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Sexual dysfunction is widely recognized as increasing with age in the general population (4-6, 42, 43). In this context, Lindau et al. (42) reported the prevalence of sexual activity, behaviours, and problems in a national sample of 3,005 US adults (1,550 women and 1,455 men) aged 57-85 years, recruited between July 2005 and March 2006. Although the prevalence of sexual activity declined with age, many older adults remained sexually active. Within the analysed population, women were less likely than men to have an intimate relationship and to be sexually active at all ages. Among respondents who were sexually active, about half of both sexes reported at least one bothersome sexual problem, with low sexual desire (43%), difficulty with vaginal lubrication (39%), and inability to climax (34%) the most prevalent problems among women. Women with diabetes were less likely to be sexually active (OR: 0.61, 95% CI: 0.46-0.81) than those without.

Data regarding a potential pathophysiologic correlation between age and impaired SF among women with diabetes are controversial, with most not showing any significant detrimental association (9, 19, 21, 23, 25, 37, 38, 40, 41). For instance, in their case-control survey on DM1, Enzlin et al. observed that women with SD were not significantly different for age, BMI, duration of diabetes, or

HbA1c compared with those without SD (19, 26). In the same study, the subanalysis of women with diabetes either with or without complications did not reveal significant differences for age (p = 0.28 and 0.36, respectively). Similar findings were also reported by Doruk et al. (38) in their subanalysis of their subset of women with DM1.

In contrast, Erol et al. noted that the incidence of all reported SDs was significantly higher in DM2 women than in age-comparable controls (40). Likewise, data from Nigeria supported this finding: age was a significant determinant (p = 0.003) of the FSFI among DM2 women (41). Indeed, women who were younger than 40 years reported a mean FSFI total score of 30.67 ± 8.4, while those above that age had a mean score of 18.36 ± 7.4 (p = 0.001).

Overall, the scientific literature lacks a well-designed, multinational, prospective survey aimed at assessing the impact of the ageing process on SF in women with diabetes.

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