New insights into sexual problems linked to rheumatoid arthritis

The results of a study presented today at the European League Against Rheumatism Annual Congress (EULAR 2016) showed that sexual dysfunction is present in more than one-third of patients with rheumatoid arthritis (RA) who are still sexually active, both men and women. A variety of difficulties may affect RA patients, including lack of libido, painful intercourse, orgasmic dysfunction, premature ejaculation and a non-satisfactory sexual life.

“Sexuality is an important dimension of an individual’s personality, and sexual problems can have a seriously detrimental impact on a couple’s relationship,” said lead author Dr Pedro Santos-Moreno of the Biomab, Centre for Rheumatoid Arthritis, Bogota, Colombia. “It is therefore rather surprising that, up until now, very little quality research on sexual disturbances in RA patients has been published in the literature, bearing in mind how common the problems are,” he added.

Many factors may influence the prevalence and worsening of these sexual disturbances; however, the relationship between having a sexual disturbance and RA disease activity was not statistically significant; the problems themselves do not affect activity of the disease. However, there is a relationship between not being sexually active and the presence of disease activity.

This study explored three different type of factors – precipitating, predisposing and maintenance — that may influence the prevalence and worsening of sexual disturbances in RA patients, as well as their relationship with disease activity.

Precipitating factors for sexual dysfunction in women and men with RA respectively included infidelity (33% and 6%), insecurity in a sexual role (32% and 16%), and biological or physical causes (17% and 3%). The range of predisposing factors in women and men respectively were related to image changes (14% and 21%), infidelity (13% and 7%), anxiety (2% and 2%) and loss of attraction (1.4% and 10%).

Reported factors felt to be responsible for sexual disturbances continuing in women and men respectively (so-called maintenance factors) included biological causes (11% and 15%), infidelity (9% and 4%), general alteration of the couple’s relationship (9% and 19%), partner’s sexual dysfunction (3% and 0.8%), and depression/anxiety (1.9% and 5%).

The relationship between these various precipitating, predisposing or maintenance factors and disease activity was also not statistically significant.

Patients in this study were all attending a specialised RA clinic, with information collected through semi-structured interviews. From a population of 1,298 RA patients, with an average age of 55 years old, 80% were women, of whom 40% reported no sexual activity. Just under one-third of the men with RA in this study also reported no sexual activity.