Effect of Intim-DM Model on Sexual Dysfunction in Type 2 Diabetes Patients
DOI:
https://doi.org/10.37287/ijghr.v8i6.2683Keywords:
diabetes mellitus, nursing intervention, PLISSIT, primary care, sexual dysfunction, sexual health educationAbstract
Sexual dysfunction is among the most frequently overlooked complications of type 2 diabetes mellitus. Chronic hyperglycaemia produces vascular damage, peripheral neuropathy, hormonal disturbance and psychosocial distress, yet stigma and limited provider competence keep the issue outside routine diabetes care in primary health services. To analyse the effect of the INTIM-DM (Integrated Intimacy Education for Diabetes Mellitus) model, an integrated sexual education model operationalised through the PLISSIT stages, on sexual dysfunction among productive-age patients with type 2 diabetes mellitus. A quasi-experimental study with a one group pretest-posttest design was conducted at Limboto Community Health Centre, Gorontalo Regency, Indonesia, from October to December 2025. Forty-four productive-age patients were recruited through purposive sampling. Sexual function was measured with the International Index of Erectile Function (IIEF) in 8 male respondents and the Female Sexual Function Index-6 (FSFI-6) in 36 female respondents, before and after three small-group education sessions delivered over three weeks. Both are validated Indonesian versions (IIEF-5: item validity r = 0.70-1.00, Cronbach's α = 0.828, Cohen's κ = 0.879; FSFI-6: item-total correlation > 0.3, Cronbach's α = 0.831). Data were analysed using the Wilcoxon Signed Ranks Test and the paired t-test in SPSS version 26. At baseline, 37 of 44 respondents (84.1%) showed sexual dysfunction. Among women, the Wilcoxon test produced Z = -5.061 with p = 0.000; 33 respondents (91.67%) recorded higher FSFI-6 scores, none recorded lower scores and 3 were unchanged. Among men, mean IIEF scores rose from 16.50 ± 6.02 to 19.63 ± 4.63, a mean difference of 3.125 (95% CI 1.681-4.569), t = -5.118, df = 7, p = 0.001, while the normal category rose from 25.0% to 50.0%. The INTIM-DM model significantly improved sexual function in both male and female patients with type 2 diabetes mellitus. Structured sexual education is feasible for nurses in primary care and merits integration into chronic disease management programmes.
References
Abdelkhaliek, N. A. A., Ramadan, S. A., Ibrahim, S. S., Mohamed, M. R. A., & Elshabory, N. E. M. (2024). Effect of counseling model on diabetic women regarding sexual dysfunction: A quasi-experimental study. BMC Public Health, 24(1), 1161. https://doi.org/10.1186/s12889-024-18585-9
Annon, J. S. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of Sex Education and Therapy, 2(1), 1-15. https://doi.org/10.1080/01614576.1976.11074483
Bijlsma-Rutte, A., Nijpels, G., Braamse, A. M. J., van Oppen, P., Snoek, F. J., Enzlin, P., Leusink, P., & Elders, P. J. M. (2020). A PLISSIT-model intervention in people with type 2 diabetes with sexual problems: Results from a cluster-randomized controlled trial in primary care. JSM Sexual Medicine, 4(1), 1-10. https://doi.org/10.47739/2578-3718/1023
Damayanti, D., Sari, Y. I. P., Chloranyta, S., Ayubana, S., Adriati, F., Wijayanti, S., & Yuliastuti, F. (2023). Efektivitas konseling seksual model PLISSIT terhadap fungsi seksual perempuan dengan kanker payudara: Literatur review. Malahayati Nursing Journal, 5(4), 1130-1145. https://doi.org/10.33024/mnj.v5i4.8272
Gebeyehu, N. A., Gesese, M. M., Tegegne, K. D., Kebede, Y. S., Kassie, G. A., Mengstie, M. A., Zemene, M. A., Bantie, B., Feleke, S. F., Dejenie, T. A., Abebe, E. C., Anley, D. T., Dessie, A. M., Bayih, W. A., & Adela, G. A. (2023). Global prevalence of sexual dysfunction among diabetic patients from 2008 to 2022: Systematic review and meta-analysis. Metabolism Open, 18, 100247. https://doi.org/10.1016/j.metop.2023.100247
Hadibrata, E., Sutyarso, S., & Sumardi, S. (2023). Disfungsi ereksi pada pasien diabetes: Apa yang terjadi pada enzim nitric oxide synthetase (NOS) dan produksi nitric oxide (NO). Universitas Lampung.
International Diabetes Federation. (2024). IDF diabetes atlas (11th ed.). International Diabetes Federation.
Ismail, S. A., Abdel-Azim, N. E., Saleh, M. A., Mohamed, A. A., Yosef, A. H., & Abbas, A. M. (2021). A new grading system for female sexual dysfunction based on the female sexual function index in Egyptian women: A cross-sectional study. Middle East Fertility Society Journal, 26(1).
Karimi, F., Babazadeh, R., Asgharipour, N., Esmaily, H., & Roudsari, R. L. (2019). The effectiveness of counseling using PLISSIT model on depression, anxiety and stress among postpartum women with sexual dysfunction: A randomized trial. Journal of Midwifery and Reproductive Health, 7(4), 1922-1930. https://doi.org/10.22038/jmrh.2019.36434.1399
Laksita, T. B., Kloping, Y. P., Hakim, L., & Rizaldi, F. (2021). Translation validity and reliability of the Indonesian version of the 5-item International Index of Erectile Function (IIEF-5). Turkish Journal of Urology, 47(6), 489-494. https://doi.org/10.5152/tud.2021.21185
Manurung, M. A., & Rahardjo, H. E. (2023). Association of perceived male sexual dysfunction and sexually transmitted disease to female sexual function among Indonesian women. Medical Journal of Indonesia, 32(1), 52-57. https://doi.org/10.13181/mji.oa.236696
Mehrabi, M., Lotfi, R., Rahimzadeh, M., & Merghati Khoei, E. (2019). Effectiveness of sexual counseling using PLISSIT model on sexual function of women with type 2 diabetes mellitus: Results from a randomized controlled trial. International Journal of Diabetes in Developing Countries, 39(4), 626-632. https://doi.org/10.1007/s13410-019-00726-1
Moch Rizal, D. (2021). Diabetes mellitus dan gangguan fungsi seksual. Jurnal Kedokteran dan Kesehatan, 4(5).
Murphy, J. C., Cooke, D., Griffiths, D., Setty, E., & Winkley-Bryant, K. (2024). Asking women with diabetes about sexual problems: An exploratory study of NHS professionals' attitudes and practice. Diabetic Medicine, 41(8), e15370. https://doi.org/10.1111/dme.15370
Ponholzer, A., Temml, C., Mock, K., Marszalek, M., Obermayr, R., & Madersbacher, S. (2005). Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire. European Urology, 47(1), 80-86.
Savan, C., Viroja, D., & Kyada, A. (2024). An updated review on diabetes mellitus: Exploring its etiology, pathophysiology, complications and treatment approach. IP International Journal of Comprehensive and Advanced Pharmacology, 9(1), 31-36. https://doi.org/10.18231/j.ijcaap.2024.005
Sesari, S. S., Elvira, S. D., Priyatini, T., & Rahardjo, H. E. (2022). A cross-sectional analysis in order to validate the translation of FSFI-6 to Bahasa Indonesia. F1000Research, 11. https://doi.org/10.12688/f1000research.110278.1
Tuncer, M., & Oskay, U. Y. (2023). Effect of sexual counseling on sexual function and sexual quality of life for women undergoing open heart surgery: A pilot randomized controlled trial. Sexuality and Disability, 41(2).
World Health Organization. (2024). Diabetes fact sheet. World Health Organization.
Youssef Abd-Ella, N., Hessin, E., Heggy, Y., & El-Kurdy, R. (2019). Effect of PLISSIT based sexual counseling model on sexual dysfunction among diabetic pregnant women. Egyptian Journal of Health Care, 10(3), 363-378. https://doi.org/10.21608/ejhc.2019.169728
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