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Both women and men with various types of inflammatory arthritic conditions commonly experienced sexual dysfunction, a systematic review of the literature found.

Among women included in 15 studies, mean scores on the Female Sexual Function Index (FSFI) in all patient groups were below the threshold for sexual dysfunction of 26.55, according to Andrew M. Briggs, PhD, of Curtin University in Perth, Western Australia, and colleagues.

And among men included in seven studies, all had mean scores on the International Index for Erectile Function (IIEF) below 25, the cutoff considered to represent erectile dysfunction, the researchers reported in .

"Our review identified that many types of inflammatory arthritis have substantial impacts on sexual function and intimate relationships. These issues are sensitive in nature and commonly addressed poorly in clinical practice as they may be embarrassing for the clinician and/or the patient to raise," the researchers wrote.

It may be difficult for healthcare providers to address these concerns, particularly early in disease when the primary focus is on complex active disease management and establishment of rapport. Nonetheless, "as sexual health is an important component of well-being, raising clinician and patient awareness of sexual dysfunction associated with inflammatory arthritis could facilitate the provision of more holistic care," Briggs and colleagues concluded.

Previous work suggests that up to 70% of patients with rheumatoid arthritis experience impaired sexual function relating to their disease, but most have never discussed this with a healthcare professional.

However, few studies had examined sexual function among patients with other types of inflammatory arthritis (such as psoriatic arthritis and spondyloarthritis) or among men, with most research having focused on women.

Briggs and colleagues therefore undertook a systematic review of publications through 2018, identifying 55 studies that were based on patient-reported questionnaires, focus groups, or semi-structured interviews.

Sixteen studies included patients with rheumatoid arthritis, 16 focused on patients with ankylosing spondylitis, nine were of patients with Sjogren's syndrome, five were of patients with systemic lupus erythematosus, and the remainder included mixed inflammatory conditions. Mean disease duration across the studies ranged from 3.3 to 19 years, and sample sizes ranged from ten to 1,272 patients.

In 13 of the studies that measured FSFI among women, comparisons were made with controls, and in most, scores among arthritis patients were consistently lower than among healthy controls. For instance, in one study that included 54 women with any type of inflammatory arthritis, patients' mean FSFI score was 22.1 compared with 31.4 among controls. The lowest mean FSFI scores were seen among patients with systemic sclerosis, with FSFI scores in one study that included 46 women with this disease being 18 for patients compared with 21.2 among controls.

Among men, most studies found lower scores on the IIEF, such as one study of 100 men with ankylosing spondylitis where IIEF scores were 20.5 for cases versus 24.9 for controls. In general, the lowest mean IIEF scores were seen in those with systemic sclerosis and ankylosing spondylitis, and those with rheumatoid arthritis had the highest scores.

Contributors to Sexual Dysfunction

The researchers then conducted a meta-synthesis of six studies that provided qualitative data, and found that patients with arthritis had two primary concerns: impaired sexual function, and compromised intimate relationships.

This analysis identified multiple deterrents to sexual physical functioning, such as disease-related pain, which limited positions and movement and often interrupted intercourse. Both men and women reported greater passivity and a loss of desire. Dysfunction also worsened during disease flares and later in the day with accumulating pain and fatigue.

Men reported frustration and a sense of emasculation, while both women and men reported guilt and alterations in their sense of sexuality resulting from negative body images and a loss of desire for intercourse.

The second key theme of compromised intimate relationships suggested that there often was a transition focusing less on the physical relationship, with some partners having greater understanding and acceptance of patients' difficulties. Patients whose partners had less understanding of the impact of arthritis reported increased tension and fear of instability in the relationship, and many women indicated that they struggled to maintain a normal sex life despite their pain, negative body image, and loss of sexual desire.

"Sexual function in people with inflammatory arthritis may be affected by disease activity (pain, functional limitations, and fatigue); psychological distress related to the disease including reduced self-esteem and altered body image perception; and/or side effects from pharmacological treatments (fatigue, lowered mood, vaginal dryness, and erectile dysfunction)," Briggs and colleagues noted.

Limitations of the analysis included the poor methodological quality of some studies and a lack of information about other health-related factors that might be influential.

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