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Perez-Garcia LF, Te Winkel B, Carrizales JP, Bramer W, Vorstenbosch S, van Puijenbroek E, Hazes JMW, Dolhain RJEM. Sexual function and reproduction can be impaired in men with rheumatic diseases: A systematic review. Semin Arthritis Rheum 2020; 50:557-573. [PMID: 32165034 DOI: 10.1016/j.semarthrit.2020.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information about the possible effect of rheumatic diseases on male sexual function and reproduction (sexual health) is scarce and difficult to summarize. Factors known to impair sexual health, such as inflammation, medication use and hypogonadism can be present in a significant proportion of male patients with rheumatic diseases. OBJECTIVES The objective of our study was to systematically review the literature for the influence of paternal rheumatic disease on sexual health, such as sexual function, reproductive hormones, male fertility, pregnancy and offspring outcomes. DATA SOURCES English language articles identified through Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar and the Clinical trial registries of Europe and the USA published until February 2019. STUDY APPRAISAL AND SYNTHESIS METHODS Literature was synthesized in narrative form and in summary tables. Outcomes were categorized as: sexual function, reproductive hormones, fertility and pregnancy and offspring outcomes. Results are presented per category and per disease. RESULTS 9735 articles were identified with our search strategy. After removal of duplicates, excluding articles by screening titles and abstracts and assessing eligibility by reading 289 fulltext articles, 87 articles fulfilled the eligibility criteria. All included studies enrolled patients diagnosed with a rheumatic disease and had results at least on one of the outcome categories. Sexual function was the most common category, followed by reproductive hormones, fertility and pregnancy and offspring outcomes. Sexual function is impaired in a high proportion of patients with rheumatic diseases. This was statistically significant in most of the studies where a control group was available. Clinically relevant abnormalities in reproductive hormones were mainly identified in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and a positive correlation with disease activity were reported. Semen quality in men with rheumatic diseases can be impaired in patients with SLE, SpA, sarcoidosis, BD and MWS. Sperm count and motility were the most common semen quality parameters affected. No negative effect of paternal RA and vasculitis on pregnancy outcomes were reported in 3 studies. No studies reporting the effect of paternal disease on offspring outcomes were identified. LIMITATIONS Most of the studies included in this review suffer from an inconsistent methodological quality, definitions of outcomes varied in several studies, a wide variety of screening questionnaires and/or diagnostic tools were used and results might only apply to the specific populations that were studied. CONCLUSIONS This systematic review suggests that sexual health is impaired in men with rheumatic diseases. The degree and extent of sexual health impairment vary per disease. More research is needed to fully understand the link between rheumatic diseases and impaired male sexual health. Meanwhile, rheumatologists should be aware of this association and discuss it with their patients. IMPLICATIONS OF KEY FINDINGS Sexual health of men with rheumatic diseases can be impaired by the disease itself. Especially in men trying to conceive, information on sexual function, reproductive hormones and sperm quality are needed to identify these problems. Treatment resulting in lower disease activity can improve overall sexual health in man with rheumatic diseases and facilitate their journey to fatherhood. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2018 CRD42018099845.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands
| | - J P Carrizales
- Servicio de Reumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Monterrey, Mexico
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands; PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen Research Institute of Pharmacy, Broerstraat 4, 9712 CP, Groningen, the Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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Fan D, Liu L, Ding N, Liu S, Hu Y, Cai G, Xia G, Xin L, Wang L, Xu S, Xu J, Zou Y, Pan F. Male sexual dysfunction and ankylosing spondylitis: a systematic review and metaanalysis. J Rheumatol 2014; 42:252-7. [PMID: 25448789 DOI: 10.3899/jrheum.140416] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE No consensus has been reached on sexual dysfunction in men with ankylosing spondylitis (AS). Our study aimed to derive a more precise estimation of the sexual function and its clinical correlations in men with AS. METHODS A metaanalysis was performed and the related literature were searched in PubMed, Elsevier Science Direct, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and in reference lists of articles and systematic reviews. Score of the International Index of Erectile Function (IIEF) was used as the outcome measurement, and standardized mean differences (SMD) with 95% CI were calculated. RESULTS Eleven studies were included, including 535 men with AS and 430 male controls. Each domain of the IIEF score (erectile function: SMD -0.52, 95% CI -0.68 - -0.37; orgasmic function: -0.72, -1.03 - -0.42; sexual drive: -0.40, -0.62 - -0.18; intercourse satisfaction: -0.86, -1.15 - -0.56; and overall satisfaction: -0.61, -0.91 - -0.32) were lower in men with AS than in controls. In the subgroup analysis, the results did not change except for the sexual drive in the Asians group (-0.15, -0.42-0.13). At metaregression, no study characteristics were significantly associated with effect size of the IIEF score. CONCLUSION Sexual function is impaired in male patients with AS and further studies are necessary to better understand risk factors for sexual dysfunction in this population.
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Affiliation(s)
- Dazhi Fan
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Li Liu
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Ning Ding
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Si Liu
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Yanting Hu
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Guoqi Cai
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Guo Xia
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Lihong Xin
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Li Wang
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Shengqian Xu
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Jianhua Xu
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Yanfeng Zou
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Faming Pan
- From the Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University; and the Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, China.D. Fan, MD; L. Liu, MD; N. Ding, MD; S. Liu, MD; Y. Hu, MD; G. Cai, MD; G. Xia, MD; L. Xin, MD; L. Wang, MD; Y. Zou, PhD; F. Pan, PhD, Department of Epidemiology and Biostatistics, School of Public Health; S. Xu, PhD; J. Xu, PhD, Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University.
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