PsA's (Invisible) Toll on Sexuality and Identity: Who Cares?

Madsen M, Jensen KV, Esbensen BA. Men's Experiences of Living with Ankylosing Spondylitis: A Qualitative Study.Musculoskeletal Care. 2014 Oct 3. doi: 10.1002/msc.1082. [Epub ahead of print]

Aguiar R, Ambrósio C, Cunha I, Barcelos A. Sexuality in spondyloarthritis--the impact of the disease.Acta Reumatol Port. 2014 Apr-Jun;39(2):152-7.

Psoriatic arthritis (PsA) and other spondyloarthropathies can impact patients’ sex lives and challenge their identities as men and women, but few discuss it with their rheumatologists. Even fewer doctors inquire, according to these two studies.

Of the many factors limiting sexual function in PsA, ankylosing spondylitis (AS), and associated diseases, fatigue rather than pain seems to be at the top of the list, especially for women, say Portuguese researchers.

The first report above, a study of interviews conducted among 13 men with AS seen at one rheumatology clinic in Copenhagen, Denmark, reveals that these subjects with a median age of 44 felt “challenged as a man” by the limitations of their disease.

In particular, inability to play sports and do other physical activies challenged their masculine identity. After around 7 years of living with AS, they described the chronic disease as “an invisible companion for life” that affected their relationships as partners and fathers, as well as their social lives.

Physical limitations also limited the men's sexual activity, but to a lesser degree, the researchers reported in the journal Musculoskeletal Care.

The men saw biological treatment as a “miracle cure,” that alleviated symptoms to the degree that they could live mostly normal lives.

Besides pointing to the need for prompt diagnosis, the authors say, the results indicate the importance of clinicians asking what the disease means to the individual and exploring ways of adapting to life with a chronic disease.

The other study analyzed anonymous questionnaires sent to 76 patients of both genders, most of them married and in their mid-40s. More than 80% said that sexual capacity is important to them, and around a third felt that their disease limits their sex lives.

The authors note that PsA patients have been excluded from pervious studies of sexual function.

These patients, two-thirds of whom had PsA or AS, also cited pain, stiffness, decreased range of motion, joint swelling, and psoriatic skin lesions as affecting sexuality to varying degrees.

Among the factors affecting intimate relationships, visual analogue scores on fatigue ranked highest, especially among the 35 women (54.85 vs 39.14 for men), followed by joint and muscle pain, joint stiffness, decreased libido, and limited range of motion.

Nearly all (66) of the patients said that health professionals had never broached the subject of sex, and 58 say they never talked about sexual problems with anyone. Forty didn’t even discuss it with their partners. Only 10 patients questioned their doctors about it.

While limited by the small number of patients and their varying diseases, the authors say their study “highlights the unawareness of health professionals towards an issue that might be difficult to approach, but must not be ignored, since it may become a major source of discomfort to the patients.”