Sexual function in axial spondyloarthritis: a systematic review and meta-analysis

Area of Science:

• Rheumatology and Immunology
• Sexual Health Research
• Clinical Epidemiology

Background:

• Axial spondyloarthritis (axSpA) is a chronic inflammatory condition affecting the spine and pelvis.
• Sexual dysfunction is a common but often underreported complication in chronic diseases.
• Understanding the impact of axSpA on sexual function is crucial for comprehensive patient care.

Purpose of the Study:

• To systematically review and meta-analyze the impact of axial spondyloarthritis (axSpA) on sexual function.
• To identify specific disease features of axSpA that influence sexual health outcomes.
• To synthesize current evidence on sexual dysfunction prevalence and severity in axSpA patients.

Main Methods:

• A systematic literature search was conducted across major medical databases (PsycINFO, CINAHL, MEDLINE, Embase, Cochrane Central) up to February 2025.
• Included studies reported sexual function outcomes in adult men or women diagnosed with axSpA.
• Data were synthesized through narrative review, with random-effects meta-analysis applied to pooled outcomes. Study quality was assessed using a modified ROBINS-E tool.

Main Results:

• Out of 342 identified studies, 37 met inclusion criteria. General sexual dysfunction prevalence in axSpA ranged from 32-71%.
• Meta-analysis in men with axSpA showed worse International Index of Erectile Function (IIEF) domain scores (except desire) compared to controls.
• Meta-analysis in women with axSpA revealed poorer Female Sexual Function Index (FSFI) total scores and sub-domain scores (arousal, pain, lubrication, desire) versus controls.

Conclusions:

• A significant proportion (one- to two-thirds) of individuals with axSpA experience sexual dysfunction.
• Evidence indicates statistically and clinically poorer sexual function in both men and women with axSpA compared to healthy individuals.
• The findings are limited by a scarcity of high-quality research, particularly concerning sexual function in women with axSpA.