Sexual dysfunction and perceptions of rheumatologist engagement on this issue in patients with systemic sclerosis

The purpose of this study is to define the prevalence of, and risk factors associated with sexual dysfunction among individuals with systemic sclerosis, evaluate the frequency of sexual health discussions between patients and rheumatologists, identify patient-perceived barriers to these discussions, and assess screening tools for detecting systemic sclerosis-associated sexual dysfunction.

The Sexual Function in SSc Questionnaire anonymously surveys individuals with self-reported SSc about their sexual function and sexual health discussions with their rheumatologist. Participants were asked to complete the Sexual Function in SSc Questionnaire and the Female Sexual Function Index or International Index of Erectile Function Questionnaire for females and males, respectively. Comparisons were made between those with versus without self-reported sexual dysfunction (measured by the Sexual Function in SSc Questionnaire) using Fisher's exact and t-test, as appropriate. Logistic regression was used to identify predictors of sexual dysfunction. Agreement to statements about barriers to sexual health conversations were compared between those who reported feeling satisfied versus not satisfied with sexual health discussions using Fisher's exact test.

A total of 41 participants completed the Sexual Function in SSc Questionnaire, and 30 (73%) also completed the Female Sexual Function Index or International Index of Erectile Function. Sexual dysfunction was self-reported in 26 (63%) participants. Age, sex, SSc subtype, and time since systemic sclerosis diagnosis were not significant predictors of sexual dysfunction. Twenty-five percent of participants who self-reported sexual dysfunction did not meet the criteria based on the Female Sexual Function Index/International Index of Erectile Function scored assessment. Thirty-six of 41 participants (88%) reported they had never discussed sexual health with their rheumatologist. Among them, 23 (64%) self-reported sexual dysfunction.

Sexual dysfunction is common in systemic sclerosis, yet most participants had never discussed sexual health with their rheumatologist. Discrepancies between self-reported dysfunction and validated questionnaire scores suggest that existing tools may not capture systemic sclerosis-specific concerns. Future studies developing better screening methods and promoting education related to sexual health in SSc care are needed.