Female Sexual Dysfunction and Pelvic Floor Muscle Function Associated with Systemic Sclerosis: A Cross-Sectional Study.

Radim Bečvář,Hana Šmucrová,Hana Štorkánová,Karel Pavelka,Jiří Vencovský,Michal Tomčík,Martin Komarc,Maja Špiritović,Sabína Oreská,Ladislav Šenolt,Barbora Heřmánková

doi:10.3390/ijerph19010612

Abstract

Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18–70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire–Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire–Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.

Highlights

Systemic sclerosis is an immune-mediated connective tissue disease characterized by vasculopathy and tissue fibrosis of the skin and various internal organs.The development of multi-organ manifestations can lead to multiple clinical complications and significantly reduce quality of life [1] including one’s sexual life [2]
Analyses on PFIQ-7 as well as PISQ-12 indicate impaired pelvic floor function compared to healthy controls (HC)
We demonstrated significantly more impaired sexual function and pelvic floor function in women with systemic sclerosis (SSc) compared to age-matched HC

Summary

Introduction

Systemic sclerosis (scleroderma, SSc) is an immune-mediated connective tissue disease characterized by vasculopathy and tissue fibrosis of the skin and various internal organs. The development of multi-organ manifestations can lead to multiple clinical complications and significantly reduce quality of life [1] including one’s sexual life [2]. Physical and psychological consequences of SSc that may affect sexual function include skin tightening, Raynaud’s phenomenon, microstomia and other disfigurement, painful digital ulcers, muscle weakness, gastrointestinal symptoms, dyspnea, fatigue, and depression [3]. Women with SSc often experience discomfort or pain during intercourse attributable to vaginal tightness and dryness. Lubrication can be decreased due to vaginal mucosal changes [4] and secondary Sjögren’s syndrome, which is present in approximately 25% of SSc patients [5]. Many symptomatic medications can inhibit sexual desire and

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