The association of body image dissatisfaction and pain with reduced sexual function in women with systemic sclerosis

Consensus statement on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: Localized scleroderma, systemic sclerosis and overlap syndromes

The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present consensus provides an update to the 2017 European Dermatology Forum Guidelines, focusing on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, updated strategies for the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 1 of this consensus provides clinicians with an overview of the diagnosis and treatment of localized scleroderma (morphea), and systemic sclerosis including overlap syndromes.

Determinants of Depressive Symptoms, Quality of Life, Subjective Health Status and Physical Limitation in Patients with Systemic Sclerosis

Systemic sclerosis is a progressive connective tissue disease for which there is limited knowledge about physical limitations, quality of life and depression. The aim of this study was to assess these parameters during the disease process of systemic sclerosis, in a cross- sectional study of 79 patients and a longitudinal study of 33 patients over 10 years. Medical data were collected by physicians' questionnaires and sociodemographic data, pain, physical limitation, quality of life, subjective health status, risk of depressive symptoms by patients' questionnaires. Data analysis was descriptive and exploratory. Cross-tabulations, χ2 test and Student's t-test were used for calculations, Pearson's correlation to measure dependencies, and logistic regression analyses for categorized parameters. The cross-sectional analysis of 79 patients with systemic sclerosis (81% female, mean ± standard deviation age 61.5 ± 12.6 years) demonstrated a higher rate of patients with risk of depressive symptoms (42.3%) higher physical limitations, lower quality of life, and subjective health status than reference values for the general German population. Moderate to strong correlations between disease-related physical limitation, quality of life, subjective health status, risk of depressive symptoms and pain were detected (correlation according to Pearson -0.459 to -0.638, p < 0.001). Longitudinal analysis revealed a significant increase in disease activity, pain, physical limitation and risk of depressive symptoms (p < 0.001) during the disease process. This study demonstrates that nearly half of patients with systemic sclerosis probably experience depressive symptoms. The rate of patients with risk of depressive symptoms, pain and physical limitations increased during the systemic sclerosis disease process. Health-related quality of life and state of health declined, indicating the need for better interdisciplinary care for patients with systemic sclerosis.

The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey

OBJECTIVE

To evaluate the impact of systemic sclerosis (SSc) on vulvovaginal atrophy (VVA) and sexual health in an Italian population.

METHODS

An Italian survey about the prevalence and severity of VVA (on a 0 to 10 scale) and sexual dysfunction (using the Female Sexual Function Index-FSFI) through an anonymous online questionnaire. We investigated couple relationships and intimacy with partners, the predisposition of patients to talk about their sexual problems, physicians' receptivity, and treatment scenarios. Risk factors for VVA symptoms and sexual dysfunction were assessed.

RESULTS

A total of 107 women affected by SSc were enrolled. Of these, 83.2% of women (89/107) complained about VVA symptoms and 89.7% (among sexually active women; 87/97) about sexual dysfunction. Menopausal status did not affect VVA symptoms, while age was the only independent risk factor for sexual dysfunction. About 70% (74/107) of women reported a negative impact of disturbances on intimacy with their partner. A total of 63 women (58.9%) had never discussed their sexual problems and VVA condition with a physician. Lubricants were the only treatment prescribed, and 75% of women would welcome new therapies, even if experimental (62.9%).

CONCLUSIONS

In women with SSc, VVA symptoms and sexual dysfunction are highly prevalent, independently from menopause. In more than half of the investigated women with SSc, we found reluctance to talk about their sexual problems, despite being symptomatic. This should encourage physicians to investigate vulvovaginal and sexual health. SSc patients would welcome the advent of new treatment possibilities for their VVA and sexual complaints.

Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study

INTRODUCTION

Systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) are very rare rheumatic diseases burdened by a high prevalence of sexual dysfunctions. However, no specific treatment has been proposed to date. To our knowledge, this is the first (pilot) study aiming to investigate the effect of an 8-week tailored physiotherapy program on the sexual health of women with SSc and IIM.

METHODS

In total, 12 women with SSc and 4 women with IIM were enrolled in the study. Based on the patients' capability to participate in the program, they were divided into an intervention group (IG) (mean ± SD age 46.8 ± 8.6 years) and a control group (CG) (mean ± SD age 46.3 ± 8.5 years). IG underwent the 8-week program (1 h of supervised physiotherapy twice weekly), whereas CG received no physiotherapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function (Female Sexual Function Index [FSFI], Brief Index of Sexual Functioning for Women [BISF-W]), sexual quality of life (Sexual Quality of Life-Female [SQoL-F]), functional ability (Health Assessment Questionnaire [HAQ]), quality of life (Medical Outcomes Short Form-36 [SF-36]), and depression (Beck's Depression Inventory-II [BDI-II]). The changes were analyzed with two-way ANOVA and Friedmann's test.

RESULTS

Compared to the statistically significant deterioration in CG over weeks 0-8, we found statistically significant improvements in the total scores of FSFI and BISF-W, and some of their domains, functional status, and the physical component of quality of life.

CONCLUSION

Our 8-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc and IIM. However, due to the lack of randomization and a relatively small sample size resulting from the strict inclusion criteria, further validation of our results is needed.

TRIAL REGISTRATION NUMBER

ISRCTN91200867 (prospectively registered).

Turkish validity and reliability study of male genital self-image scale (MGSIS)

Objective:

This study, which was carried out in order to determine the Turkish validity and reliability of the “Male Genital Self-Image Scale” in a population sample of Turkish men, is of methodological type.

Methods:

In the study, language, content, construct validity, and reliability methods were used for the intercultural adaptation of the scale. The data collection process of the scale was carried out with 336 men who applied to the Family Medicine Polyclinic of a hospital. In the language and content validity phase, the opinions of experts with technical and cultural knowledge were consulted. The data of the study were collected with the Sociodemographic Characteristics Form and the Male Genital Self-Image Scale.

Results:

As a result of experts evaluation, the Content Validity Ratio value was determined as 0.83. At the stage of construct validity, the suitability of the single-factor model of the items of the Male Genital Self-Image Scale was tested. It was determined that all items contributed significantly to the factor (0.62–0.92). As a result of the Confirmatory Factor Analysis, the measurement model was statistically validated (χ2 = 32.083, p = 0.001, χ2/df = 2.917, RMSEA = 0.076). The Cronbach’s alpha reliability coefficient was calculated as α = 0.92 in the analysis performed to evaluate the internal consistency of Male Genital Self-Image Scale.

Conclusion:

The results of the study revealed that Male Genital Self-Image Scale is a valid and reliable tool to evaluate genital self-image in Turkish men.

Female Sexual Dysfunction and Pelvic Floor Muscle Function Associated with Systemic Sclerosis: A Cross-Sectional Study

Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18-70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire-Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire-Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.

Yoga therapy as an adjunct to conventional management of systemic sclerosis: A case series

Systemic sclerosis (SSc) is an autoimmune disorder leading to significant disability and loss of Quality of Life (QoL). Yoga has become popular in recent times for its potential therapeutic benefits. Since there are no scientific reports on the use of Yoga for SSc, we present two female cases (aged 49 and 29 respectively) of limited SSc (duration of illness 4 and 3 years respectively) who underwent Yoga therapy as an adjunct to conventional management in a residential setting for a period of five and four weeks, respectively. During their stay, they underwent a specifically designed Yoga module. After their discharge, they were followed-up for four weeks, during which they were asked to continue practicing Yoga for 1 h every day. Both of them reported a reduction in pain, stiffness, symptom scores, and improved QoL on discharge and at the follow-up compared to the values on admission. Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), as biomarkers of inflammation, reduced on the discharge when compared to the baseline. No adverse events were noted during the stay and the follow-up. Thus, the present case series indicate a possible beneficial role of Yoga as an adjunct therapy to conventional management of SSc. Further studies in the area are warranted to ascertain the efficacy of Yoga for SSc.

Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review

INTRODUCTION

The association between systemic sclerosis (SSc) and sexual dysfunction was controversial.

AIM

To explore the impacts of SSc on sexual function, the prevalence of sexual dysfunction in patients with SSc and associated risk factors.

METHODS

A systematic review of all published studies was performed. Studies exploring the association between SSc and sexual function were retrieved from PubMed, Web of Science, and EBSCO. All retrieved papers were selected according to the inclusion and exclusion criteria.

MAIN OUTCOME MEASURE

The impacts of SSc on sexual function, the prevalence of sexual dysfunction in males and females with SSc and associated risk factors.

RESULTS

A total 12 studies were included in this study. The prevalence of sexual dysfunction in SSc males and SSc females were 76.9-81.4% and 46.7-86.6%, respectively. But the direct impacts of SSc on sexual function were controversial. EULAR SSc activity score ≥3, the number of complications ≥2, and the presence of anticardiolipin antibody and anti U1 ribonucleoprotein antibody in males and resistive index (RI) and the systolic/diastolic (S/D) ratio of clitoral blood in females have potential to be SSc-specific risk factors for sexual dysfunction.

CLINICAL IMPLICATIONS

Clinicians need to pay more attention to the impacts of SSc on sexual function of patients especially in those with risk factors.

STRENGTHS & LIMITATIONS

Systematically explored the prevalence of sexual dysfunction in SSc males and females, and the risk factors of sexual dysfunction for SSc were explored innovatively. However, there were some limitations in included studies prevented exploring the impacts of SSc on sexual function deeply.

CONCLUSION

Sexual dysfunction may be an important symptom of SSc, many risk factors may be associated with sexual dysfunction in males and females with SSc. Gao R, Qing P, Sun X, et al. Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review. Sex Med 2021;9:100392.

Exploring Determinants of Sexual Satisfaction in a Chilean Representative Sample

This article examines the relationship between sexual satisfaction and gender, age, social status, being in stable relationships, intercourse frequency, and satisfaction with physical attractiveness (physical appearance and sex appeal). A self-report questionnaire was applied in a representative sample of 767 residents of Santiago (Chile), over 18 years old and that have had, at least, one sexual relation (with penetration) during their lives. Higher sexual satisfaction was predicted negatively by age and positively by higher satisfaction with sex appeal, higher intercourse frequency and having a stable relationship. Among women, the principal predictors are satisfaction with sex appeal and intercourse frequency. Among men to the above, it is necessary to add satisfaction with physical appearance and having a stable relationship - at odds with supposed higher relevance for women of body satisfaction and sensibility to social relationships. Discussion emphasizes the controversial nature of the gender differences found regarding the Latin American culture.

European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes

The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present guideline focuses on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, current strategies in the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 1 of this guideline provides clinicians with an overview of the diagnosis and treatment of localized scleroderma (morphea), and systemic sclerosis including overlap syndromes of systemic sclerosis with diseases of the rheumatological spectrum.

Cross-Cultural Adaptation of the Male Genital Self-Image Scale in Iranian Men

Introduction

Certain sexual health problems in men can be attributed to genital self-image. Therefore, a culturally adapted version of a Male Genital Self-Image Scale (MGSIS) could help health professionals understand this concept and its associated correlates.

Aim

To translate the original English version of the MGSIS into Persian and to assess the psychometric properties of this culturally adapted version (MGSIS-I) for use in Iranian men.

Methods

In total, 1,784 men were recruited for this cross-sectional study. Backward and forward translations of the MGSIS were used to produce the culturally adapted version. Reliability of the MGSIS-I was assessed using Cronbach α and intra-class correlation coefficients. Divergent and convergent validities were examined using Pearson correlation and known-group validity was assessed in subgroups of participants with different sociodemographic statuses. Factor validity of the scale was investigated using exploratory and confirmatory factor analyses.

Main Outcome Measures

Demographic information, the International Index of Erectile Function, the Body Appreciation Scale, the Rosenberg Self-Esteem Scale, and the MGSIS.

Results

Mean age of participants was 38.13 years (SD = 11.45) and all men were married. Cronbach α of the MGSIS-I was 0.89 and interclass correlation coefficients ranged from 0.70 to 0.94. Significant correlations were found between the MGSIS-I and the International Index of Erectile Function (P < .01), whereas correlation of the scale with non-similar scales was lower than with similar scale (confirming convergent and divergent validity). The scale could differentiate between subgroups in age, smoking status, and income (known-group validity). A single-factor solution that explained 70% variance of the scale was explored using exploratory factor analysis (confirming uni-dimensionality); confirmatory factor analysis indicated better fitness for the five-item version than the seven-item version of the MGSIS-I (root mean square error of approximation = 0.05, comparative fit index > 1.00 vs root mean square error of approximation = 0.10, comparative fit index > 0.97, respectively).

Conclusion

The MGSIS-I is a useful instrument to assess genital self-image in Iranian men, a concept that has been associated with sexual function. Further investigation is needed to identify the applicability of the scale in other cultures or populations.

The clinical relevance of sexual dysfunction in systemic sclerosis

Systemic sclerosis is a chronic multi-organ autoimmune disease, leading to important clinical and psychological implications. Among organ complications, sexual dysfunction is a major issue for both male and female gender, with high prevalence and great impact on quality of life, although frequently not addressed by both clinicians and patients. While erectile dysfunction is the most common cause of sexual problems in males, genital tract and general physical changes are major contributors to sexual impairment in females. This review presents current state of the art on this topic, discussing published data on presentation, evaluation and therapeutic options.

The relation of sexual function to migraine-related disability, depression and anxiety in patients with migraine

Background

Depression and anxiety are two phenomena that affect quality of life as well as sexual function. Depression and anxiety levels are reported to be high in migraine sufferers. We aimed to understand whether sexual function in women with migraine was associated to migraine-related disability and frequency of migraine attacks, and whether this relationship was modulated by depressive and anxiety symptoms.

Methods

As migraine is more commonly seen in females, a total of 50 women with migraine were included. The diagnosis of migraine with or without aura was confirmed by two specialists in Neurology, according to the second edition of International Headache Society (IHS) International Classification of Headache Disorders (ICHD-II) in 2004. Migraine disability assessment scale score, female sexual function index scores, Beck depression inventory score and Beck anxiety inventory scores.

Results

Mean MIDAS score was 19.3 ± 12.8, and mean number of migraine attacks per month were 4.3 ± 2.7. Mean Female Sexual Function Index score was 20.9 ± 5.9 and 90% of patients had sexual dysfunction. Sexual dysfunction was not related to MIDAS score or frequency and severity of attacks. No relationship between sexual function and anxiety was found, whereas severity of depressive symptoms was closely related to sexual function. Depressive symptoms affected all dimensions of sexual function, except for pain.

Conclusion

Sexual dysfunction seemed to be very common in our patients with migraine, while not related to migraine related disability, frequency of attacks and migraine severity or anxiety. The most important factor that predicted sexual function was depression, which was also independent of disease severity and migraine related disability. While future larger scale studies are needed to clarify the exact relationship, depressive and sexual problems should be properly addressed in all patients with migraine, regardless of disease severity or disability.

Sexual Distress, Sexual Dysfunction and Relationship Quality in Women with Systemic Sclerosis: Correlation with Clinical Variables

To assess the rate of sexual distress, sexual dysfunction and relationship quality and their association with clinical variables in women with systemic sclerosis (SSc), 102 sexually active women with SSc were recruited. Sexual distress, sexual dysfunction and dissatisfaction with relationship quality were investigated by Female Sexual Distress Scale Revised (FSDS-R), Female Sexual Function Index (FSFI) and Dyadic Adjustment Scale (DAS), respectively. The patients underwent medical examinations and nailfold videocapillaroscopy (NVC). Of the 102 patients, 37 (36%) reported sexual distress with FSDS-R score >11, 45 (44%) had sexual dysfunction with FSFI score <19 and 49 (48%) were not satisfied with relationship quality with DAS score <100. There was a negative correlation (p<0.001, R= −0.30) between FSDS-R and FSFI. No correlation was found between FSDS-R and DAS. FSFI showed a positive correlation with DAS (p<0.0001, R= 0.36). Age correlated negatively (p<0.05, R= −0.26) with FSFI, while FSDS-R and DAS did not correlate (p>0.05) with age. SSc women with digital ulcers (DU) had a reduction of FSFI and DAS compared with women without DU. In patients with late capillaroscopic pattern, mean value of FSFI was significantly lower than the other two capillaroscopic patterns. DAS decreased with progression of capillaroscopic damage. In a high percentage of women with SSc FSDS-R was increased, while FSFI and DAS were reduced. Age correlated negatively with FSFI, while skin score showed a negative correlation with DAS. Digital vascular damage negatively influenced FSFI and DAS.

Sexual dysfunction in married women with Systemic Sclerosis

Introduction

Sexuality is an often neglected area in patients with rheumatic disease. The aim of this study is to assess sexual functioning and quality of life in a group of married women with Systemic Sclerosis (SSc).

Methods

This is a horizontal study for descriptive and analytical purposes. Married women with SSc were interviewed about their sexual functioning and their quality of life.

Results

A total of ten patients who met the criteria have accepted to participate to the study. Their mean age was 52, 4± 8,2 years. Eight women thought that the disease had affected their sexual activity. All patients reported a decrease in the frequency of intercourse since the onset of their disease. Eight of the sample reported a diminished desire for a sexual relationship. The reasons were fatigue, altered body image and pain. The assessment of sexual functioning using the Female sexual function index (FSFI) showed a mean FSFI score at 14,2±7,8 with nine women scoring in the range associated with sexual dysfunction (SD) (<26). All the subscales were affected. Our patients reported a mean total score on WHOQOL-brief (World Health Quality of Life-Brief Version) of 60 out of 120 indicating a moderate altered quality of life. Depression has been identified as determinants of impaired sexual function.

Conclusion

The prevalence of SD in women with SSc is high when a specific questionnaire is used to assess it. These results indicate that in daily practice, inquiring about sexuality and screening for depressive symptoms is indicated for every patient with SSc.

Body image and its relationship with sexual function and marital adjustment in infertile women

BACKGROUND

Body image is related to cognitive, emotional, and physical aspects of women's life. Therefore, it is expected to have an important role in women's sexual health and marital adjustment too. This issue seems to be salient in infertile women who suffer from psychological consequences of infertility. This study was conducted to investigate the relationship of body image with sexual function and marital adjustment in infertile women in 2011 in Mashhad, Iran.

MATERIALS AND METHODS

This correlational study was performed on 130 infertile women who referred to Montaserieh Infertility Research Centre in Mashhad, Iran. Subjects were selected using convenient sampling method. To collect data, valid and reliable questionnaires including demographic and infertility-related data tool, modified Younesi Body Image Questionnaire, Rosen Female Sexual Function Index (FSFI), and Spanier Dyadic Adjustment Scale (DAS) were used. Data analysis was performed by SPSS software using Student's t-test, correlation, analysis of variance (ANOVA), and Tukey post-hoc test.

RESULTS

The mean scores of body image, sexual function, and marital adjustment in women were 308.1 ± 45.8, 27.23 ± 3.80, and 113.8 ± 19.73, respectively. There was a direct correlation between overall body image and subscales of sexual function including sexual arousal (P = 0.003), sexual desire (P = 0.024), vaginal moisture (P = 0.001), orgasm (P < 0.001), sexual satisfaction (P < 0.001), and dyspareunia (P = 0.007). A direct correlation was also observed between overall body image and subscales of marital adjustment including agreement and consent (P < 0.001), satisfaction with life (P < 0.001), continuity of life (P = 0.007), and expressing emotions within the family environment (P < 0.001).

CONCLUSIONS

Improved sexual function and marital adjustment in cases with higher body image provides evidence that one of the solutions to reduce sexual dysfunction and marital dispute in infertile women could be planning educational and counseling programs to improve women's body image.

Sexual activity and impairment in women with systemic sclerosis compared to women from a general population sample

Objective

Reports of low sexual activity rates and high impairment rates among women with chronic diseases have not included comparisons to general population data. The objective of this study was to compare sexual activity and impairment rates of women with systemic sclerosis (SSc) to general population data and to identify domains of sexual function driving impairment in SSc.

Methods

Canadian women with SSc were compared to women from a UK population sample. Sexual activity and, among sexually active women, sexual impairment were evaluated with a 9-item version of the Female Sexual Function Index (FSFI).

Results

Among women with SSc (mean age = 57.0 years), 296 of 730 (41%) were sexually active, 181 (61%) of whom were sexually impaired, resulting in 115 of 730 (16%) who were sexually active without impairment. In the UK population sample (mean age = 55.4 years), 956 of 1,498 women (64%) were sexually active, 420 (44%) of whom were impaired, with 536 of 1,498 (36%) sexually active without impairment. Adjusting for age and marital status, women with SSc were significantly less likely to be sexually active (OR = 0.34, 95%CI = 0.28–0.42) and, among sexually active women, significantly more likely to be sexually impaired (OR = 1.88, 95%CI = 1.42–2.49) than general population women. Controlling for total FSFI scores, women with SSc had significantly worse lubrication and pain scores than general population women.

Conclusions

Sexual functioning is a problem for many women with scleroderma and is associated with pain and poor lubrication. Evidence-based interventions to support sexual activity and function in women with SSc are needed.