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Sexual dysfunction in women with rheumatoid arthritis
Abstract and Figures
Aim:
Rheumatoid Arthritis (RA) is a widespread disease which leads to various degrees of disability and profound impact on overall life quality of the patient with regard to social, economic, psychological and sexual aspects. It may be assumed that RA can affect sexual function. The aim of this study was to evaluate the sexual function in female subjects with RA.
Methods:
A total of 186 married women (age range 30-60 years) were included in this study. Of the total participants, 104 were RA patients and 82 were healthy women. Hospital anxiety and depression scale (HADS), Health Assessment Questionnaire (HAQ) and Disease Activity Score (DAS) were used to evaluate the differences between the controls and patient group. Sexual functions were evaluated using the validated Female Sexual Function Index (FSFI).
Results:
The mean age of the RA patients and controls was 46.71 ± 7.65 and 43.98 ± 7.97, respectively. According to the total sexual function score evaluation, 97 out of 104 women with RA (93.7 %) and in 53 out of 82 women in control group (64.6 %) were regarded as having sexual dysfunction (SD). There was significant difference between these two subgroups with regard to only depression factor.
Conclusion:
Current results have demonstrated that patients with RA have had a higher sexual dysfunction rate, when compared with the control group. SD may be related to perceived depression, which are frequently encountered conditions in patients with RA.
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... In our study, we used the FSFI as an instrument to identify the presence of sexual dysfunction because the FSFI has been shown to be reliable, have discriminate and divergent validity to distinguish between groups, has a sensitivity to change, and is easy to administer requiring only about 15 min to complete [18,24]. The prevalence of sexual dysfunction among women with RA was evaluated in different independent studies [5,15,[24][25][26][27][28]. Particularly, one of them observed that women with RA had a lower global score compared with controls [15]. ...
... Instead, in a study with Egyptian women, SD (with the FSFI) was reported in 45.7% of their patients with RA [25], a value similar to that observed in our study of Mexican women with RA. Factors associated with decreases in the FSFI were observed, showing a relationship between SD and menopause and a higher HAQ-DI score, although there was no relationship with the DAS28 in similarity with Aras, et al. [26]. These findings are different from those reported by others, who observed a correlation between the pain score and disease activity with SD [25], whereas these factors were not associated with the global index score in our patients. ...
... Similar to our results, others have not found a significant positive association between sexual dysfunction and DMARDs therapy and/or oral steroid therapy [25]. The significance of our study is based on the findings in the analysis, adjusted for age-associated female sexual dysfunction, of factors that were not analyzed in previous studies [15,[24][25][26][27]; menopause was associated with global dysfunction and female sexual dysfunction in the domains of desire, arousal, and pain. We observed that sexual dysfunction is highly prevalent in women with no rheumatic disorders. ...
We estimate the prevalence and identified the associated factors of sexual dysfunction in Mexican women with rheumatoid arthritis (RA). A cross-sectional survey was applied to 100 women with RA and compared with 100 healthy, sexually active, adult women. Assessments included an interview using the Female Sexual Function Index (FSFI). Assessment of factors related to sexual dysfunction included gynecologic characteristics, disease activity (DAS-28), and functioning questionnaire (HAQ-DI). Mann-Whitney U test and the Chi-square test were used to compare medians and proportions between the groups. A multivariate logistic regression was performed using sexual dysfunction according to impairments shown by the FSFI. A higher proportion of RA patients had sexual dysfunction compared with controls. Domains with higher impairment in RA patients were desire, arousal, lubrication, and orgasm. A decrease in sexual function correlated with age (r = −0.365 p < 0.001) and higher scores in HAQ-DI (r = −0.261 p = 0.009). Those patients with a higher disability had higher impairments in desire, arousal, lubrication, and satisfaction. In the multivariate analysis, menopause was associated with sexual dysfunction (OR: 10.02; 95% CI: 1.05–95.40, p = 0.04), whereas use of methotrexate was a protective factor (OR: 0.32; 95% CI: 0.11–0.92, p = 0.03). Sexual dysfunction is highly prevalent in Mexican women with RA. Clinicians should systematically evaluate the impairment in sexual function in women with RA.
... Up to now, only a small part of studies have revealed the rate of female sexual dysfunction (FSD), ranging from 29.4 to 93.7% among patients with RA, [12][13][14] which indicated the severity and diversity of the problem in different areas. However, the rate and risk factors of FSD in Chinese mainland RA patients have remained unknown. ...
... Previous studies revealed that several factors were responsible for FSD in patients with RA such as suffering from longer disease duration, 15,16 experiencing more clinical symptoms [16][17][18] and certain psychological problems like depression, low self-esteem and anxiety. 12,15 Other factors such as drug usage also possibly result in FSD. 19 Nevertheless, few studies have included marital quality and coping style factors in this topic. ...
Objectives:
This study aims to investigate the effects of rheumatoid arthritis (RA) on Chinese mainland female patients' sexual function compared with healthy subjects and to determine the risk factors of sexual dysfunction.
Patients and methods:
A total of 151 female RA patients (mean age: 46.3±8.6 years) and 146 healthy female controls (mean age 45.7±7.6 years) were included in this cross-sectional study whose data were collected consecutively by questionnaires between November 2017 and June 2019. Data were collected by using demographics, disease-related information, Female Sexual Function Index, Dyadic Adjustment Scale, Medical Coping Modes Questionnaire, other psychological parameters and the Short Form-36.
Results:
Our results showed that the prevalence of female sexual dysfunction was 67.5% in RA patients, which was significantly higher than the controls (54.1%) (p<0.05). Body mass index, resignation coping style, physical component summary, marital dysfunction and postmenopausal status were significant correlation factors by backward stepwise binary logistic regression.
Conclusion:
Rheumatoid arthritis negatively affected sexual function of patients who had considerably impaired sexual function compared to controls.
... This was a case-control study to investigate the sexuality of women with rheumatoid arthritis in the rheumatology department of the Ignace Deen national This concept of orgasm, which can sometimes be difficult to define, was however well understood by our respondents. Contrary to the parameters described above, the patients' sexual satisfaction was comparable to the data of Aras H et al. [22] (cases 2.05 ± 0.9 vs. controls 3.9 ± 1.3). This low sexual satisfaction could be explained by the patients' fear of pain related to movements. ...
... Interestingly, lower satisfaction score and FSFI total score were observed in RA patients who reported prolonged morning stiffness of the joints as compared with those RA patients without this symptom [126]. Perceived depression affects sexual wellbeing in RA patients, confirming the important role of RA diagnosis on this aspect of life [127]. In fact, Khnaba et al. identified the level of pain and depression as the major determinant of SD in RA patients [128]. ...
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.
Summary
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.
Introduction: Rheumatoid arthritis is a multifactorial disease that has many psychological consequences. In this regard, the present study investigated the effectiveness of acceptance and commitment therapy on sexual function, coping strategies, and distress tolerance of employees with rheumatoid arthritis. Methods: The present research has a quasi-experimental design, with pre-test-post-test and a control group. The statistical population of the research included the employees of Tehran province in 2019. Thirty patients were randomly divided into intervention (n=15) and control (n=15) groups. The data collection tools included sexual function, coping strategies, and distress tolerance questionnaires. The intervention group received eight 90-minute sessions of acceptance and commitment therapy, but the control group did not. Data were analyzed using multivariate covariance analysis by SPSS-24 software. Results: Acceptance and commitment therapy significantly reduced emotional and avoidant coping styles. On the contrary, it has increased sexual function, problem-oriented coping style, and distress tolerance (tolerance, absorption, evaluation, adjustment) in employees with rheumatoid arthritis (P<0.001). Also, according to the calculated effect size, 76% of the total variances of the intervention and control groups are due to the effect of the independent variable. Conclusion: This research findings indicated the effectiveness of acceptance and commitment therapy in increasing the rheumatoid arthritis patients' mental health. Since patients with rheumatoid arthritis are psychologically vulnerable, it is necessary to take measures to improve their psychological health.
Introduction: Sexual problems are among the most important outcomes of rheumatoid arthritis in the affected women. Incidence of this disease in women is reported 2-3 times higher than that in men. This systematic review and meta-analysis was carried out to investigate the influence of rheumatoid arthritis on women's sexual function.
Methods: In this systematic review and meta-analysis, the published articles in the databases, such as Web of Science, Cochrane, PubMed, Scopus, Magiran, SID, and Google Scholar, were searched using the English keywords of “Sexual dysfunction, Sexual behavior, Sexual problems, Rheumatoid arthritis, Sexual functioning, Sexual activity, and Sexual disorder” and their Persian equivalents until December 2018. Data analysis was done using STATA (version 14.1). The I2 index was used to assess the heterogeneity between the studies, and the random effects model was applied to pool the data and perform meta-analysis.
Results: A total of 16 articles were included in the systematic review, and 10 articles with 1580 participants were included in the meta-analysis. Meta-Analysis results showed that based on the random effects model, rheumatoid arthritis leads to the decrease of female sexual function (SMD=-1.01; 95% CI: (-1.24, -0.77); P=0.001) , (RR=1.95; 95% CI: (1.65, 2.30); P<0.0001).
Conclusion: Rheumatoid arthritis leads to the reduction of female sexual function. Therefore, healthcare providers should consider this group of patients for the incidence of female sexual problems and design and implement programs to promote their sexual function.
Aim: The aim of this study was to determine the effectiveness of Systemic-Behavioral Couple Therapy on improving family function and sexual function of women with addicted spouse. Method: The research method was semi-experimental with pre-test, post-test and a three-month follow-up with control group. The statistical population was 68 women with addicted spouse who referred to the Special Counseling Center for women under the supervision of Sanandaj University of Medical Sciences in 2019. Using the available sampling method, 30 people were selected and randomly assigned to the experimental and control groups. The research tools were Epstein, Baldwin & Bishop (1983) Family Assessment Device and Rosen & Heiman (2000) Women's sexual function questionnaire. And Crowe & Ridley (2000) Systemic-Behavioral Couple Therapy was performed in 10 sessions of 90 minute once a week for the experimental group. data was analyzed by mixed analysis of variance. Results: The results showed that Systemic-Behavioral Couple Therapy was effective on improving family function (F=1927.378, P= 0.001) and sexual function (F=43.683, P= 0.001) of women with addicted spouses in the post-test phase and this effect remained stable in the follow-up phase. Conclusion: The Systemic-Behavioral Couple Therapy approach helped women with addicted spouse increase their ability to build effective relationships, dialogue, negotiation, and interaction, thereby improving family function and sexual function.
The present quasi-experimental study was conducted to determine the effects of education about rheumatoid arthritis (RA) and sexuality on the sexual problems of women with RA. The study included 103 women with RA (51 in the experimental group, 52 in the control group). The study data were collected using the Personal Information Form and Female Sexual Function Index (FSFI). The women in the experimental group were provided education on sexuality, while those in the control group received no intervention. The aforementioned scales were administered twice: during the recruitment visit and then 1 month after the intervention. In the second measurement, the mean FSFI score increased in the experimental group, but was low in the control group, with the differences between the two groups being significant. Thus, providing sexual education to women with RA was effective in reducing sexual problems in women.
Objective:
The aim of the recent study was to identify and compare the Female Sexual Function Index (FSFI) of three female populations: those with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and healthy individuals.
Methods:
In this descriptive correlational study, convenience sampling was used to recruit 50 female RA patients, 36 female PsA patients and 50 healthy women between June and September 2018.
Results:
The mean ages of the RA patients, PsA patients and healthy controls were, respectively, 53.1 ± 11.8 years, 51.6 ± 13.7 years and 37.4 ± 10.4 years. Controls were significantly younger than RA (p < 0.001) and PsA (p = 0.002) patients. Data including all participants: Based on the total sexual functioning cut-off score of 26.55, 68% of RA patients (34/50), 67% of PsA patients (22/33) and 44% of healthy controls (11/25) met the criteria for sexual dysfunction. Data excluding participants who reported not having had sex in the previous month: Controls had significantly higher FSFI scores than the RA patients across all six domains (p ≤ 0.001) and the overall score (p < 0.001). Controls had significantly higher FSFI scores than the PsA patients across four of the six domains (p ≤ 0.026) and the overall score (p = 0.008). There were no statistically significant differences between the RA and PsA groups. Patient pain, patient global status and Health Assessment Questionnaire scores were not significantly correlated with the total FSFI score in either PsA or RA.
Conclusions:
These findings demonstrate that decreased sexual functioning is more common in women with RA and PsA when compared with controls. All female patients with RA and PsA should be screened for sexual dysfunction.
Objective
To systematically review evidence of the impact of inflammatory arthritis on, or association of inflammatory arthritis with, intimate relationships and sexual function.
Methods
Ovid Medline, Ovid PsycINFO, Ovid Embase, and EBSCO CINAHL databases were searched. Two independent reviewers selected articles, extracted data, and conducted manual searches of reference lists from included studies and previous reviews. The quality of evidence was assessed using standard risk‐of‐bias tools.
Results
Fifty‐five eligible studies were reviewed. Of these, 49 (89%) were quantitative, 5 (9.1%) were qualitative, and 1 (1.8%) used a mixed‐method design. Few quantitative studies were rated as low risk of bias (n = 7 [14%]), many were rated as moderate (n = 37 [74%]) or high risk (n = 6 [12%]). Quantitative study sample sizes ranged from 10 to 1,272 participants, with a reported age range 32–63 years. Qualitative study sample sizes ranged from 8 to 57 participants, with a reported age range 20–69 years. In studies reporting the Female Sexual Function Index, all inflammatory arthritis groups demonstrated mean scores ≤26.55 (range of mean ± SD scores: 14.2 ± 7.8 to 25.7 ± 4.7), indicating sexual dysfunction. In studies reporting the International Index of Erectile Function, all inflammatory arthritis groups reported mean scores ≤25 (range of mean ± SD scores: 16.0 ± 5.3 to 23.8 ± 7.0), indicating erectile dysfunction. Key qualitative themes were impaired sexual function and compromised intimate relationships; prominent subthemes included inflammatory arthritis–related pain and fatigue, erectile dysfunction, diminished sexual desire, and sexual function fluctuations according to disease activity.
Conclusion
Sexual dysfunction appears highly prevalent among men and women with inflammatory arthritis, and increased clinician awareness of this impairment may guide provision of tailored education and support.
Objective. To determine whether physical disability, pain, depressive mood, and criticism by the spouse are differentially related to intrusiveness of rheumatoid arthritis (RA) on sexuality in male and female patients. Methods. Physical and psychological aspects of health were assessed in 102 male and 118 female RA patients who were living with a spouse. Patients were classified into 3 levels of intrusiveness of RA on sexuality. The data were analyzed by means of analysis of covariance and multiple regression analysis. Results. Greater intrusiveness of RA on sexuality was related to greater physical disability, pain, and depression in male and female RA patients. Female patients, compared with male patients, appeared to have lower levels of mobility and self-care. Male and female patients did not differ in their level of intrusiveness of RA on sexuality. Conclusion. Physical disability, pain, and, to a lesser extent, depression were found to contribute to intrusiveness of RA on sexuality. It is suggested that differences in sexual motivation between men and women might have been influential in the absence of gender differences in intrusiveness.
The reliability and validity of the Female Sexual Function Index (FSFI) were investigated in Turkish population.
Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, arousal, lubrication, orgasm, satisfaction, and pain. Overall test-re-test reliability coefficients were high for each of the individual domains (r = 0.75 to 0.95) and a high degree of internal consistency was observed. The Cronbach alpha value of the scale was 0.95. Good construct validity was demonstrated by highly significant mean difference scores between the patient and control groups for each of the domains (p < 0.05).
The FSFI Turkish version, a 19-item questionnaire, has been developed as a brief, multidimensional self-report instrument for assessing the key dimensions of sexual function in women. FSFI Turkish version is psychometrically sound, easy to administer, and has demonstrated ability to discriminate between clinical and non-clinical populations.
The results indicated that the FSFI Turkish version is reliable and valid for in Turkish population.
The influence of arthritis upon sexual satisfaction and activity and patient receptivity to sexual rehabilitation was investigated by interviewing 169 patients with arthritis and 130 controls. Patients differed from controls in their greater loss of sexual satisfaction over time, but they were comparably satisfied with their current sexual adjustment. They reported similar reductions in frequency of intercourse over time. Joint symptoms and fatigue disturbed the sexual adjustment of patients more than controls, but damaged body image, worry about partner interest, loss of libido and loss of lubrication did not. There was receptivity to a program of sexual rehabilitation among patients and controls that was not dependent upon sexual dissatisfaction.
The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
Fifty-eight adults were studied an average of 14.5 years after the diagnosis of juvenile rheumatoid arthritis had been made. The pattern of disease had been typical with respect to various categories, complications and course; HLA-B27 antigen was found at follow-up in 25% of those tested. Two thirds now had mild to moderate disease, good sexual adjustment and "normal" educational achievement, employment history and lifestyle. One third had severe disease, often with progressive disability; this did not prevent sexual activity but caused some limitations, and the need for sexual counseling is emphasized. Ongoing activity of the disease process rather than severity of disability seemed the chief factor preventing a normal lifestyle.
The relationship of arthritis and sexual dysfunction was investigated among 169 patients with rheumatoid arthritis, osteoarthritis and spondyloarthropathy, 130 of whom were pair-matched to controls. Assessments of marital happiness and depressed mood were also made using the CES-D and the Azrin Marital Happiness Scale (AMHS). Sexual dysfunctions were found to be common among patients and controls, the majority in both groups reporting one or more dysfunctions. Impotence was more common among male patients than controls and was found to be associated with co-morbidity and the taking of methotrexate. Depressed mood was more common among patients and was associated with certain sexual difficulties, but not with impotence. Marital unhappiness, as indicated by AMHS scores, was not associated with arthritis but was associated with sexual dysfunction, sexual dissatisfaction and being female.
To assess the impact of their illness on their whole life experience 345 patients with chronic arthritis were interviewed and completed a questionnaire. Four major sub-groups were identified--rheumatoid arthritis, gout, ankylosing spondylitis and osteo-arthritis. Taking into account definite inter-group differences, the commonest problems were pain (65%), stiffness (61%), inability to do everyday tasks (43%) and sexual difficulties (31%). The implications these problems raise in clinical practice are discussed and some suggestions for a rehabilitation programme made.
Rheumatoid arthritis takes an economic toll in a variety of ways--the actual costs of treatment for the individual patient and society are only a fraction thereof. Other costs derive from the legal definition of disability, from a lack of employment opportunities, from premature retirement from work, and from the social and familial consequences of these events. Depression is a major feature of chronic disease and colors both behavior by the patient and the doctor-patient relationship. Self-image suffers in this potentially deforming disease, with consequences in sexual and social behavior. Ignorance and a confusion between disability and handicap lead to more disablement than do the physical changes of rheumatoid arthritis.
A questionnaire concerning sexual problems was given to 112 female rheumatoid arthritic (RA) patients. Replies were collected from 91 (81%). The results indicated that 1) recently married patients were concerned about pregnancy; 2) the sexual desire of most patients diminished, and intercourse became less frequent and less satisfying; 3) affected hip and knee joints made it difficult to assume sexual intercourse positions; and 4) patients who had unsatisfying sexual relationship reported a decreased demand for intercourse by their spouses and diminished frequency of their own orgasms. To lead a fulfilling married life, patients with RA should be counselled to adopt a positive attitude toward sexual relationship with their husbands.