Sexual Dysfunction Common Among Patients with Psoriatic Arthritis

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An observational, single-center study identified a high prevalence of sexual dysfunction among patients with psoriatic arthritis (PsA), with age having a negative impact on female sexual function, according to research published in Northern Clinics of Istanbul.¹

“One of the most significant aspects of human life, sexuality is experienced through a sequence of physiological changes referred to as the sexual response cycle, which is divided into 4 phases: desire, arousal, orgasm and resolution,” wrote a group of Brazilian investigators. “Several factors highly prevalent in the general population (eg, psychosocial, religious, economic, chronic disease, drug use) can affect these phases, leading to sexual dysfunction. In patients with chronic conditions, such as rheumatologic disease, sexual dysfunction tends to cause accentuated suffering and difficulty in interpersonal relationships.”

Patients with rheumatic disease are 3 times more likely to develop sexual dysfunction compared with healthy individuals, which can be caused by the disease itself, related comorbidities, and/or medication.²

To evaluate sexuality and the prevalence of sexual dysfunction among patients with PsA, investigators assessed 23 adult subjects using 2 male questionnaires (the International Index of Erectile Function [IIEF] and Male Sexual Quotient [MSQ]) and 2 female questionnaires (the Female Sexual Function Index [FSFI] and Female Sexual Quotient [FSQ]), validated for Brazilian Portuguese. Eligible patients were recruited from the rheumatology department of a university hospital in northeastern Brazil between October to December 2020.

The MSQ and FSQ categorize sexual performance, while the IIEF assesses erectile function, orgasm and ejaculation, sexual desire, sexual satisfaction, and general satisfaction. Similar to the IIEF, the FSFI evaluates separate domains of sexuality, including desire, excitement, lubrication, orgasm, satisfaction, and pain.

Factors associated with sexual dysfunction were identified using clinical parameters, skin activity, and musculoskeletal activity. Clinical data included information about the type of PsA (such as axial, dactylitis, or enthesitis), medication usage, the time of PsA or psoriasis onset, comorbidities, body mass index, and any history of anxiety and depression.

The mean age of male patients (n = 12) was 52.1 years, and the mean age was 49.1 among females (n = 11). The mean time of disease duration was 10 ± 6.2 years, 65.2% reported a steady sexual partner, and most patients exhibited low skin and peripheral joint disease activity or were in remission. Women were more likely to report abstinence in the 4 weeks prior to the interview (72.7%).

Most (91.7%) men exhibited sexual dysfunction according to the IIEF questionnaire, although most cases were characterized as mild. The prevalence of sexual dysfunction among women was 72.7%, with low domain scores, and the mean FSQ score was 64.9. A significant association between female age and domain-specific FSFI scores was observed. The general satisfaction domain of the IIEF and the Psoriasis Area and Severity Index (PASI) scores were also significantly correlated.

Investigators noted limitations including the small sample size of patients, due in part to COVID-19 restrictions, with inactive skin and peripheral joint disease. Other limitations included the cross-sectional study design, not including questionnaires that evaluated quality of life and depression, and the lack of a control group.

“More research is needed to confirm these specific findings,” investigators concluded. “Health professionals should probe for sexual dysfunction in this patient population in order to provide early treatment or, if needed, refer patients for specialized care with a view to safeguarding their quality of life and that of their partners.”

References

1. ^{Lobo JN, Ramos LMA, Mont'Alverne ARS, de Carvalho JF, Rodrigues CEM. Sexuality and sexual dysfunction in patients with psoriatic arthritis: A cross-sectional study. North Clin Istanb. 2024;11(3):191-200. Published 2024 Jun 25. doi:10.14744/nci.2023.75317}
2. ^{Østensen M. New insights into sexual functioning and fertility in rheumatic diseases. Best Pract Res Clin Rheumatol 2004;18:219–32.}