Prevalence and factors associated with sexual autonomic dysfunction among type 2 diabetes mellitus patients in Zanzibar

Type 2 diabetes mellitus (T2DM) is frequently complicated by autonomic neuropathy, which impairs sexal function. Sexual dysfunction (SD) is common in T2DM but remains under-recognized due to stigma and lack of screening. Evidence shows higher rates of erectile dysfunction in men and arousal or orgasmic disorders in women with T2DM compared to the general population. However, data on the burden and factors associated with sexual autonomic dysfunction (SEAD) in T2DM are limited in Zanzibar, prompting this study to investigate the prevalence and associated factors. A cross-sectional study was conducted at Mnazi Mmoja Hospital in Zanzibar. A total of 364 patients with type 2 diabetes mellitus (T2DM) were selected through systematic random sampling. Socio-demographic and lifestyle data were collected using a standardized questionnaire, while physical and biochemical measurements, including BMI, blood pressure, HbA1c, and lipid profile, were obtained following standard procedures. Sexual autonomic function was assessed using the Composite Autonomic Symptom Score (COMPASS) questionnaire. Factors associated with sexual autonomic dysfunction were analyzed using modified Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) with 95% confidence intervals were reported. The prevalence of sexual autonomic dysfunction (SEAD) was 15.9%. In the multivariable analysis, low income (aPR = 3.05, 95% CI: 1.18–7.87, p = 0.021), sedentary lifestyle (aPR = 0.18, 95% CI: 0.10–0.31, p < 0.001), and use of nutritional supplements (aPR = 0.49, 95% CI: 0.30–0.82, p = 0.006) remained independently associated with SEAD. However, the association with sedentary lifestyle should be interpreted cautiously because only 7 participants (1.9%) were classified as active. Sexual autonomic dysfunction (SEAD) was found to be among the complications of T2DM in Zanzibar. These findings highlight the need to screen patients early and implement risk-based interventions in diabetes care. Targeting modifiable lifestyle and socioeconomic factors may help prevent progression and improve quality of life.