Female Sexual Dysfunction as a Warning Sign of Chronic Disease Development

  • Vincenza Di Stasi
  • Nunzia Verde
  • Elisa Maseroli
  • Irene Scavello
  • Sarah Cipriani
  • Tommaso Todisco
  • Mario Maggi
  • Linda VignozziEmail author
Female Sexual Dysfunction and Disorders (T Lorenz & R Nappi, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Female Sexual Dysfunction and Disorders


Purpose of Review

Female sexual dysfunctions (FSD) in chronic diseases are often multi-factorial, integrating several bio-psychological and socio-environmental components. The aim of this review is to summarize existing evidence on the association between the most common chronic conditions and FSD and also to frame systematically experimental findings into a comprehensive overview on candidate mechanisms through which chronic diseases drive FSD pathogenesis.

Recent Findings

In men, it is now clear that several chronic diseases favour the development of sexual dysfunction (SD), especially erectile dysfunction (ED), by an integration of multiple pathogenic factors. More importantly, in men, ED has been recognized as a harbinger of several serious underlying medical conditions, including the cardiovascular ones. Conversely, the nature of the relationship between SD and chronic diseases in women remains controversial and, in contrast to the well-established associations with ED in men, FSD is not yet acknowledged as a warning sign of other systemic diseases. In this review of literature, we try to demonstrate that this is changing because there are some clinical and research evidences about the importance to recognize FSD in chronic disease. Specifically, we summarize the recent findings about the relation between cardio-metabolic, respiratory, renal, neurologic and rheumatic diseases and FSD.


Management of FSD is an important task to improve the overall quality of life of patients suffering from chronic, longstanding and often progressive diseases. It is also possible that sexual symptoms might be a warning sign for unrecognized conditions, although this is far to be completely understood. Further studies are needed to fully understand and treat this emerging topic in specific clinical settings.


Female sexuality Chronic diseases Gender medicine 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

All reported studies with human performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards and international/national/institutional guidelines).


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Rastrelli G, Corona G, Lotti F, Aversa A, Bartolini M, Mancini M, et al. Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors. J Sex Med. 2014;11(1):173–86. Scholar
  2. 2.
    Carter J, Lacchetti C, Andersen BL, Barton DL, Bolte S, Damast S, et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J ClinOncol. 2018;36(5):492–511. Scholar
  3. 3.
    Nowosielski K, Drosdzol A, Sipiński A, Kowalczyk R, Skrzypulec V. Diabetes mellitus and sexuality--does it really matter? J Sex Med. 2010;7:723–35. Scholar
  4. 4.
    Mazzilli R, Imbrogno N, Elia J, Delfino M, Bitterman O, Napoli A, et al. Sexual dysfunction in diabetic women: prevalence and differences in type 1 and type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2015;8:97–101. Scholar
  5. 5.
    Maiorino MI, Bellastella G, Castaldo F, PetrizzoM GD, Esposito K, et al. Sexual function in young women with type 1 diabetes: the METRO study. J Endocrinol Investig. 2017;40(2):169–77. Scholar
  6. 6.
    Flotynska J, Uruska A, Michalska A, Araszkiewicz A, Zozulinska-Ziolkiewicz D, et al. Sexual dysfunction is a more common problem in young women with type 1 diabetes than in healthy women. J Sex Marital Ther. 2019;21:1–9. Scholar
  7. 7.
    Ahmed MR, Shaaban MM, Sedik WF, Mohamed TY. Prevalence and differences between type 1 and type 2 diabetes mellitus regarding female sexual dysfunction: a cross-sectional Egyptian study. J Psychosom Obstet Gynaecol. 2018;39:176–81. Scholar
  8. 8.
    Chaudhary R, Kumar P, Chopra A, Chabbra S, Singh P. Comparative study of psychiatric manifestations among type I and type II diabetic patients. Indian J Psychol Med. 2017;39:342–6. Scholar
  9. 9.
    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24:1069–78.CrossRefGoogle Scholar
  10. 10.
    Clayton AH, Goldstein I, Kim NN, Althof SE, Faubion SS, Faught BM, et al. The International Society for the Study of Women’s Sexual Health process of care for management of Hypoactive Sexual Desire Disorder in women. Mayo Clin Proc. 2018;93:467–87. Scholar
  11. 11.
    Giraldi A, Kristensen E. Sexual dysfunction in women with diabetes mellitus. J Sex Res. 2010;47:199–211. Scholar
  12. 12.
    Zsoldos M, Pajor A, Pusztafalvi H. Relation between sexual dysfunction and metabolic syndrome. OrvHetil. 2019;160:98–103. Scholar
  13. 13.
    Ballester J, Muñoz MC, Domínguez J, Palomo MJ, Rivera M, Rigau T, et al. Tungstate administration improves the sexual and reproductive function in female rats with streptozotocin-induced diabetes. Hum Reprod. 2007;22(8):2128–35.CrossRefGoogle Scholar
  14. 14.
    Hashimoto H, Moritani N, Terada M, Kromkhun P, Fungfuaug W, Nakada T, et al. Improvement of hyperglycemia and sexual dysfunction in diabetic female rats by an artificial endocrine pancreas developed from mouse beta cells. Exp Anim. 2010;59(4):515–9. Scholar
  15. 15.
    Hernández-Munive AK, Rebolledo-Solleiro D, Ventura-Aquino E, Fernández-Guasti A. reduced lordosis and enhanced aggression in paced and non-paced mating in diabetic female rats. J Sex Med. 2018;15(2):124–35. Scholar
  16. 16.
    • Maseroli E, Scavello I, Vignozzi L. Cardiometabolic risk and female sexuality-part I. Risk factors and potential pathophysiological underpinnings for female vasculogenic sexual dysfunction syndromes. Sex Med Rev. 2018;6:508–24. review gives a complete explanation on the influence of cardio-metabolic diseases on FSD. CrossRefPubMedGoogle Scholar
  17. 17.
    Maseroli E, Fanni E, Cipriani S, Scavello I, Pampaloni F, Battaglia C, et al. Cardiometabolic risk and female sexuality: focus on clitoral vascular resistance. J Sex Med. 2016;13:1651–61. Scholar
  18. 18.
    Caruso S, Rugolo S, Mirabella D, Intelisano G, Di Mari L, Cianci A. Changes in clitoral blood flow in premenopausal women affected by type 1 diabetes after single 100-mg administration of sildenafil. Urology. 2006;68:161–5. Scholar
  19. 19.
    Caruso S, Cianci A, Cianci S, Monaco C, Fava V, Cavallari V. Ultrastructural study of clitoral cavernous tissue and clitoral blood flow from type 1 diabetic premenopausal women on phosphodiesterase-5 inhibitor. J Sex Med. 2019;16(3):375–82. Scholar
  20. 20.
    Esposito K, Ciotola M, Maiorino MI, Giugliano F, Autorino R, De Sio M, et al. Hyperlipidemia and sexual function in premenopausal women. J Sex Med. 2009;6:1696–703. Scholar
  21. 21.
    Baldassarre M, Alvisi S, Mancini I, Moscatiello S, Marchesini G, Seracchioli R, et al. Impaired lipid profile is a risk factor for the development of sexual dysfunction in women. J Sex Med. 2016;13:46–54. Scholar
  22. 22.
    Duncan LE, Lewis C, Jenkins P, Pearson TA. Does hypertension and its pharmacotherapy affect the quality of sexual function in women? Am J Hypertens. 2000;13:640–7.CrossRefGoogle Scholar
  23. 23.
    Lunelli RP, Irigoyen MC, Goldmeier S. Hypertension as a risk factor for female sexual dysfunction: cross-sectional study. Rev Bras Enferm. 2018;71:2477–82. Scholar
  24. 24.
    Santana LM, Perin L, Lunelli R, Inácio JFS, Rodrigues CG, Eibel B, et al. Sexual dysfunction in women with hypertension: a systematic review and meta-analysis. Curr Hypertens Rep. 2019;21(3):25–10. Scholar
  25. 25.
    Choy CL, Sidi H, Koon CS, Ming OS, Mohamed IN, Guan NC, et al. Systematic review and meta-analysis for sexual dysfunction in women with hypertension. J Sex Med. 2019;16(7):1029–48. Scholar
  26. 26.
    Nascimento ER, Maia AC, Nardi AE, Silva AC. Sexual dysfunction in arterial hypertension women: the role of depression and anxiety. J Affect Disord. 2015;181:96–100. Scholar
  27. 27.
    Löwhagen O. Diagnosis of asthma - new theories. J Asthma. 2015;52:538–44. Scholar
  28. 28.
    Soto Campos JG, RojasVillegas J, PadillaGalo A, Marina Malanda N, Garcia Rivero JL, Pinedo Sierra C, et al. Impact of asthma on the sexual functioning of patients. A case-control study. Arch Bronconeumol. 2017;53:667–74. Scholar
  29. 29.
    Başar MM, Ekici A, Bulcun E, Tuğlu D, Ekici MS, Batislam E. Female sexual and hormonal status in patients with bronchial asthma: relationship with respiratory function tests and psychological and somatic status. Urology. 2007;69:421–5. Scholar
  30. 30.
    Meyer IH, Sternfels P, Fagan JK, Ford JG. Asthma-related limitations in sexual functioning: an important but neglected area of quality of life. Am J Public Health. 2002;92:770–2.CrossRefGoogle Scholar
  31. 31.
    Steinke E, Palm Johansen P, Fridlund B, Broström A. Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review. Int J ClinPract. 2016;70:5–19. Scholar
  32. 32.
    Yilmaz Z, Sirinocak PB, Voyvoda B, Ozcan L. Sexual dysfunction in premenopausal women with obstructive sleep apnea. Urol J. 2017;14:5051–6. Scholar
  33. 33.
    Onem K, Erol B, Sanli O, Kadioglu P, Yalin AS, Canik U, et al. Is sexual dysfunction in women with obstructive sleep apnea-hypopnea syndrome associated with the severity of the disease? A pilot study. J Sex Med. 2008;5:2600–9. Scholar
  34. 34.
    Fanfulla F, Camera A, Fulgoni P, Chiovato L, Nappi RE. Sexual dysfunction in obese women: does obstructive sleep apnea play a role? Sleep Med. 2013;14:252–6. Scholar
  35. 35.
    Kahal H, Kyrou I, Tahrani AA, Randeva HS. Obstructive sleep apnoea and polycystic ovary syndrome: a comprehensive review of clinical interactions and underlying pathophysiology. ClinEndocrinol (Oxf). 2017;87(4):313–9. Scholar
  36. 36.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.CrossRefGoogle Scholar
  37. 37.
    Ip MS, Lam B, Chan LY, Zheng L, Tsang KW, Fung PC, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2000;162:2166–71. Scholar
  38. 38.
    Liu L, Kang R, Zhao S, Zhang T, Zhu W, Li E, et al. Sexual dysfunction in patients with obstructive sleep apnea: a systematic review and meta-analysis. J Sex Med. 2015;12:1992–2003. Scholar
  39. 39.
    Elborn JS. Cystic fibrosis. Lancet. 2016;388:2519–31. Scholar
  40. 40.
    Kazmerski TM, Sawicki GS, Miller E, Jones KA, Abebe KZ, Tuchman LK, et al. Sexual and reproductive health behaviors and experiences reported by young women with cystic fibrosis. J Cyst Fibros. 2018;17:57–63. Scholar
  41. 41.
    Aguiar KCA, Marson FAL, Gomez CCS, Pereira MC, Paschoal IA, Ribeiro AF, et al. Physical performance, quality of life and sexual satisfaction evaluation in adults with cystic fibrosis: an unexplored correlation. Rev Port Pneumo (2006). 2017;23:179–92. Scholar
  42. 42.
    Tuchman LK, Kalogiros ID, Forke CM, Schwarz DF, Kinsman SB. Reproductive knowledge and preferences of adolescents and adults with cystic fibrosis: a web-based assessment. Int J Sex Health. 2010;22:72–83.CrossRefGoogle Scholar
  43. 43.
    Nixon GM, Glazner JA, Martin JM, Sawyer SM. Urinary incontinence in female adolescents with cystic fibrosis. Pediatrics. 2002;110:1–9.CrossRefGoogle Scholar
  44. 44.
    Tsang A, Moriarty C, Towns S. Contraception, communication, and counseling for sexuality and reproductive health in adolescents and young adults with CF. Paediatr Respir Rev. 2010;11(2):84–9. Scholar
  45. 45.
    Frayman KB, Sawyer SM. Sexual and reproductive health in cystic fibrosis: a life-course perspective. Lancet Respir Med. 2015;3(1):70–86. Scholar
  46. 46.
    Navaneethan SD, Vecchio M, Johnson DW, Saglimbene V, Graziano G, Pellegrini F, et al. Prevalence and correlates of self-reported sexual dysfunction in CKD: a meta-analysis of observational studies. Am J Kidney Dis. 2010;56:670–85. Scholar
  47. 47.
    Noohi S, Azar M, Behzadi AH, Barbati ME, Haghshenas A, Amoozgar B, et al. Comparison of sexual function in females receiving haemodialysis and after renal transplantation. J Ren Care. 2010;36:212–7. Scholar
  48. 48.
    Saglimbene V, Natale P, Palmer S, Scardapane M, Craig JC, Ruospo M, et al. The prevalence and correlates of low sexual functioning in women on hemodialysis: a multinational, cross-sectional study. PLoS One. 2017;12(6):e0179511. Scholar
  49. 49.
    Pertuz W, Castaneda DA, Rincon O, Lozano E. Sexual dysfunction in patients with chronic renal disease: does it improve with renal transplantation? Transplant Proc. 2014;46(9):3021–6. Scholar
  50. 50.
    Basok EK, Atsu N, Rifaioglu MM, Kantarci G, Yildirim A, Tokuc R. Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients. Int Urol Nephrol. 2009;41:473e81. Scholar
  51. 51.
    Raggi MC, Siebert SB, Friess H, Schremmer-Danninger E, Thorban S, Dinkel A. Sexual and relationship functioning before and after renal transplantation: a descriptive study with patients and partners. Scand J UrolNephrol. 2012;46:431–6. Scholar
  52. 52.
    Filocamo MT, Zanazzi M, Li Marzi V, Lombardi G, Del Popolo G, Mancini G, et al. Sexual dysfunction in women during dialysis and after renal transplantation. J Sex Med. 2009;6:3125–31. Scholar
  53. 53.
    Kurtulus FO, Salman MY, Fazlioglu A. FazliogluB. Effects of renal transplantation on female sexual dysfunction: comparative study with hemodialysis and a control group. Transplant Proc. 2017;49(9):2099–104. Scholar
  54. 54.
    Premužić V, Jelaković B. Sexual dysfunction as a determinant of cardiovascular outcome in patients undergoing chronic hemodialysis. Int J Impot Res. 2018;30(1):14–20. Epub 2017 Nov 27.CrossRefPubMedGoogle Scholar
  55. 55.
    Vlachopoulos C, Ioakeimidis N, Aznaouridis K, Terentes-Printzios D, Rokkas K, Aggelis A, et al. Prediction of cardiovascular events with aortic stiffness in patients with erectile dysfunction. Hypertension. 2014;64:672–8. Scholar
  56. 56.
    Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96:19M–23M. Scholar
  57. 57.
    Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF. Migraine in the United States: epidemiology and patterns of health care use. Neurology. 2002;58(6):885–94.CrossRefGoogle Scholar
  58. 58.
    Ghajarzadeh M, Jalilian R, Togha M, Azimi A, Hosseini P, Babaei N. Depression, poor sleep, and sexual dysfunction in migraineurs women. Int J Prev Med. 2014;5(9):1113–8.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Abdollahi M, Toghae M, Raisi F, Saffari E. The prevalence of female sexual dysfunction among migraine patients. Iran J Neurol. 2015;14(1):8–11.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Solmaz V, Ceviz A, Aksoy D, Cevik B, Kurt S, Gencten Y, et al. Sexual dysfunction in women with migraine and tension-type headaches. Int J Impot Res. 2016;28(6):201–4. Scholar
  61. 61.
    Aydın M, Bitkin A, İrkılata L, Yılmaz A, Moral C, Atilla MK. The effect of migraine and tension-type headaches on female sexual functions: a prospective, cross-sectional, controlled study. Turk J Urol. 2018;44(5):418–22. Scholar
  62. 62.
    Bond DS, Pavlović JM, Lipton RB, Graham Thomas J, Digre KB, Roth J, et al. Sexual dysfunction in women with migraine and overweight/obesity: relative frequency and association with migraine severity. Headache. 2017;57(3):417–27. Scholar
  63. 63.
    Dogan VB, Dagdeviren H, Dirican A, Dirican AC, Tutar NK, Yayla VA, et al. Hormonal effect on the relationship between migraine and female sexual dysfunction. Neurol Sci. 2017;38(9):1651–5. Scholar
  64. 64.
    Nasimbera A, Rosales J, Silva B, Alonso R, Bohorquez N, Lepera S, et al. Everything you always wanted to know about sex and Neurology: neurological disability and sexuality. Arq Neuropsiquiatr. 2018;76(7):430–5. Scholar
  65. 65.
    Kaufmann H, Goldstein DS. Autonomic dysfunction in Parkinson disease. Handb Clin Neurol. 2013;117:259–78. Scholar
  66. 66.
    Malek N, Lawton MA, Grosset KA, Bajaj N, Barker RA, Burn DJ, et al. Autonomic dysfunction in early Parkinson’s disease: results from the United Kingdom tracking Parkinson’s study. Mov Disord Clin Pract. 2016;4(4):509–16. Scholar
  67. 67.
    Deng X, Tang CY, Zhang J, Zhu L, Xie ZC, Gong HH, et al. The cortical thickness correlates of clinical manifestations in the mid-stage sporadic Parkinson’s disease. Neurosci Lett. 2016;633:279–89. Scholar
  68. 68.
    Bronner G, Royter V, Korczyn AD, Giladi N. Sexual dysfunction in Parkinson’s disease. J Sex Marital Ther. 2004;30(2):95–105. Scholar
  69. 69.
    Brown RG, Jahanshahi M, Quinn N, Marsden CD. Sexual function in patients with Parkinson’s disease and their partners. J Neurol Neurosurg Psychiatry. 1990;53(6):480–6.CrossRefGoogle Scholar
  70. 70.
    Buhmann C, Dogac S, Vettorazzi E, Hidding U, Gerloff C, Jürgens TP. The impact of Parkinson disease on patients’ sexuality and relationship. J Neural Transm. 2017;124(8):983–96. Scholar
  71. 71.
    Giladi N, Treves TA, Paleacu D, Shabtai H, Orlov Y, Kandinov B, et al. Risk factors for dementia, depression and psychosis in long-standing Parkinson’s disease. J Neural Transm. 2000;107(1):59–71. Scholar
  72. 72.
    Bhattacharyya KB, Rosa-Grilo M. Sexual dysfunctions in Parkinson’s disease: an underrated problem in a much discussed disorder. Int Rev Neurobiol. 2017;134:859–76. Scholar
  73. 73.
    Csoka AB, Bahrick A, Mehtonen OP. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. J Sex Med. 2008;5(1):227–33. Scholar
  74. 74.
    Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish working group for the study of psychotropic-related sexual dysfunction. J Clin Psychiatry. 2001;62(Suppl 3):10–21.PubMedGoogle Scholar
  75. 75.
    Webber MP, Hauser WA, Ottman R, Annegers JF. Fertility in persons with epilepsy: 1935-1974. Epilepsia. 1986;27(6):746–52.CrossRefGoogle Scholar
  76. 76.
    Kolárský A, Freund K, Machek J, Polák O. Male sexual deviation. Association with early temporal lobe damage. Arch Gen Psychiatry. 1967;17(6):735–43.CrossRefGoogle Scholar
  77. 77.
    Mameniškienė R, Guk J, Jatužis D. Family and sexual life in people with epilepsy. Epilepsy Behav. 2017;66:39–44. Scholar
  78. 78.
    Zelena V, Kuba R, Soška V, Rektor I. Depression as a prominent cause of sexual dysfunction in women with epilepsy. Epilepsy Behav. 2011;20(3):539–44. Scholar
  79. 79.
    Feeney DM, Gullotta FP, Gilmore W. Hyposexuality produced by temporal lobe epilepsy in the cat. Epilepsia. 1998;39(2):140–9.CrossRefGoogle Scholar
  80. 80.
    Jensen P, Jensen SB, Sorensen PS, et al. Sexual dysfunction in male and female patients with epilepsy: a study of 86 outpatients. Arch Sex Behav. 1990;19(1):1–14.CrossRefGoogle Scholar
  81. 81.
    Duncan S, Blacklaw J, Beastall GH, Brodie MJ. Sexual function in women with epilepsy. Epilepsia. 1997;38(10):1074–81.CrossRefGoogle Scholar
  82. 82.
    Bergen D, Daugherty S, Eckenfels E. Reduction of sexual activities in females taking antiepileptic drugs. Psychopathology. 1992;25(1):1–4. Scholar
  83. 83.
    Morrell MJ, Sperling MR. SteckerMet al. Sexual dysfunction in partial epilepsy: a deficit in physiologic sexual arousal. Neurology. 1994;44(2):243–7.CrossRefGoogle Scholar
  84. 84.
    Harden CL. Sexual dysfunction in women with epilepsy. Seizure2008;17 (2): 131–135. doi: CrossRefGoogle Scholar
  85. 85.
    Herzog AG, Drislane FW, Schomer DL, Pennell PB, Bromfield EB, Kelly KM, et al. Differential effects of antiepileptic drugs on sexual function and reproductive hormones in men with epilepsy: interim analysis of a comparison between lamotrigine. Epilepsia. 2004;45(7):764–8. Scholar
  86. 86.
    Isojarvi J. Disorders of reproduction in patients with epilepsy: antiepileptic drug related mechanisms. Seizure. 2008;17(2):111–9. Scholar
  87. 87.
    Hess MJ, Hough S. Impact of spinal cord injury on sexuality: Broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012;35(4):211–8. Scholar
  88. 88.
    Dusenbury W, Palm Johansen P, Mosack V, Steinke EE. Determinants of sexual function and dysfunction in men and women with stroke: a systematic review. Int J ClinPract. 2017 ;71(7). Scholar
  89. 89.
    Bugnicourt JM, Hamy O, Canaple S, Lamy C, Legrand C. Impaired sexual activity in young ischaemic stroke patients: an observational study. Eur J Neurol. 2014;21:140–6. Scholar
  90. 90.
    Seymour LM, Wolf TJ. Participation changes in sexual functioning after mild stroke. OTJR (Thorofare N J). 2014 Spring;34(2):72–80. Scholar
  91. 91.
    Hatzichristou D, Rosen RC, Derogatis LR, Low WY, Meuleman EJ, Sadovsky R, et al. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010;7:337–48. Scholar
  92. 92.
    Brandstater M, Kim M. The challenge of altered sexual function in stroke survivors undergoing rehabilitation. Top Geriatr Rehabil. 2016;32:199–203 Accessed 17 Dec 2018CrossRefGoogle Scholar
  93. 93.
    Choi-Kwon S, Kim JS. Poststroke emotional incontinence and decreased sexual activity. Cerebrovasc Dis. 2002;13:31–7. Scholar
  94. 94.
    Kellogg-Spadt S, Bowes C. Hypersexual behavior following a stroke. Am J Nurse Pract. 2007;11:42–3, 73. Scholar
  95. 95.
    Taman Y, Taman L, Akil E, et al. Post-stroke sexual functioning in first stroke patients. Eur J Neurol. 2008;15:660–6. Scholar
  96. 96.
    Akinpelu AO, Osose AA, Odole AC, Odunaiya NA. Sexual dysfunction in Nigerian stroke survivors. AfrHealth Sci. 2013;13:639–45. Scholar
  97. 97.
    McGrath M, Lever S, McCluskey A, Power E. How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies. Clin Rehabil. 2019;33(2):293–303. Scholar
  98. 98.
    McGrath M, Lever S, McCluskey A, Power E. Developing interventions to address sexuality after stroke: findings from a four-panel modified Delphi study. JRehabil Med. 2019;51(5):352–60. Scholar
  99. 99.
    Courtois F, Alexander M, McLain ABJ. Women’s sexual health and reproductive function after SCI. Top Spinal Cord InjRehabil. 2017;23(1):20–30. Scholar
  100. 100.
    Bérard E. The sexuality of spinal cord injured women: physiology and pathophysiology. A Rev Paraplegia. 1989;27(2):99–112. Scholar
  101. 101.
    Sipski ML, Alexander CJ, Rosen RC. Physiological parameters associated with psychogenic sexual arousal in women with complete spinal cord injuries. Arch Phys Med Rehabil. 1995;76(9):811–8.CrossRefGoogle Scholar
  102. 102.
    New PW, Currie KE. Development of a comprehensive survey of sexuality issues including a self-report version of the International Spinal Cord Injury sexual function basic data sets. Spinal Cord. 2016;54(8):584–91. Scholar
  103. 103.
    Kreuter M, Taft C, Siösteen A, Biering-Sørensen F. Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord. 2011;49(1):154–60. Scholar
  104. 104.
    Basson R, Leiblum S, Brotto L, et al. Revised definitions of women’s sexual dysfunction. J Sex Med. 2004;1:40–8. Scholar
  105. 105.
    Courtois F, Charvier K. Sexual dysfunction in patients with spinal cord lesions. HandbClin Neurol. 2015;130:225–45. Scholar
  106. 106.
    Hubscher CH, Herrity AN, Williams CS, Montgomery LR, Willhite AM, Angeli CA, et al. Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury. PLoS One. 2018;13(1):e0190998. Scholar
  107. 107.
    Gardiner PF. Changes in alpha-motoneuron properties with altered physical activity levels. Exerc Sport Sci Rev. 2006;34(2):54–8.CrossRefGoogle Scholar
  108. 108.
    Harkema SJ, Hurley SL, Patel UK, Requejo PS, Dobkin BH, Edgerton VR. Human lumbosacral spinal cord interprets loading during stepping. J Neurophysiol. 1997;77(2):797–811. Scholar
  109. 109.
    Donati AR, Shokur S, Morya E, Campos DS, Moioli RC, Gitti CM, et al. Long-term training with a brain-machine interface-based gait protocol induces partial neurological recovery in paraplegic patients. Sci Rep. 2016;6:30383. Scholar
  110. 110.
    Shokur S, Donati ARC, Campos DSF, Gitti C, Bao G, Fischer D, et al. Training with brain-machine interfaces, visuo-tactile feedback and assisted locomotion improves sensorimotor, visceral, and psychological signs in chronic paraplegic patients. PLoS One. 2018;13(11):e0206464. Scholar
  111. 111.
    Dasgupta R, Wiseman OJ, Kanabar G, Fowler CJ, Mikol D. Efficacy of sildenafil in the treatment of female sexual dysfunction due to multiple sclerosis. J Urol. 2004;71(3):1189–93. Scholar
  112. 112.
    Basson R, Brotto LA. Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled trial. BJOG. 2003;110(11):1014–24.CrossRefGoogle Scholar
  113. 113.
    Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(4):453–62. Scholar
  114. 114.
    Wilson SK, Delk JR 2nd, Billups KL. Treating symptoms of female sexual arousal disorder with the eros-clitoral therapy device. J Gend Specif Med. 2001;4(2):54–8.PubMedGoogle Scholar
  115. 115.
    Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handb Clin Neurol. 2014;122:231–66. Scholar
  116. 116.
    Marck CH, Jelinek PL, Weiland TJ, et al. Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross sectional study. BMC Neurol. 2016;4:16Y21. Scholar
  117. 117.
    Nortvendt MW, Riise T, Myhr KM, Landtblom AM, Bakke A, Nyland HI. Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler J. 2001;7:231–5. Scholar
  118. 118.
    Merghati-Khoei E, Qaderi K, Amini L, Korte JE. Sexual problems among women with multiple sclerosis. J Neurol Sci. 2013;331(1-2):81–5. Scholar
  119. 119.
    Salhofer-Polanyi S, Wöber C, Prohazka R, Dal-Bianco A, Bajer-Kornek B, Zebenholzer K. Similar impact of multiple sclerosis and migraine on sexual function in women: is the multiple sclerosis impact scale questionnaire useful? Wien Klin Wochenschr. 2017;129(3-4):115–20. Scholar
  120. 120.
    Bartnik P, Wielgoś A, Kacperczyk J, Pisarz K, Szymusik I, Podlecka-Piętowska A, et al. Sexual dysfunction in female patients with relapsing-remitting multiple sclerosis. Brain Behav. 2017;7(6):e00699. Scholar
  121. 121.
    Calabrò RS, Russo M, Dattola V, De Luca R, Leo A, Grisolaghi J, et al. Sexual function in young individuals with multiple sclerosis: does disability matter? J Neuro Sci Nurs. 2018;50(3):161–6. Scholar
  122. 122.
    • Zhao S, Li E, Wang J, Luo L, Luo J, Zhao Z. Rheumatoid arthritis and risk of sexual dysfunction: a systematic review and metaanalysis. J Rheumatol. 2018;45:1375–82. this review and meta-analysis, the authors confirm the importance and high frequency of sexual dysfunction in patients with rheumatoid arthritis. CrossRefPubMedGoogle Scholar
  123. 123.
    Gerosa M, De Angelis V, Riboldi P, Meroni PL. Rheumatoid arthritis: a female challenge. Womens Health (Lond). 2008;4:195–201. Scholar
  124. 124.
    Maasoumi R, Moridi M, Farhadi F, Moshfeghi Z. Sexual function in women with rheumatoid arthritis. Womens Health Bull. 2014;1:e20098. Scholar
  125. 125.
    Hari A, Rostom S, Lahlou R, Bahiri R, Hajjaj-Hassouni N. Sexual function in Moroccan women with rheumatoid arthritis and its relationship with disease activity. Clin Rheumatol. 2015;34:1047–51. Scholar
  126. 126.
    Coskun B, Coskun BN, Atis G, Ergenekon E, Dilek K. Evaluation of sexual function in women with rheumatoid arthritis. Urol J. 2014;10:1081–7.PubMedGoogle Scholar
  127. 127.
    Aras H, Aras B, Icagasioglu A, Yumusakhuylu Y, Kemahli E, Haliloglu S, et al. Sexual dysfunction in women with rheumatoid arthritis. Med Glas (Zenica). 2013;10:327–31.Google Scholar
  128. 128.
    Khnaba D, Rostom S, Lahlou R, Bahiri R, Abouqal R, Hajjaj-Hassouni N. Sexual dysfunction and its determinants in Moroccan women with rheumatoid arthritis. Pan Afr Med J. 2016;24:16. Scholar
  129. 129.
    Dorner TE, Berner C, Haider S, Grabovac I, Lamprecht T, Fenzl KH, et al. Sexual health in patients with rheumatoid arthritis and the association between physical fitness and sexual function: a cross-sectional study. Rheumatol Int. 2018;38:1103–14. Scholar
  130. 130.
    Puchner R, Sautner J, Gruber J, Bragagna E, Trenkler A, Lang G, et al. High burden of sexual dysfunction in female patients with rheumatoid arthritis: results of a cross-sectional study. J Rheumatol. 2019;46:19–26. Scholar
  131. 131.
    Boone D, Ronson A, Karsh J. Comparison of Female Sexual Function Index in patients with psoriatic and rheumatoid arthritis and healthy controls. Musculoskeletal Care. 2019. Scholar
  132. 132.
    Generali E, Costanzo A, Mainetti C, Selmi C. Cutaneous and mucosal manifestations of Sjögren’s syndrome. Clin Rev Allergy Immunol. 2017;53(3):357–70. Scholar
  133. 133.
    Both T, Dalm VA, Van Hagen PM, Van Daele PL. Reviewing primary Sjögren’s syndrome: beyond the dryness - from pathophysiology to diagnosis and treatment. Int J Med Sci. 2017;14:191–200. Scholar
  134. 134.
    MaddaliBongi S, Del Rosso A, Orlandi M, Matucci-Cerinic M. Gynaecological symptoms and sexual disability in women with primary Sjögren’s syndrome and sicca syndrome. ClinExpRheumatol. 2013;31:683–90.Google Scholar
  135. 135.
    Van Nimwegen JF, Arends S, van Zuiden GS, Vissink A, Kroese FG, Bootsma H. The impact of primary Sjögren’s syndrome on female sexual function. Rheumatology (Oxford). 2015;54:1286–93. Scholar
  136. 136.
    Priori R, Minniti A, Derme M, Antonazzo B, Brancatisano F, Ghirini S, et al. Quality of sexual life in women with primary Sjögren syndrome. J Rheumatol. 2015;42:1427–31. Scholar
  137. 137.
    Golder V, Hoi A. Systemic lupus erythematosus: an update. Med J Aust. 2017;206(5):215–20.CrossRefGoogle Scholar
  138. 138.
    Godoy Junior AC, Gaertner H, Skare T, Nisihara R. Sexual dysfunction in systemic lupus erythematosus patients. Acta Reumatol Port. 2017;42:341–2.PubMedGoogle Scholar
  139. 139.
    Shen B, He Y, Chen H, Zhao C, Zhu L, Gao Y, et al. Body image disturbances have impact on the sexual problems in Chinese systemic lupus erythematosus patients. J Immunol Res. 2015;2015:204513. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Vincenza Di Stasi
    • 1
    • 2
  • Nunzia Verde
    • 3
  • Elisa Maseroli
    • 1
    • 2
  • Irene Scavello
    • 1
    • 2
  • Sarah Cipriani
    • 1
    • 2
  • Tommaso Todisco
    • 1
    • 2
  • Mario Maggi
    • 1
    • 4
    • 5
  • Linda Vignozzi
    • 1
    • 2
    • 5
    Email author
  1. 1.Department of Experimental, Clinical, and Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
  2. 2.Andrology, Women’s Endocrinology and Gender Inconguence UnitAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  3. 3.Medicine and Surgery, Section of Endocrinology, Federico IIUniversity of NaplesNaplesItaly
  4. 4.Endocrinology Unit, Medical-Geriatric DepartmentAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  5. 5.Istituto Nazionale Biostrutture e BiosistemiRomeItaly

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