Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Sexual Activity and Impairment Among Women with Systemic Sclerosis.
Levis1, Brooke, Hudson1, Marie, Knafo1, Ruby, Baron2, Murray, Nielson3, Warren, Hill3, Marilyn, Thombs1, Brett D.
Systemic Sclerosis (SSc), or scleroderma, is a chronic, multi-system, connective tissue disorder with a number of physical and psychological consequences that might be expected to affect sexual functioning among women, including fatigue, depression, distressing changes in appearance, Raynaud's phenomenon, skin tightening and discomfort, vaginal tightness and dryness, thickening of the skin around the lips, finger ulcers and calcium deposits that are painful to the touch, gastrointestinal symptoms, joint pain and muscular weakness. Existing studies of sexual functioning among women with SSc have concluded that rates of sexual dysfunction are high, but have been limited by the use of single, unvalidated items to assess dysfunction and problems; by not explicitly distinguishing between sexual inactivity and sexual dysfunction; by small sample sizes; by investigating only a limited amount of etiological factors, or by not including multivariate assessments. The objectives of this study were to assess (1) the rates of sexual activity and impairment in a large sample of female SSc patients, (2) clinical correlates of sexual activity/impairment, and (3) common sources of pain during and after sex.
Cross-sectional, multi-center study of female SSc patients from the Canadian Scleroderma Research Group Registry. Patients underwent medical examinations and clinical histories and were asked whether they had engaged in sexual activities with their partner in the past 4 weeks. Sexually inactive patients indicated reasons for inactivity. Sexually active patients completed a 9-item version of the Female Sexual Function Index (FSFI) and items related to problems that may be linked to sexual dysfunction in SSc. Multivariate logistic regressions were done to assess independent predictors of activity/inactivity and sexual dysfunction.
238 of 559 patients (43%), including 226 of the 412 patients currently in relationships (55%), reported having engaged in sexual activities with a partner in the past 4 weeks. Independent predictors (p<0.05) of sexual activity were younger age, fewer GI symptoms and less severe Raynaud's symptoms. Among the 165 sexually active patients with complete data for all variables, 102 (62%) scored below the FSFI cut-off of 22.5, indicating impaired sexual function, which was independently associated with older age, higher skin scores and more severe breathing problems. Ratings of pain both during and after sex were substantially higher for all 10 variables reflecting potential sources of pain among those impaired in comparison to those not impaired. Both during and after sexual activity, women with sexual impairment were significantly more likely to report at least one source of pain (p<0.001). Among individual sources of pain, after controlling for multiple comparisons, they were significantly more likely to report vaginal pain (p<0.001).
Rates of sexual impairment are high among women with SSc compared to rates reported in the general population. Research is needed to develop interventions to address impaired sexual function in women with SSc.
To cite this abstract, please use the following information:
Levis, Brooke, Hudson, Marie, Knafo, Ruby, Baron, Murray, Nielson, Warren, Hill, Marilyn, et al; Sexual Activity and Impairment Among Women with Systemic Sclerosis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2489