Poor Glycaemic Control Tracks with Female Sexual Dysfunction in Nigerian Diabetes Clinics
Female sexual health rarely sits at the center of diabetes care, yet the signal in this study was hard to miss. Among 180 premenopausal women with diabetes attending two tertiary clinics in northern Nigeria, female sexual dysfunction was identified in 51.7% of participants, using the Female Sexual Function Index cutoff of 26 or less.
The association that stood out was not hormonal. Women with suboptimal glycaemic control, defined by HbA1c above 7.0%, had higher odds of sexual dysfunction than those with better control, with an adjusted odds ratio of 2.80. In the domain-specific analyses, poor glycaemic control also lined up with lower orgasm scores and lower satisfaction scores, two measures that matter directly in day-to-day sexual well-being and relationship quality.
The study adds local evidence to a question that has remained underexamined in sub-Saharan Africa: whether chronic hyperglycaemia carries a measurable sexual health burden for women beyond the familiar vascular and neurologic complications. In this cohort, it did. The pattern is biologically plausible. Long-standing diabetes can impair genital blood flow, disrupt nerve signaling, and affect lubrication and arousal, all of which can erode sexual response even in women who remain premenopausal and menstruating regularly.
One result cut against a common assumption. Reproductive hormone measures did not show statistically significant associations with female sexual dysfunction or with any FSFI domain score.
Hormone Panels Did Not Explain the Sexual Function Signal
The investigators measured several reproductive hormones at phase-specific points in the menstrual cycle: FSH, LH, oestrogen, testosterone, prolactin, and progesterone. Despite that careful timing, none of these markers was significantly associated with the presence of female sexual dysfunction in the final models. None of the hormone values was linked to the FSFI domain scores either.
That finding shifts the clinical focus. In this sample, the sexual function burden did not appear to be explained by an obvious endocrine imbalance. Instead, the more consistent relationship was with metabolic control. For clinicians, that matters because it points toward an intervention pathway already embedded in diabetes care: tighter glycaemic management.
The biology fits the outcome. Sexual response in women depends on intact sensory input, autonomic function, vascular relaxation, and adequate genital blood flow. Diabetes can disturb all of those systems. Microvascular disease can blunt tissue perfusion, peripheral neuropathy can dull genital sensation, and autonomic dysfunction can interfere with arousal and lubrication. In that setting, a normal hormone panel does not rule out a diabetes-related cause.
The study did not show that hormone testing has no role in all women with sexual symptoms. It showed something narrower and more clinically useful: in these premenopausal women with diabetes, measured reproductive hormones did not account for the dysfunction observed. The stronger association was metabolic.
Why This Matters for Routine Diabetes Care
The women in this study were aged 18 to 45 years, sexually active, and had regular menstrual cycles. They were recruited from endocrinology clinics at Aminu Kano Teaching Hospital and Murtala Muhammad Specialist Hospital in Kano between December 2024 and June 2025. Those selection criteria matter because they focus the findings on women who might otherwise be assumed to have preserved sexual function simply because they are premenopausal.
They did not.
More than half screened positive for sexual dysfunction, a rate that should prompt clinicians to ask whether sexual health is being ignored during diabetes follow-up. In many settings, consultations for diabetes concentrate on glucose logs, medication adherence, eye exams, renal risk, and neuropathy screening. Sexual symptoms are often left unspoken unless a clinician asks directly. The data here suggest that silence may be costly.
The study also carries practical value because it comes from a setting where evidence has been limited. Sexual dysfunction research in diabetes has focused far more heavily on men, leaving a gap in the understanding of women’s experiences, especially in Africa. This report helps fill part of that gap by linking a common complication of diabetes to a measurable and validated sexual function instrument.
There are limits, and they are important. The design was cross-sectional, so the analysis can show association, not causation. Convenience sampling was used, which is understandable in a clinic-based sexual health study but still restricts how broadly the findings can be generalized. The participants were drawn from tertiary centers, so the results may not reflect women managed in primary care or those who never reach specialist services. Self-reported sexual function can also be affected by distress, cultural norms, and reluctance to disclose intimate concerns.
Even with those constraints, the central message is consistent: in this cohort, suboptimal glycaemic control was linked to female sexual dysfunction, while reproductive hormone measures were not. The clinical implication is direct. Better glucose control may do more than reduce microvascular and macrovascular risk; it may also protect sexual function or at least reduce one contributor to its decline.
For women living with diabetes, sexual health should not remain an optional conversation. For clinicians, this study offers a concrete prompt to ask about desire, arousal, orgasm, pain, and satisfaction when glycaemic control is drifting upward. The unanswered question is how much of this burden can be reversed with improved metabolic management alone, and whether longer follow-up would show a shift in sexual function as glycaemic control improves over time.