Reproductive Health in Men with Rheumatic Diseases

Autoimmune rheumatic diseases (AIRDs) can affect reproductive hormones, impair gonadal function, and cause sexual dysfunction in men. Low testosterone levels are commonly seen due to the effect of underlying disease on the HPG axis at the gonadal levels. This can be associated with low sperm counts with impaired motility. Anti-sperm antibodies and aneuploidy (47, XXY) have a high prevalence in patients with SLE. Erectile dysfunction is widespread in patients with AIRDs, particularly in patients with systemic sclerosis. Varicocele, a correctable cause of male infertility, is more common in patients with spondyloarthritis and Behcet’s disease. Cardiovascular co-morbidities and psychological problems associated with chronic diseases further potentiate sexual problems. Sexual health in men remains a big taboo. Most patients do not seek help due to fear of judgement or embarrassment, yet they still want their physician to discuss their sexual health. Hence, it is important that healthcare professionals actively engage patients in discussions related to their sexual health.