Sexual Dysfunction in Scleroderma­ Common for Both Men and Women

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by Patricia Inacio PhD |

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Sexual dysfunction is common among both men and women with scleroderma (SSc), a review study says.

According to the researchers, closer consideration of sexual dysfunction is warranted as it impairs patients’ quality of life.

“Paying greater attention to the sexual function of patients with SSc is meaningful because sexual function [impairments] are important symptoms,” the researchers wrote. “Clinicians can identify patients with impaired sexual function as early as possible by [identifying] risk factors and initiate early intervention.”

The study, “Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review,” was published in the journal Sexual Medicine.

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Scleroderma Is Complicated to Explain and Challenging to Live With

Autoimmune diseases, including scleroderma, also known as systemic sclerosis or SSc, are known to impair the sexual well-being of patients.

However, the prevalence of sexual dysfunction among people with SSc, and the associated risk factors, remain poorly known.

Now, a team of researchers in China sought to address this knowledge gap by conducting a systematic review of published studies through September 2020. Their work was approved by the ethics committee of West China Second University Hospital, in Chengdu.

After a search in three online databases — PubMed, Web of Science, and EBSCO — the team included 12 studies in its final analysis. Duplicate studies and those that did not meet certain eligibility criteria were removed, the team noted.

Among the selected studies, nine focused on women’s sexual health and three on men’s.

“For males with SSc, ED [erectile dysfunction] is the most studied symptom,” the researchers wrote. Conversely, among women, “the manifestation of sexual dysfunction is complex.”

“It is worth … noting that sexual dysfunction in women is closely related to psychological health,” the team wrote.

For men, ED was the most commonly reported symptom in addition to being the most studied. According to the three selected studies exploring this issue, ED was seen in 76.9% to 81.4% of male patients.

One study compared the prevalence of erectile dysfunction in men diagnosed with scleroderma versus those with rheumatoid arthritis, an autoimmune condition that can affect the joints and other parts of the body. The results showed that the prevalence of erectile dysfunction was significantly higher in the SSc group, with 81% of men with scleroderma having the condition versus 48% of those in the arthritis group.

In another study, 30.8% of men with scleroderma had severe ED, according to the score of the five-item International Index for Erectile Function. Less than one-fifth of the men (17.7%) had a normal score.

“This limited evidence indicated that ED [erectile dysfunction] may be an important symptom in men with SSc,” the researchers wrote. They added, however, that “the impacts of SSc itself on sexual function were not clear because there were no healthy males as control groups in included studies.”

Age was identified in one study as a potential risk factor for erectile dysfunction in scleroderma, as was alcohol consumption — of more than “2 units [per] day” — in another.

Other risk factors included a scleroderma activity score of three or higher in the European Alliance of Associations for Rheumatology classification criteria, having at least two complications affecting others organs, and the presence of characteristic scleroderma autoantibodies — those targeting the body’s own tissues.

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Sexual Health and Dysfunction

In women, sexual dysfunction was found to affect sexual desire, arousal, lubrication, orgasm, and sexual satisfaction.

The studies revealed that sexual dysfunction affected 46.7% to 86.6% of female patients.

One study reported that the total Female Sexual Functioning Index or FSFI scores were significantly lower in women with scleroderma than in a control group. Specifically, the scores were 15.27 versus 25.63. A total score lower than 22.7 was considered indicative of sexual dysfunction.

A second study showed that FSFI scores and scores on orgasm, arousal, and pain subscales were lower for women with scleroderma.

Meanwhile, another study suggested that women with scleroderma had higher rates of sexual dysfunction and reduced sexual activity compared with healthy women — after adjusting for age, marital status, and education level.

Two studies identified long disease duration and diffuse cutaneous scleroderma — in which patients are more likely to have extensive skin scarring or fibrosis on the arms, legs, and trunk — as likely risks for sexual dysfunction.

In addition, marital dissatisfaction, psychological factors, and clitoral blood flow also were potentially linked with sexual problems.

While manifestations of sexual impairments are complex and still hard to characterize, this study suggests that “sexual dysfunction appears to be an important and noteworthy symptom in patients with SSc,” the researchers wrote.

Among its limitations, the investigators said, were not having clear criteria for the classification and diagnosis of sexual dysfunction, which implicates considerable variability among the included studies.

“Studies with large samples are necessary to explore the direct impacts of SSc on sexual function and to investigate more exact risk factors in the future,” the team concluded.