Editorial
Sexuality and rheumatic diseases
Sexualidad y enfermedades reumáticas
Montserrat Romera Baures
Servicio de Reumatología, Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain
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=> "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Sexuality and rheumatic diseases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "126" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Montserrat Romera Baures" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Montserrat" "apellidos" => "Romera Baures" "email" => array:1 [ 0 => "m.romera@bellvitgehospital.cat" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Reumatología, Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sexualidad y enfermedades reumáticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The World Health Organization defines sexual health as a state of physical, emotional, mental and social well-being. Sexuality is described as an essential part of the individual, and integral part of the human being.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the aspects that can influence the quality of life of patients with rheumatic diseases is sexuality. The prevalence of sexual problems in rheumatic diseases can range between 36% and 70%, and increases with the duration of the disease.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2–5</span></a> There are a number of causes. Physical or emotional problems, hormonal changes, certain treatments and difficulties in the relationships of the patients with their partners, can contribute to a less active and often less satisfactory sex life.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> In phases of high activity, there can be a decrease in sexual desire because of chronic pain, fatigue and stiffness. On the other hand, changes in body image due to deformities can lead to a loss of self-esteem and a decline in sexual satisfaction. Pain during sexual relations, erectile dysfunction and difficulty in adopting certain positions are physical questions also related to sexuality that may lead to a loss of interest and in a decrease in the frequency of sexual relations.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Specific sexual problems have been reported in different rheumatic diseases, such as rheumatoid arthritis (RA),<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2,7</span></a> Sjögren's syndrome,<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">8–10</span></a> systemic lupus erythematosus,<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11,12</span></a> scleroderma,<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">13,14</span></a> ankylosing spondylitis,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2,15,16</span></a> psoriatic arthropathy<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> and osteoarthritis of the hip,<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">18,19</span></a> among others.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sexual problems in RA patients have been related to disease duration, loss of mobility and joint pain.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> Erectile dysfunction in men is correlated with the activity or severity of the disease, pain and fatigue. In woman, we can add depression, which affects sexual desire, arousal, orgasm and sexual satisfaction.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3,4</span></a> In patients with juvenile idiopathic arthritis, sexual dysfunction has been related to changes in body image.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> In women with Sjögren's syndrome, vaginal dryness and vaginitis can produce dyspareunia in 40–50% of the patients.<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">21,22</span></a> Dyspareunia can also develop in scleroderma, in RA and in systemic lupus erythematosus. In scleroderma, Raynaud's phenomenon can affect the tongue and nipples; sclerosis of the fingers and digital ulcers can interfere both in the sense of touch and in sexual stimulation. In men with systemic sclerosis, erectile dysfunction is produced by a reduced blood pressure in the penis due to the involvement of small vessels.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> Cases of been reported of decreased libido, erectile dysfunction, premature ejaculation and difficulty in achieving orgasm in men with systemic lupus erythematosus.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> In woman, sexual dysfunction has been associated with depression and a poorer body image.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> In psoriatic arthropathy, functional deterioration, decreased self-esteem, anxiety disorders, lesions in genital regions and certain treatments can affect sexuality.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> A number of authors have indicated that high levels of proinflammatory cytokines, such as tumor necrosis factor alpha and interleukin 1, which participate in the pathogenesis of psoriasis, are related to the depression that affects patients with psoriatic arthropathy. In men with erectile dysfunction, this condition has been related to arteriosclerosis.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> The sexual relationships of patients with ankylosing spondylitis are affected by different causes. Substantial impact is associated with physical function, pain, high disease activity, anxiety and depression, and unemployment.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> There are cases in which cauda equina syndrome has been linked to impotence.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Limitations to sexual activity are common in patients with osteoarthritis of the hip. In a study carried out in 121 patients, 67% of those who completed a questionnaire reported experiencing sexual problems. It was more frequent among women and was related to pain and stiffness.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> Another of the aspects recorded was the lack of communication between physicians and patients. In a more recent retrospective study, 89% of the patients who had undergone hip arthroplasty mentioned that arthritis of the hip joint had limited their sex life before surgery.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> According to the data of a systematic review, quality of life related to sexuality after total hip replacement improved, but the magnitude of the effect varies greatly (0–77%).<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The lack of communication and comprehension of the disease on the part of patients’ partners or, on occasion, too much attention on the part of the latter for fear of causing physical harm, can be another aspect that complicates sexual relationships.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23,28</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the care of rheumatic patients, there is a lack of communication with respect to sexuality. There are barriers on the part of patients, either due to insecurity about mentioning the problem, because of the consideration that sexuality is not a disease, due to fear of a possible negative attitude on the part of the physician, or because of a belief that nothing can be done about sexual problems.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The subject of sexuality is not usually taken up between physicians and patients<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> and reference to it does not appear in questionnaires utilized to assess health-related quality of life.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">31,32</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The evaluation of sexual problems requires valid and reliable tools, that must be easy to put into practice.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> In this respect, a group of French rheumatologists drew up a questionnaire with 10 simple items on sexual health in RA patients, which was validated in a population in France.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is very little information in our field about the prevalence of sexual dysfunctions in rheumatic diseases. The identification of the causes that can provoke them is a challenge, given the large number of factors that can be involved. A first step would be the utilization of self-administered, reliable and validated questionnaires to detect these problems. Thus, in the Research Unit of the Spanish Society of Rheumatology (SER), we have proposed a project to adapt and validate the “Qualisex” questionnaire developed in France for use in Spanish patients with RA. This questionnaire will provide us with a tool that will enable us to assess this important aspect of the quality of life of our patients both in clinical practice and in research. We will be able to utilize it in observational studies and in clinical trials to evaluate the efficacy of certain interventions or even new treatments. It could also be of interest to employ it in other rheumatic diseases.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rheumatic diseases should not be an impediment to maintaining satisfactory sexual relationships. Sexual activity should be planned ahead in accordance with desire and physical condition. Communication with the one's partner concerning feelings, desires, games and sexual needs is essential. It is necessary to recognize the importance of acts of affection, of caresses and of any physical contact.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In terms of practical advice, it is best to avoid cold temperatures while taking a shower or having a warm bath, or the utilization of an electric blanket to maintain a pleasant temperature. It is advisable to be rested and relaxed, to take medication for the pain 30<span class="elsevierStyleHsp" style=""></span>min before having sexual relations and to employ an intimate lubricating gel to ease discomfort during intercourse. Smoking and alcohol should be avoided. We recommend sexual positions that are more effective for the avoidance of pain<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2,35,36</span></a> and to remember the importance of confiding in health professionals.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The most attractive part of the body is the mind, and attitude is everything.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Romera Baures M. Sexualidad y enfermedades reumáticas. Reumatol Clin. 2018;14:125–126.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sexual health document series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "WHO" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2006" "editorial" => "World Health Organisation" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0190" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sexual problems in rheumatoid arthritis and ankylosing spondylitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Elst" 1 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 94 | 53 | 147 |
| 2024 September | 118 | 36 | 154 |
| 2024 August | 138 | 48 | 186 |
| 2024 July | 90 | 35 | 125 |
| 2024 June | 93 | 44 | 137 |
| 2024 May | 127 | 49 | 176 |
| 2024 April | 105 | 31 | 136 |
| 2024 March | 113 | 44 | 157 |
| 2024 February | 99 | 18 | 117 |
| 2024 January | 115 | 30 | 145 |
| 2023 December | 123 | 23 | 146 |
| 2023 November | 113 | 30 | 143 |
| 2023 October | 133 | 62 | 195 |
| 2023 September | 143 | 39 | 182 |
| 2023 August | 100 | 9 | 109 |
| 2023 July | 84 | 34 | 118 |
| 2023 June | 84 | 30 | 114 |
| 2023 May | 115 | 42 | 157 |
| 2023 April | 104 | 25 | 129 |
| 2023 March | 170 | 36 | 206 |
| 2023 February | 135 | 29 | 164 |
| 2023 January | 111 | 35 | 146 |
| 2022 December | 156 | 51 | 207 |
| 2022 November | 114 | 41 | 155 |
| 2022 October | 143 | 47 | 190 |
| 2022 September | 85 | 44 | 129 |
| 2022 August | 74 | 44 | 118 |
| 2022 July | 63 | 48 | 111 |
| 2022 June | 68 | 43 | 111 |
| 2022 May | 80 | 67 | 147 |
| 2022 April | 75 | 53 | 128 |
| 2022 March | 72 | 44 | 116 |
| 2022 February | 65 | 28 | 93 |
| 2022 January | 98 | 37 | 135 |
| 2021 December | 58 | 45 | 103 |
| 2021 November | 54 | 53 | 107 |
| 2021 October | 79 | 52 | 131 |
| 2021 September | 66 | 46 | 112 |
| 2021 August | 54 | 60 | 114 |
| 2021 July | 31 | 28 | 59 |
| 2021 June | 73 | 33 | 106 |
| 2021 May | 87 | 39 | 126 |
| 2021 April | 159 | 93 | 252 |
| 2021 March | 89 | 30 | 119 |
| 2021 February | 50 | 23 | 73 |
| 2021 January | 55 | 33 | 88 |
| 2020 December | 54 | 24 | 78 |
| 2020 November | 37 | 24 | 61 |
| 2020 October | 34 | 21 | 55 |
| 2020 September | 51 | 28 | 79 |
| 2020 August | 24 | 19 | 43 |
| 2020 July | 29 | 36 | 65 |
| 2020 June | 37 | 27 | 64 |
| 2020 May | 30 | 26 | 56 |
| 2020 April | 24 | 17 | 41 |
| 2020 March | 18 | 3 | 21 |
| 2019 May | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 July | 0 | 1 | 1 |
| 2018 June | 0 | 1 | 1 |
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