Swedish-born participants. On the other hand, patients’ perceptions of sex and sexual practices may be individual. This might be investigated more deeply using valid and standardized scales on sexual life and sexual function.
Strengths and limitations
This study has several strengths. Registration by ethnicity does not occur in the official Swedish statistics, where immigrants are identified according to country of birth, parents’ country of birth, and/or citizenship. A unique feature of this study is the use of data on self-reported ethnicity and its main strength is that it is the first study of sexual life in Assyrians/Syrians with type 2 diabetes. Another strength of this study is the inclusion of patients from several health care centers; the sample can therefore be considered highly representative of Assyrians/Syrians in Södertälje.
One limitation of the study is that the instrument used to explore sexual dysfunction has not been validated. Another limitation is that it assessed Assyrian/Syrian patients with type 2 diabetes living in one town and the results cannot therefore be generalized to the entire Assyrian/Syrian population with diabetes in Sweden. A third limitation is that the cross-sectional nature of the study and the relatively small sample size precluded the possibility of drawing extensive causal conclusions.