Sexual dysfunction (SD) is a common complication among men living with diabetes (MLWD), which adds to stresses induced by medical condition. Effect of stress on their daily living activities has been only poorly described.
This study aimed to explore the behaviour and challenges of MLWD experiencing SD in respect of daily living activities.
Five clinics in Senwabarwana in Limpopo province.
Qualitative approach and phenomenological exploratory design were adopted to collect data from 15 male participants selected from five clinics using purposive homogeneous sampling. One-on-one interviews were conducted using voice recorders, and field notes were taken of non-verbal cues. Unstructured interview guide with principal question enabled instructive probing to be conducted. Data were analysed using eight steps of Tesch’s inductive, descriptive and open coding technique.
Participants reported stressful experiences, difficulty coping with diabetes and its accompanying complication of SD that led to fear of losing their wives. They indicated that as a result of stress and difficulty in coping with the condition, they were engaged in less physical activity than before their diagnosis.
Sexual dysfunction is prevalent among male diabetics and often feel stressed and worried about losing their wives. They struggle to cope with conditions to the point where they are less capable of performing tasks than they were before diagnosis. These outcomes are critical issues that should be addressed in any diabetes treatment strategy.
Support-based collaboration of healthcare providers with spouses and revision of South African diabetes management strategy to incorporate healthy coping strategies are recommended.
A total of 537 million men and women aged 20–79 years are reported to be diagnosed with diabetes
Sexual dysfunction (SD) is a serious complication of diabetes mellitus
Sexual health is a major component of human well-being. Sexual fulfilment and satisfaction are positively correlated with quality of life (QoL).
The literature on the subject revealed that MLWD commonly experience SD, resulting in poor or a lack of sexual fulfilment, which ultimately affects all aspects of their daily lives and increased stress.
A qualitative method and phenomenological exploratory descriptive study design was applied, in which 15 participants (MLWD with SD) were interviewed individually, to explore their experiences and performance of daily living activities.
The study was conducted in the rural Blouberg municipality in Senwabarwana, Capricorn District, Limpopo province, South Africa. The municipality supports 22 clinics, two health centres, four mobile clinics and one hospital. The clinics are divided into four sections, with two clinics from each area being purposefully sampled; however, in area 1, three clinics were sampled because of the high number of clinics with diabetes patients. There were five clinics included in all. Most persons residing in the Senwabarwana area observe a Sepedi culture. The customs of the Sepedi people are distinctive and fascinating. The philosophy of humanity, or
A total of 15 male diabetics experiencing SD were purposively sampled from selected clinics in the Blouberg municipality. Data saturation was reached at participant 12; however, additional three participants were sampled for confirmation and added no new information; hence data collection was ceased. The sample was dependent on data saturation having been reached. Only male diabetics who had lived with diabetes for six or more months and were older than 18 years were included, because they can share lived experiences reliably and give consent to being interviewed.
The data were collected through unstructured interviews using voice recorders and field notes taken of non-verbal cues observed. The interviews were conducted in Sepedi, which is a dominant language in the area and translated into English by language translator before transcripts were submitted to independent coder for analysis. The principal question for the interview was: ‘
A measure of rigour was ensured through trustworthiness by researchers observing credibility, transferability, confirmability and dependability.
Prolonged engagement was applied through the use of first author, that is, Mphasha was responsible for data collection, and worked as a dietitian at the only hospital in Blouberg, which provides service delivery through outreach to the clinics. The researcher is known in the area and also stayed in the field for an extended period to build trust and rapport with the participants. For triangulation, researchers used both interviews and observations in the collection of data, which complemented each other in gaining insights. Member checks was ensured and thorough follow-up interviews were conducted with participants for confirmation after data analysis.
Data saturation was ensured through collection of data until saturation was reached, which was achieved after 12 individual interviews. An additional three were sampled to confirm the findings. A detailed description was carried out through outlining fully describing study setting, target population and methodology for other researchers to conduct similar study in different setting.
Peer review was ensured through the use of independent coder who also analysed data. The researcher independently coded and recoded data and also developed themes. This ultimately led to a consensus meeting of the researcher and the coder for confirmation of the findings. Neutrality was ensured through researcher remaining neutral and was not emotional throughout the data collection and prolonged engagements.
The researchers adhered to the fully described methods during data collection. Reliance on data collection tools, independent coder and supervisors was carried out through relying on performed interview guide, voice recorders, supervisors and independent coder.
All interviews were audio-taped and then transcribed. The researchers used the services of a language translator to turn interviews conducted in Sepedi into English before analysis. Subsequently, all researchers analysed the verbatim transcripts independently and further procured the services of an independent coder. All researchers and the coder met in a consensus meeting and agreed on themes and sub-themes based on the ones that emerged when independently analysing the transcripts of interviews. Participants’ direct quotations were captured to support findings. Data were analysed using the eight steps of Tesch’s open coding qualitative data analysis method by Creswell.
This study is part of bigger study approved by Turfloop Research and Ethics Committee (No. TREC/35/2019: PG) and permission to conduct this study was granted by Limpopo Department of Health (ref: LP 201903-007) to access patients in the clinics. This article focuses on exploring experiences and challenges of performing ADL among diabetic men with SD. All participants provided written informed consent. Participation was voluntary, and participants of their right to withdraw from the study at any stage without penalty. Privacy and confidentiality of the participants data were also maintained.
Socio-demographic profile of participants.
| Participant no. | Age (years) | Education | Time living with diabetes | Economic status | Relationship status |
|---|---|---|---|---|---|
| 1 | 60 | Secondary | 5+ years | Pensioner | Married |
| 2 | 65 | Secondary | 5+ years | Pensioner | Married |
| 3 | 63 | Tertiary | 10+ years | Pensioner | Married |
| 4 | 64 | Primary | 5–6 years | Pensioner | Married |
| 5 | 58 | Primary | 15 years | Unemployed | Married |
| 6 | 47 | Primary | 2 years | Unemployed | Married |
| 7 | 69 | Primary | 23 years | Pensioner | Married |
| 8 | 73 | Primary | 5 years | Pensioner | Married |
| 9 | 80 | Primary | 18 years | Pensioner | Married |
| 10 | 84 | None | Since 1990s | Pensioner | Married |
| 11 | 56 | Secondary | 8 months | Unemployed | Married |
| 12 | 54 | Tertiary | 5 years | Unemployed | Married |
| 13 | 52 | Secondary | 3+ years | Unemployed | Married |
| 14 | 61 | Tertiary | 14 years | Pensioner | Married |
| 15 | 56 | Secondary | 4 years | Employed | Married |
Living with diabetes and SD bring a psychological burden and may impact diabetes management, overall well-being and QoL. Participants described experiences of living with diabetes, as evident in the following sub-themes:
‘I also developed hypertension and diabetes-associated sexual dysfunction. This stresses me and makes me have sleepless nights even though, as a man, I’m adhering to health advice from healthcare professionals.’ (Participant 1, 60 years old, pensioner)
‘I really don’t know how to survive with this disease, which does not have a cure. I don’t sleep because it has been a long time now without having good sex with my wife. I’m afraid this will finish me.’ (Participant 4, 64 years old, pensioner)
‘Since my wife and I haven’t had real sex in years, I’ve been having trouble sleeping. I worry about where my wife gets her sexual pleasure.’ (Participant 12; 54 years old, unemployed)
‘I’m 10 years older than my wife; and still have appetite for sex; my wife too has an appetite for sex as she is still younger. I’m unable to give her that pleasure she needs and deserves. I’m likely to lose my wife I married for many years, if nothing changes.’ (Participant 4, 64 years old, pensioner)
‘Inability to have sex with my wife brought me a lot of stress. Though my wife and I are done with having kids, we were doing sex for fun. However, nowadays we cannot have fun and I’m afraid she may get someone to have fun with, which may lead to her divorcing me.’ (Participant 5, 58 years old, unemployed)
‘I might lose my wife to whoever she is getting sexual pleasure from, even though I’m not sure if she does. Sex is vital and she is younger. I still need sex as well. I love her and don’t want to lose her because build family with her. Anyway, if she can leave me, I will have no one since I’m no longer capable of sexually satisfying any woman.’ (Participant 12, 54 years old, unemployed)
‘Sometimes I feel like I should just die and rest, because I no longer enjoy anything. Inability to sexually satisfy the woman you married is very overwhelmingly.’ (Participant 5, 58 years old, unemployed)
‘I’m overwhelmed; I really cannot do anything. I’m always asking myself questions as to where will I end. I see no value in living because I cannot satisfy my wife sexually. I feel I will be better off if I’m dead.’ (Participant 6, 47 years old, unemployed)
‘I enjoy nothing, and I feel like I’m a lesser man because of my inability to satisfy my wife sexually. This stress will kill me more than diabetes because every second of my life I ask myself questions like, why should I live if I cannot have fun with my wife through sex; I’m no longer productive at work, too.’ (Participant 15, 56 years old, employed)
Participants expressed challenges of living with diabetes and SD, which includes inability to perform work usually before diagnosis and as a result engaged in less physical activity. This is evident in the following sub-theme:
‘I’m always weak; I no longer walk the longer distances I used to. I can’t perform heavy duties or even work for a prolonged time without resting many times.’ (Participant 5, 58 years old, unemployed)
‘I am unable to do hard labour because of body weakness and dizziness, which I used to do before diagnosis. I used to work at the farms doing hard labour before diagnosis.’ (Participant 6, 47 years old, unemployed)
‘I am no longer working like before I was diagnosis, in fact I just wakeup eat, sleep again or sit under a shade.’ (Participant 8, 73 years old, pensioner)
The aim of this study was to record the experiences and performance of ADL among men, living with diabetes and reporting SD, in rural areas of Limpopo. The authors learned that their study subjects are stressed, fear losing their wives and had difficulty coping with their conditions. Moreover, the study sample indicated that they are engaged in less physical activity because of their inability to perform duties carried out before their diagnosis as diabetics.
Participants reported experiencing stress brought on by diabetes and SD. The findings are consistent with a qualitative study conducted in three other parts of sub-Saharan Africa namely, Cape Town, Johannesburg and Lilongwe – which highlighted that sexual problems are serious complications of diabetes and are often accompanied by psychological issues.
Our study population indicated that they have sleepless nights because of fear of losing their wives to other men as a consequence of their inability to engage in sexual activities. Moreover, diabetics are exposed to various other fears related to diagnosis, treatment, expected impact, prognosis and daily management of the condition.
The study’s interviewees expressed difficulty coping with their diabetes diagnoses and sexual issues. Despite the fact that family is supportive, it became clear through probing that there is still a lack of coping among males with diabetes. Coping is defined as a psychological process developed at a conscious level and used to manage difficult and stressful situations in life.
The interviewees in this study reported that they are engaged in less physical activity than previously because of the disruption of ADL. It was also found that the prevalence of stress among diabetics is linked with deterioration in their QoL and functionality, as reported elsewhere.
Most care of MLWD happens at home
The findings of this study are based on a relatively small sample of 15 males living with diabetes in Senwabarwana in Limpopo province. However, the authors believe that they are broadly applicable to other populations in similar circumstances elsewhere.
This study establishes that MLWD and experiencing SD are stressed because of their state of health and inability to satisfy their partners sexually. Moreover, MLWD suffering SD fear losing their wives to other men and have difficulty in coping with these circumstances. Hence, the authors consider stress to be a critical issue among diabetic men. It is recommended that the South African department of health revise its strategy for the treatment of diabetes, and incorporate healthy coping methods. The coping methods should be benchmarked, adapted, and adopted as a key element in its management. Conversely, a study regarding obstacles to healthy coping should be conducted. The support-based collaboration of healthcare providers with spouses of MLWD and experiencing SD is encouraged to ameliorate their condition.
This article is partially based on the author’s PhD thesis in Public Heath at the University of Limpopo, South Africa with supervisors Prof. T.M. Mothiba and Prof. L. Skaal.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
M.H.M. was the project leader, responsible for data collection and interruption, and he contributed to the writing of this article. T.M.M. and L.S. supervised the data collection, interpretation and co-authored the article. The final manuscript was approved by all the authors.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
This article is based on the data collected from diabetes patients in Blouberg Municipality, Senwabarwana area of Limpopo Province, South Africa. The data generated or analysed during this study is not publicly available.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.