|Year : 2019 | Volume
| Issue : 1 | Page : 1-4
Assessment of sexual dysfunction in females with systemic lupus erythematosus
Hani H Dessoki1, Ahmed A Moussa2, Hisham Salah1, Yasmeen A Noor3
1 Department of Psychiatry, Faculty of Medicine, Beni-Suef University, Maghagha, El-Minia, Egypt
2 Department of Andrology and Sexology, Faculty of Medicine, Beni-Suef University, Maghagha, El-Minia, Egypt
3 Department of Dermatology, Faculty of Medicine, Beni-Suef University, Maghagha, El-Minia, Egypt
|Date of Submission||02-Apr-2018|
|Date of Acceptance||26-Aug-2018|
|Date of Web Publication||9-May-2019|
Yasmeen A Noor
Department of Dermatology, Faculty of Medicine, Beni-Suef University, Maghagha, El-Minia, 11711
Source of Support: None, Conflict of Interest: None
Introduction Sexual dysfunctions are common sexual health problems affecting a substantial proportion of females with systemic lupus erythematosus (SLE).
Objective This study aimed at the evaluation of female sexual dysfunction in patients with SLE.
Materials and methods A total of 50 females with SLE and 50 matched healthy female volunteers were assessed using the Arabic version of Female Sexual Function Index. Married and sexually active females during the past 6 months with established diagnosis of SLE were recruited from the Rheumatology Clinic, Beni-Suef University hospital during the period from March to August 2017. All data were statistically analyzed using the IBM statistical package for the social sciences version 20.
Results The study showed that 60% of females with SLE and 16% of healthy controls reported abnormal sexual function according to the FSFI total scores, with a statistically significant differences in-between (P=0.00).
Conclusion Female sexual dysfunction is a common problem among patients with SLE.
Keywords: females, sexual dysfunction, systemic lupus erythematous
|How to cite this article:|
Dessoki HH, Moussa AA, Salah H, Noor YA. Assessment of sexual dysfunction in females with systemic lupus erythematosus. Egypt J Psychiatr 2019;40:1-4
|How to cite this URL:|
Dessoki HH, Moussa AA, Salah H, Noor YA. Assessment of sexual dysfunction in females with systemic lupus erythematosus. Egypt J Psychiatr [serial online] 2019 [cited 2020 Oct 26];40:1-4. Available from: http://new.ejpsy.eg.net/text.asp?2019/40/1/1/257852
| Introduction|| |
Systemic lupus erythematosus (SLE) is a chronic systemic, autoimmune disease with multiorgans affection characterized by recurrent attacks of remission and exacerbation (Cervera et al., 2003). It is estimated to be nine times more prevalent in female than male individuals (Tsokos, 2011), and it is found to be more likely to affect African Americans than whites (Demas and Costenbader, 2009). Prior studies indicated that SLE has a negative effect on the psychological status and quality of life (QoL) of the patients (Schmeding and Schneider, 2013; Shen et al., 2013).
Female sexual dysfunction (FSD) is a complex multifactorial disorder that involves physiological, anatomical, neurological, and vascular problems, along with correlated psychological and cultural factors (Perelman, 2007). The WHO defined FSD as ‘the various ways in which a woman is unable to participate in a sexual relationship as she would wish’ (WHO, 1993).
An increasing body of evidence has linked the presence of sexual dysfunction with autoimmune diseases. Prior reports showed a significant sexual dysfunction in patients with autoimmune Addison’s disease, multiple sclerosis, and rheumatic diseases (Anyfanti et al., 2014).
Although FSD is a troublesome problem that causes severe emotional distress and affects the QoL, the association between SLE and FSD is still underreported in the published literature (Laumann et al., 1994).
| Materials and methods|| |
In this case–control study, 70 females with SLE were interviewed in the Rheumatology Clinic, Beni-Suef University hospital, with a consecutive sampling during the period from March to August 2017. The study’s protocol was reviewed and accepted by the ethics committee of Anrology, Sexology, and Dermatology department, Faculty of Medicine, Beni-Suef University. Married and sexually active females during the past 6 months with established diagnosis of SLE were included. Females with gynecologic disorders (inflammatory genital disease, vaginal discharge, polycystic ovary, abnormal uterine bleeding, etc.), lower urinary tract symptoms, major pelvic surgery or mastectomy, uncontrolled medical or endocrinological disorders, history of drug and/or alcohol abuse, or distressing sexual problems of the male partner were excluded. Pregnant, breastfeeding, or postpartum females were also excluded.
Of those 70 patients, five patients were excluded as they were not married, five were excluded as they were in renal crisis, and 10 refused to participate. A total of 50 female patients with SLE and 50 matched healthy female volunteers were included in this research according to inclusion and exclusion criteria. All participants provided an informed written consent.
The data collection was carried out at a single visit with no follow-up. Demographic and characteristics data that were collected included a detailed sexual history of the couple, menstrual status, obstetric and gynecological history, reproductive morbidity as well as past history of medical disorders or drug prescriptions. The characteristics of SLE (onset, course and duration of disease, durations and doses of medications used, etc.) were also collected.
The female sexual function was assessed using the Arabic version of Female Sexual Function Index (ArFSFI). It is a valid and reliable questionnaire for the measurement of key domains of female sexual activity. It is a 19-item questionnaire that assesses the sexual function or problems during the past 4 weeks (Rosen et al., 2000). Specific domains analyzed in ArFSFI are the quality of desire (questions 1 and 2), arousal (questions 3–6), lubrication (questions 7–10), orgasm (questions 11–13), satisfaction (questions 14–16), and degree (questions 17–19) of pain (Anis et al., 2011). The results of ArFSFI were interpreted according to the reported cutoff values by Wiegel et al. (2005).
All variables recorded during the study were summarized. Absolute and relative frequencies were provided for categorical variables. Mean and SD were provided for continuous variables. The characteristics of the two groups were compared by the χ2-test for qualitative variables and the Student’s t-test for quantitative variables. One-way analysis of variance was used to analyze the difference in multiple groups (was used for statistical analysis). The level of statistical significance was set as P value of less than 0.05 (IBM, 2011).
| Results|| |
The mean age of the patients with SLE was 31.28±7.09 years and of the control group was 29.74±6.57 years. Most participants were housewives, and almost half of them were residents of urban areas. Only 6% of the participants had a higher education. Moreover, 28% of patients with SLE reported irregular menstrual history compared with only 6% in the control group (P=0.00).
Regarding clinical characteristics, 20% of the patients used contraceptive methods such as oral contraceptive pills, intrauterine device, and injectable contraceptives; 4% of the patients were diabetic; 4% were hypertensive; 4% of patients had hepatitis C virus; and 4% of patients had history of previous abortion. Moreover, 8% of the patients had relatives with SLE and 8% of patients had relatives with rheumatoid arthritis. Patients were stable under medical therapy such as hydroquine, steroid, immuran, calcium, endoxan, stomigus, neuroton, one-alpha, and marivan.
Regarding the ArFSFI scores, 60% of females with SLE reported lower total scores compared with 16% of healthy controls (P=0.00), and this means that women with SLE had higher frequency of abnormal sexual function than healthy controls. Moreover, there was a statistically significant difference between the two groups regarding all individual domain scores of ArFSFI (P=0.00). Women with SLE showed higher frequency of abnormality related to lubrication (74%), orgasm (64%), pain (76%), satisfaction (74%), arousal (74%), and desire (70%) domains compared with the control group [Table 1] and [Table 2].
|Table 2 Total and domain scores of Arabic version of Female Sexual Function Index for both groups|
Click here to view
| Discussion|| |
SLE is an autoimmune disease that may lead to impaired sexual function in female patients. Sexual function is an important component of individual well-being; however, impairment in sexual function is a distressing condition and strongly affects the different aspects of QoL (Basson, 2008).
Although the factors that contributes to FSD are not fully understood, previous reports indicated that the prevalence of FSD may be as high as 40% of the general population (Laumann et al., 1994).
In the present study, the sexual functions of 50 patients with SLE and 50 healthy controls were assessed using the ArFSFI. It was found that women with SLE had significantly lower scores in all key domains of ArFSFI compared with healthy control. This means that women with SLE had a greater degree of sexual impairment (60%) than general population (10%), in Whom all domains of normal sexual functions were negatively affected. Such prevalence might be higher in SLE owing to the multiorgan affection nature of the disease and may affect patient self-esteem (Shen et al., 2015).
In concordance with these results, Garcia Morales et al. (2013) has conducted the FSFI on 61 patients with SLE compared with 53 healthy controls. It was found that 46% of women with SLE were labeled as having impaired sexual function, compared with 29% in the control group (P<0.05).Another study reported that women with SLE had a significantly lower frequency of sexual activity, measured by FSFI, compared with control group (Curry et al., 1994).
In contrast, Tseng et al. (2011) reported a similar proportion of patients with SLE (52.5%) and sexually active controls (47%) who had an impaired sexual function; a significant difference was only found when the patients had an exacerbation period. The authors concluded that vascular factors are the only predictor of impaired sexual function in patients with SLE (Tseng et al., 2011).
Similarly, a meta-analysis reported insignificant difference between females with SLE and healthy controls on any of the FSFI key domain. Such discrepancy in the published literature regarding SLE effect on sexual function of female patients may be attributed to low sample size within each study. Therefore, large-scale studies are still needed to address the association between SLE and FSD. Previous study showed that the lower sexual function of women with SLE is strongly correlated with lower QoL scores (Yin et al., 2017).
To the best of our knowledge, this is the first study to assess the FSD in female patients with SLE in Egyptian population. The sample size was relatively small, which affects the generalizability of our findings. Moreover, the study was cross-sectional in nature without a follow-up assessment, so we could not assess the changes in FSD with the disease progression.
| Conclusion|| |
Married female patients with SLE revealed a higher degree of impairment of sexual functions on all domains than married females without SLE. Better understanding of the pathological mechanisms of SLE and further large-scale studies are needed to confirm these findings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Anis TH, Gheit SA, Saied HS, Al-kherbash SA (2011). Arabic Translation of Female Sexual Function Index and validation in an Egyptian population. J Sex Med 8:3370–3378.
Anyfanti P, Pyrpasopoulou A, Triantafyllou A, Gavriilaki E, Chatzimichailidou S et al.
(2014). Association between mental health disorders and sexual dysfunction in patients suffering from rheumatic diseases. J Sex Med 11:2653–2660.
Basson R (2008). Women’s sexual function and dysfunction: current uncertainties, future directions. Int J Impot Res 20:466–478.
Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P et al.
(2003). Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 82:299–308.
Curry SL, Levine SB, Corty E, Jones PK, Kurit DM. (1994). The impact of systemic lupus erythematosus on women’s sexual functioning. J Rheumatol 21:2254–2260.
Demas KL, Costenbader KH (2009). Disparities in lupus care and outcomes. Curr Opin Rheumatol 21:102–109.
Garcia Morales M, Callejas Rubio JI, Peralta-Ramirez MI, Henares Romero LJ, Rios Fernandez R, Camps Garcia MT et al.
(2013). Impaired sexual function in women with systemic lupus erythematosus: a cross-sectional study. Lupus 22:987–995.
IBM (2011) IBM statistical package for the social science IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows (Version 20.0). Armonk, NY: IBM Corp.
Laumann EO, Gagnon JH, Michael RT, Michaels S. (1994). The social organization of sexuality: sexual practices in the United States. Chicago, USA: University of Chicago Press.
Perelman MA (2007). Clinical application of CNS-acting agents in FSD. J Sex Med 4:280–290.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R et al.
(2000). The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208.
Schmeding A, Schneider M (2013). Fatigue, health-related quality of life and other patient-reported outcomes in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 27:363–375.
Shen B, Tan W, Feng G, He Y, Liu J, Chen W et al.
(2013). The correlations of disease activity, socioeconomic status, quality of life, and depression/anxiety in Chinese patients with systemic lupus erythematosus. Clin Dev Immunol 2013:270878.
Shen B, He Y, Chen H, Zhao C, Zhu L, Gao Y et al.
(2015). Body image disturbances have impact on the sexual problems in Chinese systemic lupus erythematosus patients. J Immunol Res 2015:204513.
Tseng J-C., Lu L-Y., Hu J-C., Wang L-F, Yen L-J, Wu H-C et al.
(2011). The impact of systemic lupus erythematosus on women’s sexual functioning. J Sex Med 8:3389–3397.
Tsokos GC (2011). Systemic lupus erythematosus. N Engl J Med 365:2110–2121.
Wiegel M, Meston C, Rosen R (2005). The Female Sexual Function Index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31:1–20.
WHO (1993). Impotence: NIH Consensus Development Panel on Impotence. JAMA J Am Med Assoc 270:83–90.
Yin R, Xu B, Li L, Fu T, Zhang L, Zhang Q et al.
(2017). The impact of systemic lupus erythematosus on women’s sexual functioning: a systematic review and meta-analysis. Medicine (Baltimore) 96:e7162.
[Table 1], [Table 2]