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Sexual dysfunction and its determinants in women with rheumatoid arthritis

Sexuelle Dysfunktion und ihre Determinanten bei Frauen mit rheumatoider Arthritis

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Abstract

Objectives

To evaluate sexual function in Tunisian women with rheumatoid arthritis (RA) and to examine factors that are predictors of female sexual dysfunction including sociocultural factors, disease activity, and psychological status.

Methods

We conducted a cross-sectional study including 71 women with a confirmed diagnosis of RA according to the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria. Clinical and sociodemographic characteristics were collected. The participants were asked to complete the Female Sexual Function Index (FSFI), which contains 19 questions, assessing six areas of female sexual function in the previous 4 weeks. Sexual dysfunction was defined as an FSFI score less than or equal to 26.55. The psychosocial status was evaluated by the Hospital Anxiety and Depression (HAD) scale. Prevalence of sexual dysfunction and predictors of sexual difficulties were assessed.

Results

The prevalence of female sexual dysfunction in women with RA was 49.3%. All areas were altered especially desire (2.92 ± 1.3), arousal (3.27 ± 1.5), and orgasm (3.77 ± 1.5). In univariate analysis, sexual dysfunction was correlated with the age of patients (p = 0.049), the age of partners (p = 0.013), pain (p = 0.001), number of night awakenings (p = 0.02), morning stiffness (p = 0.010), tender joints (p = 0.05), disease activity score (DAS28 ESR) (p = 0.043), fatigue (p = 0.028), and Health assessment questionnaire (HAQ) (p = 0.02). In multivariate analysis, the age of patients and pain were predictive factors of sexual dysfunction. By analyzing each area of the FSFI score, the age of patients was the independent variable associated with desire. Tender joints were associated with lubrication and the age of partners with arousal, orgasm, and satisfaction.

Conclusion

Our study suggests that rheumatoid arthritis has a negative impact on patients’ sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function.

Zusammenfassung

Zielsetzungen

Evaluierung der Sexualfunktion bei tunesischen Frauen mit rheumatoider Arthritis (RA) und Analyse der Prädiktoren für weibliche sexuelle Funktionsstörungen aus soziokulturellen Faktoren, der Krankheitsaktivität und dem psychologischen Status.

Methoden

Wir führten eine Querschnittsstudie mit 71 Frauen mit einer bestätigten RA-Diagnose nach den ACR/EULAR(American College of Rheumatology/European League against Rheumatism)-Kriterien 2010 durch. Dabei wurden klinische und soziodemographische Merkmale erhoben. Die Teilnehmerinnen wurden gebeten, den FSFI(Female Sexual Function Index)-Fragebogen auszufüllen. Er enthält 19 Fragen zur Bewertung von 6 Bereichen der Sexualfunktion in den letzten 4 Wochen. Die sexuelle Funktionsstörung wurde als ein FSFI-Score kleiner oder gleich 26,55 definiert. Der psychosoziale Status wurde anhand der HAD(Hospital Anxiety and Depression)-Skala ermittelt. Bewertet wurden die Prävalenz sexueller Funktionsstörungen und Prädiktoren für sexuelle Probleme.

Ergebnisse

Die Prävalenz der weiblichen Sexualfunktionsstörungen bei Frauen mit RA betrug 49,3%. Alle Bereiche waren verändert, insbesondere das Verlangen (2,92 ± 1,3), die Erregung (3,27 ± 1,5) und der Orgasmus (3,77 ± 1,5). In der univariaten Analyse wurde die sexuelle Dysfunktion korreliert mit dem Alter der Patientinnen (p = 0,049), dem Alter ihrer Partner (p = 0,013), Schmerzen (p = 0,001), der Anzahl nächtlicher Wachzustände (p = 0,02), Morgensteifigkeit (p = 0,010), schmerzempfindlichen Gelenken (p = 0,05), DAS28 ESR (p = 0,043), Fatigue (p = 0,028) und HAQ (p = 0,02). In der multivariaten Analyse waren das Patientinnenalter und Schmerzen prädiktive Faktoren für sexuelle Funktionsstörungen. Bei der Analyse der einzelnen Bereiche des FSFI-Score war das Patientinnenalter die unabhängige Variable mit dem Verlangen assoziierte Variable. Schmerzempfindliche Gelenke waren mit Lubrikation assoziiert, das Alter der Partner mit Erregung, Orgasmus und Befriedigung.

Schlussfolgerung

Unsere Studie legt nahe, dass RA einen negativen Einfluss auf die Sexualität hat. Das Alter der Patientinnen und ihrer Partner, Schmerzen und schmerzempfindliche Gelenke scheinen die wesentlichen Faktoren zu sein, welche die sexuelle Funktion beeinflussen.

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Acknowledgements

We thank the department of rheumatology for assistance, access to patients, and for comments that greatly improved the manuscript.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.

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Authors and Affiliations

  1. Rheumatology Department, Mongi Slim Hospital, La Marsa, Tunisia

    R. B. Saad, A. Fazaa, L. Rouached MD, S. Miladi, K. Ouenniche, L. Souabni, S. Kassab, S. Chekili, K. B. Abdelghani & A. Laatar

  2. Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia

    R. B. Saad, A. Fazaa, L. Rouached MD, S. Miladi, K. Ouenniche, L. Souabni, S. Kassab, S. Chekili, K. B. Abdelghani & A. Laatar

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  1. R. B. Saad
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  2. A. Fazaa
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  3. L. Rouached MD
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  4. S. Miladi
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  9. K. B. Abdelghani
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Corresponding author

Correspondence to L. Rouached MD.

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Conflict of interest

R.B. Saad, A. Fazaa, L. Rouached, S. Miladi, K. Ouenniche, L. Souabni, S. Kassab, S. Chekili, K.B. Abdelghani and A. Laatar declare that they have no competing interests.

Our study complies with the Declaration of Helsinki. Our locally appointed ethics committee has approved the research protocol and informed consent has been obtained from the subjects.

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U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

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Saad, R.B., Fazaa, A., Rouached, L. et al. Sexual dysfunction and its determinants in women with rheumatoid arthritis. Z Rheumatol 80, 373–378 (2021). https://doi.org/10.1007/s00393-020-00890-4

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