Female Sexual Dysfunction Across Diabetes Types Compared to Non-Diabetic Controls: A Systematic Review and Meta-Analysis

To compare Female Sexual Function Index (FSFI) scores between women with Type 1 or Type 2 diabetes mellitus (DM) and non-diabetic controls, PubMed, Scopus, Web of Science, and Cochrane were searched through March 2026. Observational studies using the FSFI with non-diabetic controls were eligible. A random-effects meta-analysis (REML) was conducted using the standardized mean difference (SMD), with subgroup analyses by diabetes type and menopausal status. Sixteen studies (N = 3,261) from 9 countries were included. Diabetic women had lower FSFI scores than controls (SMD = −0.764, 95% CI [−1.042, −0.486], p < .001)—a medium-to-large effect. Heterogeneity was very high (I² = 91.65%) and the 95% prediction interval (−1.853 to 0.325) crossed zero. The effect was numerically larger in Type 1 (SMD = −0.994) than Type 2 DM (SMD = −0.627), though the subgroup difference was nonsignificant (p = .498). Menopausal status moderated the effect (p = .043): premenopausal samples (SMD = −0.911) versus mixed-status samples (SMD = −0.434). No clear funnel plot asymmetry was observed, though tests were underpowered. Diabetes is associated with reduced female sexual function, but very high heterogeneity and a prediction interval crossing zero warrant cautious interpretation.