Sexual Dysfunction in Systemic Autoimmune Rheumatic Diseases: Prevalence, Impact, and Management Strategies.

Abstract

Background: Systemic autoimmune rheumatic diseases (SARDs) profoundly impact patients' quality of life (QoL) including sexual health, yet sexual dysfunction (SD) remains underrecognised in clinical care. Contributing factors include chronic pain, fatigue, joint stiffness, hormonal imbalances and psychological distress.

Objective: This review evaluates the prevalence, impact, and management of SD in patients with systemic autoimmune rheumatic diseases (SARDs), including Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Sjögren's disease (SjD), and Systemic Sclerosis (SSc), as well as the related chronic condition Fibromyalgia Syndrome (FMS).

Methods: A systematic literature review was conducted using PubMed, Web of Science, and Scopus with relevant MeSH terms. Studies reporting SD in SARDs were included, with sexual function commonly assessed via the Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF).

Results: SD prevalence ranged from 30% to 90%, varying by disease and gender. Up to 90% of women with SLE reported reduced desire and arousal. RA affected 30-70% of patients, with pain and depression as key drivers. In AS, erectile dysfunction affected 41-58% of men, influenced by age and disease duration. Over 56% of women with SjD experienced SD, often linked to vaginal dryness. SSc-induced fibrosis led to erectile dysfunction in 80% of men. FMS showed a 63% SD rate, associated with chronic pain and psychological burden.

Conclusion: SD is highly prevalent yet underaddressed in SARDs. A multidisciplinary approach combining pain management, psychological support, hormonal therapy, and patient education is essential.