Response to Comment on: Wing et al. Effect of Intensive Lifestyle Intervention on Sexual Dysfunction in Women With Type 2 Diabetes: Results From an Ancillary Look AHEAD Study. Diabetes Care 2013;36:2937–2944

Our recent publication (1) focuses on the changes in sexual function that occurred in overweight or obese individuals with type 2 diabetes who were randomly assigned to intensive lifestyle intervention or a comparison condition. The primary finding was that the intensive lifestyle intervention had positive effects on those women who reported sexual dysfunction at baseline. Although data are presented on the prevalence of sexual dysfunction in this cohort at baseline, the primary goal of the study was not to provide a precise estimate of the prevalence of sexual dysfunction in obese women with diabetes. The limited sample size and the extensive selection criteria raise concerns about using these data to estimate prevalence of sexual dysfunction in the general population of women with diabetes. Thus, we were surprised by the comment by Maiorino et al. (2), which focuses entirely on the prevalence estimates. Moreover, although neither our trial, nor previous studies cited (3,4), used representative samples, the prevalence of sexual dysfunction in each of these reports was high, ranging from 50 to 60%. Rather than focusing on the slight differences between these studies, the important point appears to be that the prevalence of sexual dysfunction is high in these samples of women with diabetes. As discussed in our article, we agree with the point that sexual inactivity may be a response to sexual dysfunction. However, we also note that the female sexual function index (5) is designed to assess sexual dysfunction inwomenwho are sexually active. Moreover, we feel it is most appropriate to use 26.55 as the cutoff as this is the empirically validated cutoff value. Given the fact that sexual dysfunction is common in women with diabetes, our study suggests that lifestyle intervention may be beneficial for these individuals.