Sexual Dysfunction In Cirrhosis: A Prospective Multicenter Study

Abstract

Introduction: All the manifestations of cirrhosis, sexual dysfunction, mainly because of its taboo nature. The least sought after by hepatologists and the least reported spontaneously by patients. Taking this condition into account is a necessity to improve the quality of life of patients. Methods: We conducted a prospective descriptive and analytical study over 14 months from March 2020 to April 2021 in patients followed for cirrhosis. Recruitment was multicenter. We included all cirrhotic patients who gave their consent to participate in the study. The diagnosis of cirrhosis was made on the basis of clinical, biological, radiological, endoscopic and histological evidence. The classification used was the simplified ASEX classification. Each element of the classification was scored from 1 to 3. Sexual Dysfunction was defined by a total ≥7, or a score of 3 on any item, or 2 on at least 3 items. Data were entered with Sphinx software version 5.1.0.2 and analyzed with version 18. The comparison of frequencies was done using Pearson's Chi-square test or Fisher's two-tailed exact test according to their applicability conditions with a significance threshold of 0.05. Results: We interviewed 50 patients with cirrhosis during our study period. Sexual dysfunction was observed in 34 patients, 68% of our population. The mean age was 52 years with extremes of 23 and 73 years. An age below 50 years was found in 40% of the patients.In patients with sexual dysfunction, the average age was 53 years with extremes of 35 and 73 years. Of these, 32.4% were younger than 50 years of age. The population was composed of 35 men and 15 women, for a sex ratio of 2.33. Sexual dysfunction was found in 24 men (84%). Active smoking was present in 18 patients. Alcohol abuse was present in 21 patients. Alcohol abuse was present in 21 patients. 95.2% of them had an alcohol abuse (p = 0.0001). Cirrhosis was most often associated with diabetes (13 cases), metabolic syndrome (11 cases) and hypertension (10 cases). In multivariate analysis, only diabetes was significantly associated with sexual dysfonction (p = 0.027). The most common etiologies of cirrhosis were alcohol (25 cases), HBV (15 cases), and NASH (10 cases). Sexual dysfonction was found in 84% of patients with alcoholic cirrhosis, in 80% of patients with postNASH cirrhosis, and 40% of patients with post-HBV cirrhosis. In multivariate analysis, there was a significant association between alcohol and sexual dysfonction (p = 0.015), and between HBV and Sexual dysfonction (p = 0.002). Twenty-nine patients had cirrhosis classified as CHILD A (58% of cases), and 18 patients (36% of cases) had cirrhosis classified as CHILD B. All patients with cirrhosis classified as CHILD C had sexual dysfonction. Sexual dysfonction was significantly related to the severity of the CHILD PUGH score (p = 0.002). Twenty-nine patients had cirrhosis classified as CHILD A (58% of cases), and 18 patients (36% of cases) had cirrhosis classified as CHILD B. All patients with cirrhosis classified as CHILD C had sexual dysfonction. Sexual dysfonction was significantly related to the severity of the CHILD PUGH score (p = 0.002). Conclusion: Our study shows that about three quarters of cirrhotic patients present a sexual dysfunction. The alcoholic etiology and the severity of cirrhosis seem to be the factors associated with sexual dysfunction in cirrhotic patients.