Autoimmune and Rheumatic Diseases and Sexuality

Autoimmune and rheumatic diseases are a group of chronic conditions characterized by chronic inflammation and immune system dysfunction that can result in joint and tissue damage, pain, and disability. In addition, they can also impact patients’ sexual health and quality of life. In a recent systematic review and meta-analysis including more than 5400 females with systemic autoimmune diseases, the overall prevalence of sexual dysfunction (SD) was 63%. Across the different systemic autoimmune diseases, women with Sjögren’s syndrome and systemic sclerosis reported the highest levels of sexual dysfunction (74% and 69%, respectively). The SD in patients with autoimmune and rheumatic diseases can be caused by a variety of factors including disease activity, chronic pain, fatigue, and medication side effects. Moreover, it is important to keep in mind that systemic rheumatic diseases commonly have mental functioning disorders including anxiety and affecting disorders among others, and it is well-known the complex relationship between sexuality and mental disorders. Despite the high prevalence of SD in patients with autoimmune and rheumatic diseases, this topic is often overlooked in clinical practice. Nevertheless, sexual functioning remains a neglected area of quality of life in patients affected by autoimmune and rheumatic diseases. There is a lack of sufficient evidence to recommend a certain management strategy for SD in patients with autoimmune and rheumatic diseases. Although the impact of the different therapeutic interventions is not well-known, beyond the control of inflammation of the underlying disease and pain, non-pharmacological therapies such as psychotherapy, physical exercise, and local measures for dry symptoms such as lubricant creams, among others, are useful strategies. This chapter will focus on sexual health in patients with autoimmune and rheumatic diseases. It will explore the prevalence, causes, and treatment of sexual dysfunction in this population.