Abstract Background: Female sexual dysfunction (FSD) is an important sexual-health concern among women with diabetes. This systematic review synthesized evidence on the prevalence, affected sexual-function domains, associated factors, and healthrelated quality of life (HRQoL) among women with diabetes in low- and middle-income countries (LMICs). Methods: The review followed PRISMA 2020 guidelines. OpenAlex, Taylor & Francis Online, PubMed/MEDLINE, and ScienceDirect were searched for studies published from January 2000 to 15 August 2026. Eligible quantitative studies involved adult women with diabetes in LMICs and reported FSD, sexual-function domains, associated factors, or HRQoL. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Findings were synthesized narratively because of clinical and methodological heterogeneity. Results: Thirty studies were included. Reported FSD prevalence ranged from 25.6% to 92.7%. The most frequently affected domains were sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/dyspareunia. Factors associated with FSD included older age, longer diabetes duration, menopause, depression, obesity, hypertension, diabetes-related complications, vascular disease, and genitourinary conditions. Two studies directly assessed HRQoL using the SF-36 and the Sexual Quality of Life Questionnaire for Women, respectively. Both reported poorer quality of life among women with impaired sexual function. One additional study described reduced quality of life without quantitative assessment. Conclusion: FSD was frequently reported among women with diabetes in LMICs, with considerable variation in prevalence across studies. The findings indicate that FSD is associated with several demographic and clinical factors and may adversely affect quality of life. Routine assessment of sexual health and further research using standardized diagnostic criteria and validated HRQoL instruments are warranted.

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