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Sexual Dysfunction and Associated Factors in Iranian Women with Systemic Lupus Erythematosus: A Cross-Sectional Study
Mahdieh Kiani1, Shadab Shahali1, Fazlollah Ahmadi2
1Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Background:
Sexual dysfunction is a prevalent yet under-investigated dimension of quality of life in women with systemic lupus erythematosus (SLE). This study aimed to determine the prevalence of sexual dysfunction and its associated demographic, reproductive, and SLE-related clinical factors among Iranian women with SLE.
Methods:
This cross-sectional study enrolled women with SLE recruited from private rheumatology practices in two Iranian cities between December 2025 and June 2026. Data were collected via a clinical-demographic questionnaire and the Female Sexual Function Index (FSFI). Of 116 recruited women, 97 participants were included in the final analysis. Univariable and multivariable (backward elimination) linear regression models were used to identify factors associated with total and subdomain FSFI scores.
Results:
The mean (±SD) age of participants was 39.31 (±8.11) years, and sexual dysfunction was identified in 68 of 97 women (70.1%). Arousal 2.65 (±0.59) and desire 3.02 (±1.16) were the most impaired domains, while pain 5.06 (±1.08) was the least affected. In multivariable analysis, active lupus showed the strongest association with poorer sexual function, with significantly lower total FSFI scores (β=-5.33; 95% CI: -6.83, -3.82; P<0.001) and all subdomains (P≤0.009). Longer disease duration and older age at SLE diagnosis were independently associated with lower total, arousal, and satisfaction scores. Current infertility in a small subgroup (n=11/97), higher intercourse frequency, and unemployment were associated with better sexual outcomes in specific domains, while higher parity and chronic comorbidities were associated with worse orgasm and pain scores, respectively.
Conclusion:
Sexual dysfunction is highly prevalent among Iranian women with SLE, particularly affecting arousal and desire. Disease activity, duration, and age at diagnosis are independently associated factors. These findings suggest the potential value of integrating routine sexual health assessments into comprehensive SLE care.