Dysfonctions sexuelles de la maladie chronique, l’état des lieux. Première partie : fréquence, impact et gravité

Sexual Dysfunction in Patients with Chronic Non-Genital Physical Disease: An Umbrella Review

Many primary studies and reviews have been published on the influence of chronic diseases (CDs) on sexual dysfunction (SD), but CDs not involving the genitals are less well represented in the literature.

AIM

To determine the prevalence of SD in patients with non-genital CD and assess the overall impact on sexual functioning.

METHODS

An umbrella review was performed of published systematic reviews on the relationship between the occurrence of CDs not involving the genitals and patients' sexual functioning, following the PRISMA guidelines. PubMed, EMBASE, the Cochrane Library, PsycInfo, Scopus, and CINAHL were used to find publications for inclusion in the review, with two independent researchers performing the search and selection of articles, data extraction, and quality assessment. The relative risk (RR) or odds ratio (OR) with 95% confidence was used as an indicator of the association between CD and SD across studies. The quality of studies included in the review was assessed using Amstar-2.

OUTCOMES

Forty-three systematic reviews, thirty of which included a meta-analysis, met the inclusion criteria, representing a total of 880,586 patients (756,629 (85.9%) men, 68,388 (7.8%) women, and 55,569 (6.3%) unspecified).

RESULTS

Among men, CD is associated with erectile dysfunction, and among females, with lower levels of desire, arousal, lubrication, orgasm, and sexual satisfaction and with increased pain during intercourse. For both men and women, depression, anxiety, and fatigue are also reported, while women with CD are more affected by a poor body image than men.

CLINICAL IMPLICATIONS

Patients with CD, especially females, should be more routinely assessed for the impact of their condition on sexual functioning. The impact of CD on men's sexuality has been extensively studied in terms of erectile capacity, but other aspects of their sexuality are largely neglected. Strengths and limitations: This is the first umbrella review to bring together the documented findings regarding sexual dysfunction among patients with various non-genital CDs. While the heterogeneity of the CDs makes the study unique and clinically relevant, it renders the interpretation of the results more difficult. The overrepresentation of men in existing studies reflects the current state of research but limits the applicability of the findings for women.

CONCLUSIONS

Women and men with non-genital CDs can suffer from SD or reduced sexual function. Health professionals should pay more attention to managing these sexual disorders, even when the disease does not affect the genitals.

Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review

AIMS

To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs.

DESIGN

A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews.

REVIEW METHODS

A literature search and thematic analysis were conducted.

DATA SOURCES

Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included.

RESULTS

Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies.

CONCLUSION

Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being.

IMPACT

What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients.

REPORTING METHOD

PRISMA extension for scoping reviews.

NO PATIENT OR PUBLIC CONTRIBUTION

Not required as it was a literary work (scoping review).

Sexual dysfunction and its determinants in women with rheumatoid arthritis

OBJECTIVES

To evaluate sexual function in Tunisian women with rheumatoid arthritis (RA) and to examine factors that are predictors of female sexual dysfunction including sociocultural factors, disease activity, and psychological status.

METHODS

We conducted a cross-sectional study including 71 women with a confirmed diagnosis of RA according to the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria. Clinical and sociodemographic characteristics were collected. The participants were asked to complete the Female Sexual Function Index (FSFI), which contains 19 questions, assessing six areas of female sexual function in the previous 4 weeks. Sexual dysfunction was defined as an FSFI score less than or equal to 26.55. The psychosocial status was evaluated by the Hospital Anxiety and Depression (HAD) scale. Prevalence of sexual dysfunction and predictors of sexual difficulties were assessed.

RESULTS

The prevalence of female sexual dysfunction in women with RA was 49.3%. All areas were altered especially desire (2.92 ± 1.3), arousal (3.27 ± 1.5), and orgasm (3.77 ± 1.5). In univariate analysis, sexual dysfunction was correlated with the age of patients (p = 0.049), the age of partners (p = 0.013), pain (p = 0.001), number of night awakenings (p = 0.02), morning stiffness (p = 0.010), tender joints (p = 0.05), disease activity score (DAS28 ESR) (p = 0.043), fatigue (p = 0.028), and Health assessment questionnaire (HAQ) (p = 0.02). In multivariate analysis, the age of patients and pain were predictive factors of sexual dysfunction. By analyzing each area of the FSFI score, the age of patients was the independent variable associated with desire. Tender joints were associated with lubrication and the age of partners with arousal, orgasm, and satisfaction.

CONCLUSION

Our study suggests that rheumatoid arthritis has a negative impact on patients' sexuality. Age of patients and partners, pain, and tender joints appear to be the main factors influencing sexual function.