Sexual Dysfunction in Women with Axial Spondyloarthritis: A Narrative Review Integrating Quantitative Evidence

Sexual dysfunction is an underrecognized but clinically relevant manifestation in women with axial spondyloarthritis (axSpA), with significant implications for quality of life. This review aims to provide a comprehensive synthesis of the biological, clinical, and psychosocial mechanisms underlying sexual dysfunction in axSpA, integrating available literature with supportive quantitative evidence.

Emerging evidence demonstrates that sexual dysfunction in axSpA is common and multifactorial. Chronic inflammation may contribute to endothelial dysfunction, neuroendocrine alterations, and fatigue, which may indirectly affect physiological components of sexual response. Clinical factors such as pain, functional limitation, and reduced mobility further compromise sexual activity, while psychological burden; including depression, anxiety, and body image disturbance; plays a critical mediating role. Structural changes, including genital atrophy associated with disease duration, may also contribute to persistent dysfunction. Quantitative data from a meta-analysis involving 547 women suggest that there may be lower Female Sexual Function Index scores in patients with axSpA compared to healthy controls, despite the low-to-moderate certainty of evidence. This seems particularly evident in areas such as arousal, lubrication, orgasm, pain, and desire. Sexual dysfunction in women with axSpA appears to involve a complex interplay between inflammatory, physical, psychological, and structural factors. A multidisciplinary approach might be beneficial for improving patient outcomes, and systematic assessment of sexual health should be considered into routine care.