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

This systematic review and meta-analysis examined how axial spondyloarthritis (axSpA), and its specific disease features, impact sexual function.

Systematic review of medical literature databases PsycINFO, CINAHL, MEDLINE, Embase, and Cochrane Central from their inception to February 2025. Studies reporting sexual function outcomes in men or women with axSpA were included. After narrative synthesis of included studies, random-effects meta-analysis was used to pool a subset of outcomes. Study quality was assessed using a modified version of the ROBINS-E tool.

From the initial 342 identified studies, 37 were included. Nineteen (50%) examined sexual function in men only, 13 (34%) across both genders, five (13%) in women only, and one (3%) did not specify. Nine studies (24%) reported general sexual dysfunction prevalence in people with axSpA, ranging from 32% to 71%. A meta-analysis of studies (n = 4) examining the International Index of Erectile Function in men with axSpA found that all domain scores, except sexual desire, were worse compared with controls. In women with axSpA, a meta-analysis (n = 4) of Female Sexual Function Index data revealed significantly poorer total sexual function scores, and arousal, pain, lubrication and desire sub-domain scores compared with controls.

Between one- to two-thirds of people with axSpA report a sexual dysfunction. Pooling of data from a small subset of studies demonstrated statistically, and at times clinically, poorer sexual function scores in both men and women compared with controls. This conclusion is constrained by a lack of high-quality research and a notable scarcity of data concerning women.