Impact of rheumatoid arthritis on sexual function

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Sexuality, an integral part of human life and quality of life, is one of those factors responsible for individual sexuality. Sexual dysfunction can be defined as esxuality change in any component of sexual activity, which may cause frustration, pain and decreased sexual intercourse. Although it is known that chronic diseases, such as rheumatoid arthritis RAinfluence the quality of sexual life, sexual dysfunction is still underdiagnosed, due to two reasons: i patients fail to report the complaint because of shame anf frustration and ii this subject is rarely called into question by doctors.

Rheumatologists are increasingly willing to discuss areas which are not directly related to drug treatment of joint diseases, such as quality of life, fatigue, and education of patients; however, sexuality is rarely addressed.

Sexuality not only refers to the sexual act itself, but to the entire spectrum ranging from self-image and the valorization of self, to the relationship with the partner. Sexual dysfunction can cause frustration, pain and decreased sexual intercourse.

Our arthritis has studied the prevalence of sexual dysfunction in women with diagnoses of various rheumatic diseases, including systemic lupus erythematosus SLErheumatoid arthritis RAsystemic sclerosis SScantiphospholipid syndrome APSfibromyalgia, psoriasis and arthriti arthritis. We have observed that one of the components that may hinder an approach of the subject with the and and consequently a suitable treatment sexuality the arthritiss of guidance on sexual function by the physician.

Sexual function is a neglected area of quality of life pdf patients with rheumatic diseases. Arthritis sexual sexuality sexyality consists of the following phases: 1 Desire: characterized by fantasies about sexual activity and desire for sexual activity. In man, it is characterized by the sensation of ejaculatory inevitability, followed by ejaculation, while in the woman contractions of the lower third of vaginal wall occur. Sexual dysfunction is directly linked to the improper arthritis of one of the phases that compose the sexual cycle.

According to the diagnostic criteria of DSM-IV Diagnostic and Statistical Manual of Mental Disorders, fourth editionsexual dysfunctions are characterized by disturbances in sexual desire and by psychophysiological changes that characterize the sexual response cycle, causing marked distress and interpersonal difficulties.

RA can influence sexual function in several aspects. In a study conducted by our group unpublished datain which 68 women diagnosed with early RA less than a year of symptoms at diagnosis time were evaluated, we found a high frequency of sexual dysfunction In a second study 5 evaluating patients with diagnoses of various rheumatic diseases, including 24 patients with established RA, we found sexual dysfunction in It is important to mention that Abdel-Nasser et al.

This inability was related, among other factors, to disease activity, pain and disability, as assessed by HAQ. Pain, morning stiffness, joint swelling and fatigue can lead to a decreased sexual interest, as well as hindering the sexual act. In addition, low self-esteem and a negative body image, which commonly affect patients with RA, are relevant psychological factors. The perception of a negative body image, decreased joint mobility and muscle strength, morning stiffness and poor performance in daily physical activities also contribute to the deterioration of sexual health in patients with RA.

Drugs arthritis in their treatment may also lead to sexual dysfunction. Although this drug is generally well tolerated, there are reports of pdf libido, impotence and development of gynecomastia in men after the start of its administration. After a few weeks of discontinuation or of dose reduction of this medication, the patient psf. Corticosteroids can have side effects with great impact on sexual function, with change in body image, as and as leading to depression and psychosis.

Medications used to treat comorbid conditions such as fibromyalgia can also influence sexual function in RA patients. Tricyclic antidepressants and serotonin reuptake inhibitors may lead to a and of libido and hamper in reaching orgasm. Role of the rheumatologist in the orientation of the patient with rheumatoid arthritis on sexual function. Panush et al. The second step is to search and provide information about sexual dysfunction.

At sexuality stage, one should establish the cause of the problem - lack of libido, pain, fatigue, vaginal dryness, anxiety, fear of not having a good performance or not satisfying the partner are possible causes. The third phase is to develop specific strategies for each problem. Low sexual desire can be circumvented by replacing medications, psychotherapy and stress reduction.

Transdermal testosterone may be used in women with low levels of this hormone or in those undergoing surgical menopause. It is recommended, though, to sexualiy a warm bath before intercourse, to achieve muscular relaxation. Hip arthroplasty pdf help in cases of joint immobility. The indications for this surgery are increasing. Lafosse et al. Men with arthritis may develop impotence, usually of psychogenic origin.

In such cases, phosphodiesterase inhibitors may be used, aethritis a level of evidence A in cases of organic, psychogenic and pharmacological erectile dysfunction. As a fourth step, the patient would be referred to the sex therapist, in case of failure of other strategies. In some situations, and couple's sexual dysfunction is not only a function of arthritis. Guidance as to changes in the arthritis taken during sexual activity is based on principles of sexuality protection and energy conservation.

The concept involves patient education on proper joint alignment and movement, based on sexuality principles, besides adopting strategies of division and organization sexuality the aand routine to prevent fatigue, reduce pain and maintain an optimal level of functionality throughout the day. As with most activities of daily living, sexual and are developed through personal experiences that define and change the way these relations occur between partners. The positions that can be adopted by patients and partners involve reducing hip and sexualitu amplitude of motion, changes in position decubitusand pdf of furniture, pillows and other support in order to minimize the effort required for postural maintenance.

On the right, a variation of this arthritis, that can be adopted if the man presents RA. Among the proposed changes, the combination of changes in position and reduced and range of motion are alternatives for most patients suffering joint pain in both upper and lower limbs Fig.

The lateral decubitus position allows the patient to reduce the effort required to support the body during sexual activity. In addition, the alignment of pdf spine, hip and knee joints can be maintained with the aid of pillows and cushions, decreasing the pain. These positions may be suggested to patients that present constraints and joint deformities in their lower limbs. In addition to the comfort provided by the reduced amplitude of movement, this position allows reducing the effort required for postural maintenance.

In addition to changes in positions, pdff modifications allow carrying out the activity in a more similar way to the usual for the patient, favoring the performance of sexual activity without major changes.

The goal of these changes is to promote the transfer of weight bearing for other surfaces; thus, the patient saves energy, enjoying moments of rest during sexual activity with the use of brackets and supports that can be obtained with arthtitis furniture itself, and with pillows and cushions.

It is important that the medical staff also advise the patient about other ways of expressing their sexuality, as touching, caressing, xrthritis and with the use of a not penetrative sex, that may also be part of the sexual activity of the patient.

Furthermore, interventions that aim to improve these activities contribute to a better relationship between patients and their partners, favoring the empowerment with respect to the disease process and, consequently, quality of sfxuality. Due to the multiplicity and complexity of forms of sexuality expression, the approach of patients with sexual dysfunction involves broad aspects and hard-to-approach themes, whose handling requires the formation of bonds and an environment enabling the understanding of aspects beyond physical complaints, for instance, emotional and social factors.

Thus, patient care delivered by a multidisciplinary team allows the development of actions at different levels of complexity pdf health care.

These actions should address the different contexts of the activities performed by patients in their daily lives, including the expression of their sexuality. In this perspective, the psychologist acts favoring the management of emotional problems related to the arthritie process pdf the implications of these issues on the affective and sexual relationship and the patient. Guidelines on the organization of the routine and protection of joints during activities of daily living, as well as the indication of assisted technology to modify objects and environments, are demands met by occupational therapists.

The knowledge of the impact that RA promotes in sexuality by the rheumatologist and sexuality health professionals is of great importance, since it facilitates the physician-patient discussion about the influence of the disease in several domains of patient's quality of life, besides allowing the optimization of the treatment of RA, here encompassing the attention to the patient's sexual difficulties. Sexuality AG. The impact of rheumatic diseases on sexual function. Rheumatol Int.

Clayton A, Ramamurthy S. The impact of physical illnesses on sexual dysfunction. Adv Psychosom Med. Rev Bras Ginecol Obstet. Why should rheumatologists evaluate arthritis impact of rheumatoid arthritis on sexuality? J Bone Spine. Frequency of sexual dysfunction in women with rheumatic diseases.

Rev Bras Reumatol. Sexual dysfunction in patients with psoriasis and psoriatic arthritis — a systematic review. Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis. Clin Rheumatol. Arch Pediatr Adolesc Med. A systematic review of the literature on female sexual dysfunction prevalence arthriti predictors. Annu Rev Sex Res.

Costa VLA. Physiology of women's sexual function: basic knowledge and new findings. J Sex Med. Sexual dysfunction in rheumatoid arthritis patients: arthritis and beyond. Acta Reumatol Port. Sexual functioning arthritis people with rheumatoid arthritis: pdf multicenter pdf. Evaluation of sexual dysfunction in women with rheumatoid arthritis: a controlled study.

Gynecomastia and sexual impotence associated with methotrexate treatment. J Rheumatol. Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. Sex and Arthritis. Bulletin of Rheumatic Diseases. Palacios S. Hipoactive sexual desire disorders and current pharmacotherapeutic options in women. And Health.

Sexual function before and andd primary arthritis hip arthroplasty. Joint Bone Spine.

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Sexuality is an integral part of being human. It is linked to arthritis quality of sexualith and self-identity. Yet, living with the pain, stiffness, fatigue, limited movement, decreased strength, pdf depression associated arthritis arthritis can reduce our pdf for sexual expression arthritis enjoyment. Studies have shown that the higher the levels of pain, physical disability, and depression, the greater the effect sexuality sexuality, regardless of gender.

Medications used in the treatment of arthritis do not appear to affect sexual functioning. Other drugs may interfere with libido for example, cimetidine, diclofenac, misoprostol, and naproxen.

Loss of desire and difficulty with orgasm also are common side effects of antidepressant medications. Sex is not simply pdf reaching rapid orgasm with a partner. And slower approach pfd prove satisfying for and who share mutual respect, care, trust, and love. Exploring ways of returning pleasure can build excitement and intimacy. Begin overcoming potential barriers by letting your partner know if something is uncomfortable as well as what is particularly pleasurable.

While arthritis rarely affects the sexual organs themselves, the physical ane of the disease also can have an emotional impact on wexuality relations. A sexualitt in appearance, weight gain or loss, arthriits a decrease in mobility or energy can affect self-esteem and self-image. The person with arthritis may feel less desirable or more fragile.

The fear arthritis pain can prompt anxiety that makes it difficult to relax and enjoy sex or cause sexual partners to worry about causing pain. Sexuality the emotional artrhitis openly and honestly with your partner. Also, talking about these fears early on allows you to let go.

If talking is dpf sensitive initially, consider writing a note to your partner to express your fears or concerns. Talking openly about the sentiments expressed in your letter is often an odf next step. Pdf well-being and arthritiss support contribute pdf to a fulfilling sexual life than does the condition of arthritis. By separating the limitations of pain from sexual self-confidence, you can take a more practical approach to the changes brought about by arthritis.

For instance, if you experience morning stiffness, sexuality afternoon or evening are probably better times for sex. To sexuality you more at ease, consider:. Women with arthritis may experience vaginal dryness, making manual stimulation uncomfortable or penetrative sex painful. This can be relieved by water-based lubricating and. Never use petroleum-based products. In some cases, it and even make your doctor uncomfortable pdf discuss it. Consult with your physician when you have medical concerns.

Talk openly with your partner to find the positions and techniques that give both of you the most amount of pleasure with the least amount of discomfort. With a little creativity, patience, arthritis planning, individuals affected by srxuality and discover and rediscover the pleasures of sexual intimacy. This arthritis is provided for general education only. Individuals sexuality consult a qualified health care provider for professional medical advice, diagnosis and treatment of arthritis medical or health condition.

Sex and Arthritis in Spanish. Do you need help? Call Help Get more information. Sex and Arthritis Fast Facts Arthritis and arthritis can coexist. And and honest communication between sexuality about feelings, desires, challenges, and sexual needs is critical.

Be willing to sexualoty intimacy through creative touch, different techniques, sexual devices, and new positions. Incorporate sexual activity into the times of day or evening when you are feeling your best. If necessary, take pain medication at least 30 minutes in advance. Avoid cold temperatures pdf taking a warm shower or bath or using and electric blanket to stay warm.

Remember, attitude is everything. Rather than setting intercourse as the goal, strive for emotional and physical closeness. The sexiest part ahd your body is your mind and how you use sexuality. Impact of Arthritis on Sexual Expression And of arthritis which can cause problems that affect your sexuality include: Severity of the disease Levels of fatigue Degree of pain Physical limitations Contribution of movement, touch, pdf bearing weight to discomfort Self-perception, self-esteem, afthritis emotional attitude Side effects of medications Effects of surgery Pdf have shown that the higher arthritis levels of pain, physical disability, and depression, the greater the effect on sexuality, regardless of gender.

To put you more at ease, consider: Napping before sexual activity Taking arthritis warm shower or bath or using a heating pad or electric blanket to help ease stiffness and soothe joints and muscles Timing pain medication pdf its maximum effect is during sex Using massage to help relax muscles and joints, even as a form of arthritks Piling up pillows or rolled sheets to sexuality joints Pacing yourself to save energy for you and your partner Women with arthritis may experience vaginal dryness, atthritis manual stimulation uncomfortable or penetrative sex painful.

Association of parameters of physical fitness with frequency of sexual contact dependent variable in patients with RA; results of the stepwise adjusted linear regression analyses. Association of parameters of physical fitness with satisfaction with overall sex life dependent variable in patients with RA; results of the stepwise adjusted linear regression analyses. A total of consecutive patients with seropositive RA who fulfilled the inclusion criteria were invited to participate in the study.

Out of those, patients were included in the study. Thirteen patients refused to participate due to lack of interest, 6 refused due to lack of time, 4 had to be excluded due to language problems, and 17 participants initially agreed to participate, but did not come to the agreed appointment for strength measurements. Out of the participants of the study, 54 also filled in the questionnaire on sexual health.

Other patients explained that they regarded those questions as too intimate or that sexuality did not play a role in their life anymore. Three-fourth had secondary education and most participants were currently employed.

Most patients had received therapy with disease-modifying anti-rheumatic drugs and one-half received biologics. One-half also had comorbidities. A minority of patients had ACE inhibitors, beta blockers or psychoactive substances as co-medication. Mean pain intensity was 3 on the point VAS scale.

Physical performance showed a mean of 11 points out of a max. Patients who did not answer the questions about sexual health were significantly older, and less often employed. All of the subjects who filled in the questionnaire in Serbo-Croatian or in Turkish were among those who did not answer the questions about sexual health.

Patients who did not respond had a significantly longer median disease duration and a higher mean pain intensity. Out of the 54 patients who filled in the questionnaire about sexual function, Reasons for difficulty in sexual intercourse were joint stiffness Forty-nine subjects answered the question about the desire to engage in sexual intercourse. Forty-nine patients also answered the question of how often they had sexual contact during the last month.

Forty-six patients answered how satisfied they were with their overall sex life. Male gender significantly correlated with the desire for sexual intercourse and the frequency of sexual contact. Pain intensity inversely correlated with satisfaction with overall sex life.

Handgrip strength and knee extensor strength correlated with all three parameters of sexual health. Furthermore, there was a weak but significant negative correlation between medication with biologics and frequency of sexual contact, as well as between beta blockers and desire for sexual intercourse and satisfaction with overall sex life, and between psychoactive substances and all three measures of sexual health. Age and disease activity correlated only weakly and non-significantly inversely with the parameters of sexual health.

In the linear regression analysis, muscle strength in all four limbs and the results of the repeated chair stands test were significantly associated with the desire for sexual intercourse.

After adjusting for age and gender, hand grip strength right, the SPPB total score, the repeated chair stands test and the walking test remained significant. After adjusting additionally for disease activity, only the repeated chair stands test remained significantly associated with the desire for sexual intercourse.

Similarly, strength in all four limbs was associated with the frequency of sexual intercourse in the unadjusted model. Adjusting for age and gender yielded a significant association between knee extensor strength left, the SPPB total score, the repeated chair stands test and the walking test. Handgrip strength right, knee extensor strength right, the SPPB total score and the repeated chair stands score were significantly associated with the satisfaction with overall sex life in the unadjusted model.

Adjusting for age, gender and disease activity did not change those associations. Our findings showed that more than half of the respondents of patients with RA had problems with sexual intercourse. Besides gender, pain intensity, medication, and co-medication, the parameters of physical fitness muscle strength in the extremities and physical performance correlated with sexual performance and sexual satisfaction.

The association between physical fitness parameters and parameters of sexual health clearly weakened when adjusted for disease activity, pain intensity, comorbidities, and co-medication. Therefore, those parameters seemed to contribute to the explanation of the found association; however, some parameters of physical fitness remained significantly associated with sexual function in the fully adjusted model.

Interestingly, we found an association between sexual parameters and parameters of physical fitness. Handgrip strength and knee extensor strength, especially on the right side, as well as physical performance, especially the repeated chair stands test, were associated with the desire to engage in sexual intercourse, with the frequency of sexual contact and with the satisfaction with overall sex life. The associations were similar for all three of the included parameters of sexual health, but were slightly stronger regarding satisfaction with overall sex life according to the magnitude of the regression coefficient.

Adjusting for age and gender had little effect on altering these associations, additionally adjusting for disease activity only marginally reduced these associations and additionally adjusting for comorbidities, co-medication, and pain intensity clearly weakened this association.

This can be interpreted as disease activity only marginally mediates and pain intensity together with comorbidities and co-medication strongly mediates the association between physical fitness and sexual health in RA patients. Still, there was a significant independent association between the repeated chair stands test and the frequency of sexual contact, and the satisfaction with overall sex life, in the fully adjusted model.

As always in cross-sectional studies, no causal conclusions can be drawn from the associations we found. Explanations for the found association could be: 1 that physical fitness contributes to better sexual health; 2 that better sexual health contributes to better physical fitness; or that 3 sexual health and physical fitness are both influenced by a third factor.

What gives us a hint in favour that physical fitness contributes to better sexual health is the fact that, in our study, the strongest association was found for the repeated chair stands test and sexual health. Sexual intercourse is moderate to vigorous exercise [ 17 ], and might require the same physical prerequisites that are also necessary for the repeated chair stands test. In addition, as physical performance is often reduced in patients with RA [ 28 ], these patients might be especially prone to the consequences of this loss.

This would explain the strong association between the chair stands test score and sexual health in RA patients. It could also be asserted that sexual activity through physical training leads to better physical performance. It has been shown that physical training has many positive effects in patients with RA [ 29 ]. This could also contribute to the explanation of why physical performance is associated with sexual health in RA patients. Finally, a third factor might explain the association between physical fitness and sexual function in RA patients.

Clearly, disease activity and pain intensity could be such confounding factors, as adjusting for them weakened the association between physical fitness and sexual health in our study. Disease activity and pain intensity were found to be associated with sexual function in RA patients in previous studies [ 4 , 11 ].

Disease activity and pain are also associated with physical fitness in RA patients, especially with muscular strength [ 14 , 30 ]. It has been argued that loss in muscle mass and muscle strength in RA patients are consequences of chronic inflammation and the catabolic effect of inflammatory cytokines [ 31 , 32 ]. Chronic inflammation, on the other hand, has been show to affect sexual function in both men [ 33 ] and women [ 34 ]. In addition, in men, low testosterone levels as a consequence of chronic inflammation might be important, since this leads to loss of muscle mass and strength as well as to a decline in sexual function [ 35 , 36 ].

In women, general loss in muscle strength also includes loss of muscle strength of the pelvic floor [ 18 , 19 ], and thus can explain problems with sexual health. Other possible confounders include joint stiffness and fatigue, which were most often reported as causes for problems with sexual intercourse in our study, and these factors could also explain problems in physical fitness, e.

There are several implications of the findings for clinical routine that should be stressed: first, we cannot prove that improving physical fitness in RA patients will also improve sexual function and sexual satisfaction. However, several studies have shown the beneficial effects of physical training in RA patients [ 29 , 37 ], and physical training should, therefore, be implemented in RA patients for many different reasons. In addition, the effect of physical training on chronic inflammation has been shown in several studies [ 38 , 39 ], and this could, in addition to many other benefits, also improve sexual function.

Furthermore, our results, in line with other studies, show how frequent sexual problems are in patients with RA, and it is, therefore, necessary to address sexual health and actively ascertain sexual function in RA patients. Open communication about sexuality with RA patients can be regarded as the first step to improve the situation, and the treatment will depend on the specific problem [ 4 ].

Some possible limitations of our study have to be mentioned: first, the relatively small sample size may lead to possible underpowerment of the statistical analyses. The non-responders were older, had a longer disease duration, a higher pain intensity and lower physical fitness. Since all these factors are associated with a higher probability of sexual problems, our findings are likely to underestimate the real problem with sexual health in RA patients.

Shame of talking about sexuality might be the main reason for the low response rate, which might also be a religious or cultural issue, since the non-responders significantly more often used the questionnaire of another language than the responders.

Cultural and religious issues in talking about sexuality in the medical care setting have also been reported in other studies [ 40 ]. Furthermore, it has to be mentioned that we did not use a validated instrument to assess sexual health. In conclusion, our study shows that problems with sexual health are highly prevalent in patients with RA.

Most frequently mentioned are sexual problems due to joint stiffness, fatigue and pain. Factors associated with sexual health include, gender, pain intensity and also factors of physical fitness such as muscle strength and physical performance.

After controlling for disease activity and pain intensity, the ability to rise from a chair remains as an independent factor associated with sexual function.

Open access funding provided by Medical University of Vienna. The authors would like to thank Mark Ackerley for the professional proofreading. TED performed statistical analyses and drafted the paper.

All authors reviewed and approved the manuscript. Thomas E. In addition, the alignment of the spine, hip and knee joints can be maintained with the aid of pillows and cushions, decreasing the pain. These positions may be suggested to patients that present constraints and joint deformities in their lower limbs.

In addition to the comfort provided by the reduced amplitude of movement, this position allows reducing the effort required for postural maintenance. In addition to changes in positions, environmental modifications allow carrying out the activity in a more similar way to the usual for the patient, favoring the performance of sexual activity without major changes.

The goal of these changes is to promote the transfer of weight bearing for other surfaces; thus, the patient saves energy, enjoying moments of rest during sexual activity with the use of brackets and supports that can be obtained with the furniture itself, and with pillows and cushions.

It is important that the medical staff also advise the patient about other ways of expressing their sexuality, as touching, caressing, kissing and with the use of a not penetrative sex, that may also be part of the sexual activity of the patient. Furthermore, interventions that aim to improve these activities contribute to a better relationship between patients and their partners, favoring the empowerment with respect to the disease process and, consequently, quality of life.

Due to the multiplicity and complexity of forms of sexuality expression, the approach of patients with sexual dysfunction involves broad aspects and hard-to-approach themes, whose handling requires the formation of bonds and an environment enabling the understanding of aspects beyond physical complaints, for instance, emotional and social factors. Thus, patient care delivered by a multidisciplinary team allows the development of actions at different levels of complexity in health care.

These actions should address the different contexts of the activities performed by patients in their daily lives, including the expression of their sexuality. In this perspective, the psychologist acts favoring the management of emotional problems related to the illness process and the implications of these issues on the affective and sexual relationship with the patient.

Guidelines on the organization of the routine and protection of joints during activities of daily living, as well as the indication of assisted technology to modify objects and environments, are demands met by occupational therapists. The knowledge of the impact that RA promotes in sexuality by the rheumatologist and other health professionals is of great importance, since it facilitates the physician-patient discussion about the influence of the disease in several domains of patient's quality of life, besides allowing the optimization of the treatment of RA, here encompassing the attention to the patient's sexual difficulties.

Tristano AG. The impact of rheumatic diseases on sexual function. Rheumatol Int. Clayton A, Ramamurthy S. The impact of physical illnesses on sexual dysfunction. Adv Psychosom Med. Rev Bras Ginecol Obstet. Why should rheumatologists evaluate the impact of rheumatoid arthritis on sexuality?

J Bone Spine. Frequency of sexual dysfunction in women with rheumatic diseases. Rev Bras Reumatol. Sexual dysfunction in patients with psoriasis and psoriatic arthritis — a systematic review. Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis. Clin Rheumatol. Arch Pediatr Adolesc Med. A systematic review of the literature on female sexual dysfunction prevalence and predictors. Annu Rev Sex Res. Costa VLA. Physiology of women's sexual function: basic knowledge and new findings.

J Sex Med. Sexual dysfunction in rheumatoid arthritis patients: arthritis and beyond. Acta Reumatol Port. Sexual functioning of people with rheumatoid arthritis: a multicenter study. Evaluation of sexual dysfunction in women with rheumatoid arthritis: a controlled study. Gynecomastia and sexual impotence associated with methotrexate treatment. J Rheumatol. Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. Sex and Arthritis.

Bulletin of Rheumatic Diseases. Palacios S. Hipoactive sexual desire disorders and current pharmacotherapeutic options in women.

Sexuality is an integral part of being human. It is linked to our quality of life and self-identity. Yet, living with the pain, stiffness, fatigue, limited movement, decreased strength, and depression associated with arthritis can reduce our ability for sexual expression and enjoyment. Studies have shown that the higher the levels of pain, physical disability, and depression, the greater the effect on sexuality, regardless of gender.

Medications used in the treatment of arthritis do not appear to affect sexual functioning. Other drugs may interfere with libido for example, cimetidine, diclofenac, misoprostol, and naproxen.

Loss of desire and difficulty with orgasm also are common side effects of antidepressant medications. Sex is not simply about reaching rapid orgasm with a partner. A slower approach can prove satisfying for partners who share mutual respect, care, trust, and love.

Exploring ways of returning pleasure can build excitement and intimacy. Begin overcoming potential barriers by letting your partner know if something is uncomfortable as well as what is particularly pleasurable. While arthritis rarely affects the sexual organs themselves, the physical effects of the disease also can have an emotional impact on sexual relations.

A change in appearance, weight gain or loss, or a decrease in mobility or energy can affect self-esteem and self-image. The person with arthritis may feel less desirable or more fragile.

The fear of pain can prompt anxiety that makes it difficult to relax and enjoy sex or cause sexual partners to worry about causing pain.

arthritis and sexuality pdf

Handgrip strength and and extensor strength were measured with a dynamometer, and physical performance with the Short Physical Performance Battery SPPB. Fifty-four patients, mean age Fifty-seven percent reported, at least, sometimes having difficulty with sexual intercourse And strength and knee extensor strength significantly correlated with the desire to engage in sexual intercourse, frequency of sexual contact and satisfaction with overall sex life.

The SPPB total score correlated with satisfaction with overall sex life, and the SPPB repeated chair stands test with the desire to have sexual intercourse and satisfaction with overall sex life. After adjusting for age, gender, disease activity, comorbidity, co-medication and pdff intensity, the repeated chair stands test remained significantly associated with the frequency of sexual contact 0.

The results of this study show that problems with sexual health are highly prevalent in patients with RA. The ability to rise from a chair is associated with sexual function, independent of disease activity and pain intensity.

In patients with rheumatoid arthritis RAsubjective measures such as quality of life and sexua,ity satisfaction have been recognised as very important health outcomes [ 1 ]. Sexual health is one of the strongest determinants of general health and quality of life [ 2 arthritis, especially pdf patients affected by diseases associated with chronic pain [ 3 ]. In patients with RA, sexuality has not pdf comprehensively examined, and it is and a neglected aspect of quality of life [ 4 ].

Compared to the general population, sexual health, which includes sexual function, sexual activity and sexual relationships, is often significantly affected in patients with RA [ 5 — 8 ]. In female RA patients, many aspects of sexual function, such as desire, arousal, lubrication, orgasm and satisfaction, are often affected [ 7 ], while male RA patients often suffer from impaired sexual desire [ 9 pdf and erectile dysfunction [ 10 ].

Factors that have been found to explain the impairment in sexual health in RA patients include pain intensity, disease activity, physical capacity and disability, joint stiffness, fatigue, mental conditions and the use of certain drugs [ 4arthritsi12 ]. Additionally, co-morbidities such as diabetes mellitus or depression, as well as treatment with medication such as antihypertensives, beta blockers or psychoactive substances can cause sexual dysfunction [ 13 ].

In patients with RA, physical sexuality is often impaired. Loss of muscle mass and muscle strength is common in patients with RA and is arthritis to disease activity [ 14 ]. This loss of muscle strength has and shown to be associated with a higher grade of disability and a poorer quality of life [ 1516 ]. Sexual activity may be considered as a type of physical exercise with energy expenditure that has been classified as moderate to vigorous physical activity [ 17 ].

Therefore, a certain level of physical fitness is required, which is often limited by the disease in RA patients. The association between fitness parameters such as muscle strength and physical performance with sexual health has rarely been examined, particularly for RA patients. In the general population, the association between sexual function especially sexual arousal and orgasm and muscle strength of the pelvic floor in women has been previously examined [ 1819 ].

In men, the association between muscle strength and sexual function, arthritis sexual arthritis and libido, is usually explained by sexualify level [ 20 ]. It was the aim of this study to examine sexual health in male and female patients with RA, to analyse the factors associated seuxality sexual health and to explore if there is an association between sexual function and physical fitness, operationalised by muscle strength in the upper and lower extremities and physical performance.

The study is part of a larger monocentric cross-sectional study with the primary aim of assessing workability in patients with RA. Methods used in the whole study have been published in detail separately [ 21 ]. Participants were recruited from November until August at the outpatient clinic of a hospital department with a focus on rheumatic diseases as they waited for their appointment.

The following exclusion criteria were applied: 1 no informed consent; 2 unable to follow advice with regard to physical measurements and understand interview questions; 3 severe comorbidities, e. Sexual health pdv assessed with a self-administered questionnaire individually designed for this study. This questionnaire consisted of two sections addressing the main problems with sexual health in patients with RA, difficulties in performing intercourse and problems in sexual drive [ 49 ].

The following questions were asked:. How often do you experience difficulties in sexual intercourse? How often have you approximately had sexual contact during the last month? How satisfied do you feel with your overall sex life? For the measurement of maximum handgrip strength and maximum knee extensor strength, these were measured on both sides. Handgrip strength was measured with a portable Jamar hydraulic hand dynamometer Patterson Sexuality.

Knee extensor strength was assessed isometrically with a dynamometer in a standardised procedure [ 24 ]. Pff and thigh were fixed, arms arthritis crossed, and ankles were fixed in a flexed position to the dynamometer. A load cell Chatillon, Ametek Inc was mounted on arthritis ankle via a length-adjustable cord.

The highest values were used for the analyses. This test consists of five tasks: one for gait speed, a repeated chair stands test and three tasks assessing balance skills. For each category, patients can score 4 points, with 0 representing inability to complete the test and 4 representing the highest level of performance.

A score for each of the three domains sexuality a summary score of the total SPPB ranging from 0 worst performance to 12 best performance were used for the analyses. Pain intensity was assessed pdf a visual analogue scale VAS [ sexuality ], where 1 was no pain at all and 10 the maximum pain imaginable.

Demographic sexuality such as gender, age, language of the questionnaire filled in, marital status, education level and employment status were recorded. In addition, clinical data, including drug therapy and presence of comorbidities, were assessed. For the analysis, angiotensin converting and ACE inhibitors, beta blockers, and psychoactive substances antidepressants, benzodiazepines, and neuroleptic drugs were regarded as relevant parameters.

Sample size calculation was performed according to the main study objective, which was to determine the difference in work ability between patients with high versus low disease activity. With an alpha risk of and. To determine the data distribution for the categorical variables, the Kolmogorov—Smirnov test and histogram analysis were applied. In the case of a skewed distribution, median and interquartile range IQR are presented and the Mann—Whitney U test was performed. For each fitness parameter, separate regression annd were calculated.

We calculated crude models model I and stepwise znd for possible confounders: age sexualuty gender sexuality II ; additional disease activity model III ; additional co-morbidities and the treatment with ACE inhibitors, beta blockers, and psychoactive substances model Pdf seuxality additional pain sexuality model V. Socio-demographic and clinical characteristics among subjects who participated vs. Correlation of socio-demographic, clinical and physical fitness parameters with parameters of sexual health.

Association of parameters of physical fitness with the desire for sexual intercourse dependent variable in patients with RA; results of the stepwise adjusted linear regression analyses.

Model IV: adjusted ahd age, gender, disease activity, co-morbidity, treatment with ACE inhibitors, beta blockers and sexuality substances. Model V: adjusted for age, gender, disease activity, co-morbidity, treatment with ACE inhibitors, beta blockers, psychoactive substances and pain intensity. Association of parameters of physical fitness with frequency of sexual contact dependent variable in patients with RA; results of pdf stepwise adjusted linear regression analyses.

Association of parameters of physical fitness with satisfaction with pdf sex life dependent variable in patients with RA; results of the stepwise adjusted linear regression analyses. A total of consecutive patients with seropositive RA who fulfilled the inclusion criteria were invited to participate in the study. Out of those, patients were included in the study. Thirteen patients refused to participate due to lack of interest, 6 refused due to lack of time, 4 had to be excluded sexuality to language problems, and 17 participants initially agreed to participate, but did not come to the agreed arthtitis for strength measurements.

Out of the participants of the study, 54 also sexuality in the questionnaire on sexual health. Other patients explained that they regarded those questions as arrthritis intimate or that sexuality did not play a role pdf their life anymore.

Three-fourth had secondary education and most participants were currently arthrltis. Most patients had received therapy with disease-modifying anti-rheumatic drugs and one-half received biologics. One-half also had comorbidities. A minority of patients had ACE inhibitors, beta blockers or psychoactive substances as co-medication. Mean pain and was pdf on the point VAS scale. Physical performance showed a mean of 11 points out of a pdf.

Patients who did not answer the questions about sexual health were significantly older, and less often employed. All of the subjects who filled in the questionnaire in Serbo-Croatian or in Turkish were among those who did not answer the questions about sexual health.

Patients who arthritis not respond had a significantly longer and disease duration and a higher mean pain intensity. Out of the 54 patients who filled in the questionnaire about sexual function, Reasons for difficulty in sexual intercourse were joint stiffness Forty-nine subjects answered the question about the desire to engage pff sexual intercourse.

Forty-nine patients also answered the question of how often they had sexual contact during the last month. Forty-six patients answered how satisfied they were with their overall sex life. Male gender significantly correlated with the desire for sexual intercourse and the frequency of sexual contact. Pain intensity inversely correlated with satisfaction with overall sex life. Handgrip strength and knee extensor sexualihy correlated with all three parameters of sexual health. Furthermore, there was a weak but arthritis negative correlation between medication with biologics and frequency of sexual contact, as well as between beta blockers and desire for sexual intercourse and satisfaction with overall sex life, and between psychoactive substances and all three measures of sexual health.

Age and disease activity correlated only weakly sexyality non-significantly inversely with the parameters of sexual health. In the linear regression analysis, muscle strength in all four limbs and the results of the repeated chair stands test were significantly associated sexualitg the desire for sexual intercourse.

After adjusting for age and gender, hand grip strength prf, the SPPB total score, the repeated chair stands test and the walking test remained significant. After adjusting additionally for disease activity, only the repeated chair stands test remained significantly associated with the desire for sexual intercourse.

Similarly, strength in all four limbs was associated with the frequency of sexual intercourse in the unadjusted model. Adjusting for age and gender yielded a significant association between knee extensor strength left, the SPPB total score, the repeated chair stands test and the walking test.

Handgrip strength right, knee extensor strength right, the SPPB total score and the repeated chair stands score were significantly associated with the satisfaction with overall sex life in the unadjusted model.

Adjusting for age, gender and disease activity did not change those associations. Our findings showed that more than half of the respondents of patients with RA had problems with sexual intercourse. Besides gender, pain intensity, medication, and co-medication, the parameters of physical fitness muscle strength arthriits the extremities and physical performance correlated with sexual performance and sexual satisfaction.

The association between physical fitness parameters and parameters of sexual health clearly weakened arthritis adjusted for disease activity, pain intensity, comorbidities, and co-medication.

Therefore, those parameters seemed and contribute to arthritis explanation of the found association; however, some and of physical fitness remained significantly associated with sexual function in the fully adjusted model. Interestingly, we found an association between sexual parameters and parameters of physical fitness. Handgrip strength and knee extensor strength, especially on the right side, as well as physical performance, especially the repeated chair stands test, were associated with the desire to engage in sexual intercourse, with the frequency of sexual contact and with the satisfaction with overall sex life.

The associations were similar for all three of the included parameters of sexual health, but were slightly stronger regarding satisfaction with overall sex life according to the magnitude of the regression coefficient. Adjusting for age and gender had little effect on altering these associations, additionally adjusting for disease activity only marginally reduced these associations and additionally adjusting for comorbidities, co-medication, and pain intensity clearly weakened this association.

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The aim of this study was to examine sexual health in patients with rheumatoid arthritis (RA), and to analyse factors associated with sexual. The reasons for disturbing sexual functioning are multifactorial and comprise disease-related factors as well as therapy. Rheumatoid arthritis.

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