Abstract
Previous research has identified two main problems of sexuality in female rheumatoid arthritis (RA) patients: difficulties in sexual performance and diminution of sexual desire and satisfaction. This study attempts to determine the clinical and psychological factors significantly contributing to sexual disability and dissatisfaction in female RA patients. Ninety consecutive female RA outpatients were assessed by a gynecologist. After excluding patients who were not sexually active and those with genital tract abnormalities, 52 patients were examined and investigated rheumatologically and given questionnaires assessing sexual performance, desire, and satisfaction, as well as demographic variables, pain, disability, anxiety, and depression. Following a correlation analysis, the contributions of demographic, disease, and psychological variables to sexual disability and dissatisfaction were explored by hierarchical and stepwise regression. Thirty-two patients (62%) had difficulties in sexual performance including nine patients (17%) who were totally unable to engage in sexual intercourse because of arthritis. Sexual desire or satisfaction were diminished in 24 patients (46%) and completely lost in 24 patients (46%). Sexual disability was not significantly correlated with any psychodemographic variables, but with parameters of disease activity (p<0.001), Health Assessment Questionnaire (HAQ)-disability (p<0.001), hip (p<0.001) but not knee joint disease, seropositivity (p<0.05), and diminished desire (p<0.05). However, HAQ-disability and hip joint disease were the only independent and significant determinants of sexual disability in the regression model after controlling for the effects of age and disease duration. These variables together explained 64% of the variance of sexual disability. On the other hand, pain (p<0.001), age (p<0.05), and depression (p<0.05) were the significant determinants in the regression model for sexual dissatisfaction, all together contributing 36% of its variance. More than 60% of female RA patients experience variable degrees of sexual disability and diminished sexual desire and satisfaction. Difficulties in sexual performance are related more to overall disability and hip involvement, while diminished desire and satisfaction are influenced more by perceived pain, age, and depression.
Similar content being viewed by others
References
Ehrlich GE (1983) Social, economic, psychologic, and sexual outcomes in rheumatoid arthritis. Am J Med 75(6A):27–34
Ehrlich GE (1973) Sexual problems of the arthritic patient. In: Ehrlich GE (ed) Total Management of the arthritic patient. JB Lippincott, Philadelphia, pp 193–208
Yoshino S, Uchida S (1981) Sexual problems of women with rheumatoid arthritis. Arch Phys Med Rehabil 62(3):122–123
Elst P, Sybesma T, van der Stadt RJ, Prins AP, Muller WH, den Butter A (1984) Sexual problems in rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum 27(2):217–220
Cohen M (1987) Sexuality and the arthritic patient—how well are we doing? J Rheumatol 14:403–404
Blake DJ, Maisiak R, Koplan A, Alarcon GS, Brown S (1988) Sexual dysfunction among patients with arthritis. Clin Rheumatol 7(1):50–60
Britto MT, Rosenthal SL, Taylor J, Passo MH (2000) Improving rheumatologists’ screening for alcohol use and sexual activity. Arch Pediatr Adolesc Med 154(5):478–483
Blake DJ, Maisiak R, Alarcon GS, Holley HL, Brown S (1987) Sexual quality-of-life of patients with arthritis compared to arthritis-free controls. J Rheumatol 14(3):570–576
Bhadauria S, Moser DK, Clements PJ, Singh RR, Lachenbruch PA, Pitkin RM, Weiner SR (1995) Genital tract abnormalities and female sexual function impairment in systemic sclerosis. Am J Obstet Gynecol 172(2 Pt 1):580–587
Ostensen M, Almberg K, Koksvik HS (2000) Sex, reproduction, and gynecological disease in young adults with a history of juvenile chronic arthritis. J Rheumatol 27(7):1783–1787
Walker EA, Keegan D, Gardner G, Sullivan M, Bernstein D, Katon WJ (I997) Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect. Psychosom Med 59(6):572–577
Kraaimaat FW, Bakker AH, Janssen E, Bijlsma JW (1996) Intrusiveness of rheumatoid arthritis on sexuality in male and female patients living with a spouse. Arthritis Care Res 9(2):120–125
Waltz M, Kriegel W, van’t Pad Bosch P (1998) The social environment and health in rheumatoid arthritis: marital quality predicts individual variability in pain severity. Arthritis Care Res 11(5):356–374
Gutweniger S, Kopp M, Mur E, Gunther V (1999) Body image of women with rheumatoid arthritis. Clin Exp Rheumatol 17(4):413–417
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA Jr, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp TJ, Wilder RL, Hunder GG (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Ferraz MB, Quaresma MR, Aquino LRL, Atra E, Tugwell P, Goldsmith CH (1990) Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 17:1022–1024
Fries JF, Spitz P, Krainer RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145
El-Behairy AA (1984) The Symptom Checklist-90-R. El-Nahda El-Misrya, Cairo
Derogatis L (1983) The SCL-90-R manual-II: administration, scoring and procedures. Clinical Psychometric Research, Baltimore
Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL (1983) The prevalence of psychiatric disorders among cancer patients. JAMA 249:751–757
Parker JC, Buckelew SP, Smarr KL, Buescher KL, Beck NC, Frank RG, Anderson SK, Walker SE, Harry S (1990) Psychological screening in rheumatoid arthritis. J Rheumatol 17:1016–1021
Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TJ, Grieveson P, Buchanan WW (1968) Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 37:393–406
Steinbrocker O, Traeger C, Batterman RC (1949) Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662
Mallya RK, Mace BEW (1981) The assessment of disease activity in rheumatoid arthritis using a multivariate analysis. Rheumatol Rehabil 20:14–17
van der Heijde DMFM, van’t Hof MA, van Riel PLCM, van Leeuwen MA, van Rijswijk MH, van de Putte LBA (1992) Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis 51:177–181
SPSS Inc. (1994) SPSS for windows, version 6.1
Bartellas E, Crane JM, Daley M, Bennett KA, Hutchens D (2000) Sexuality and sexual activity in pregnancy. Br J Obstet Gynecol 107:964–968
Hill J, Bird H, Thorpe R (2003) Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatology 42:280–286
Zabinski SJ, Sculco TP, Dicarlo EF, Rivelis M (1998) Osteonecrosis in the rheumatoid femoral head. J Rheumatol 25(9):1674–1680
Yoshino S, Fujimori J, Morishige T, Uchida S (1984) Bilateral joint replacement of hip and knee joints in patients with rheumatoid arthritis. Arch Orthop Trauma Surg 103(1):1–4
van Lankveld W, Ruiterkamp G, Naring G, de Rooij DJ (2004) Marital and sexual satisfaction in patients with RA and their spouses. Scand J Rheumatol 33(6):405–408
Channon LD, Ballinger SE (1986) Some aspects of sexuality and vaginal symptoms during menopause and their relation to anxiety and depression. Br J Med Psychol 59:173–180
Frohlich P, Meston C (2002) Sexual functioning and self-reported depressive symptoms among college women. J Sex Res 39:321–325
Abdel-Nasser AM, Abd El-Azim S, Taal E, El-Badawy SA, Rasker JJ, Valkenburg HA (1998) Depression and depressive symptoms in rheumatoid arthritis patients: an analysis of their occurrence and determinants. Br J Rheumatol 37:391–397
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abdel-Nasser, A.M., Ali, E.I. Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis. Clin Rheumatol 25, 822–830 (2006). https://doi.org/10.1007/s10067-005-0175-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-005-0175-0