Sexual Function and Dysfunction among Patients with Systemic and Auto-Immune Diseases

Abstract

1. Summary Systemic autoimmune diseases affect various organs and they can determine sexual dysfunction in females and males patients particularly with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren syndrome (SS), antiphospholipid syndrome, Behçet’s disease and other vasculitis. Sexual dysfunction among patients with rheumatic diseases is multifactorial due to disease-related factors (chronic disease aspects, disease activity) as well as therapy. There is little data regarding the impact of these diseases and treatments, mainly with large population, on sexual function. In rheumatoid arthritis patients, sexual dysfunction is principally associated with pain and depression. In patients with SLE, Sjögren’s syndrome and systemic sclerosis, vaginal discomfort or pain during intercourse could be the principal factors contributing to sexual dysfunction. Sexual dysfunction is probably associated with psychological status and neurological involvement in patients with BD. This systematic review synthesizes the current literature concerning sexual function and dysfunction in patients with systemic and auto-immune diseases. Our attention was directed specifically on the sexual function and dysfunction of patients affected by SLE, systemic Sclerosis, primary Sjogren syndrome, antiphospholipid syndrome and Behçet’s disease. 2. Introduction Sexuality is a complex aspect of the human being’s life and is closely associated to the quality of life (QoL). Sexuality has been cited as an important part of the whole person, and sexual expression has been described as a crucial part of personal’s self-identity [1]. Normal sexual functioning is important for healthy and all individuals and consists of sexual activity with transition through the phases from arousal to relaxation with no problems, and with a feeling of pleasure, and satisfaction [2,3]. Sexual dysfunction refers to a term that encompasses problems that affect any phase of sexual responses. Sexual dysfunction in females mainly includes desire, arousal, orgasmic, as well as sexual pain disorders whereas males encounter erectile dysfunction, diminished libido, and abnormal ejaculation [4,5]. Systemic autoimmune diseases affect various organs and they can determine sexual dysfunction in patients particularly with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren syndrome (SS), Behçet’s disease (BD) and other vasculitis. Sexual dysfunction among patients with rheumatic or systemic auto-immune diseases is multifactorial due to disease-related factors (chronic disease aspects, disease activity) and drugs. Many factors including pain, stiffness, fatigue, functional impairment, negative body image, reduced libido, hormonal imbalance, depression and anxiety, contribute to reduce an individual’s sexual interest and lead to a less active and enjoyable sex life [6]. Because of sexuality may be a taboo subject to many people, sexual health is rarely addressed by health professionals during routine consultations and is rarely proactively reported by patients. In other hand, sexual dysfunction can cause frustration and distress