UNCORRECTED
PROOF
Clin Rheumatol (2006) 25: 822–830
DOI 10.1007/s10067-005-0175-0
ORIGINAL ARTICLE
Ahmed M. Abdel-Nasser
.
Essam I. Ali
Determinants of sexual disability and dissatisfaction in female
patients with rheumatoid arthritis
Received: 15 October 2005 / Revised: 19 November 2005 / Accepted: 3 December 2005 / Published online: 7 March 2006
# Clinical Rheumatology 2006
Abstract Previous research has identified two main
problems of sexuality in female rheumatoid arthritis (RA)
patients: difficulties in sexual performance and diminution
of sexual desire and satisfaction. This study attempts to
determine the clinical and psychological factors signifi-
cantly contributing to sexual disability and dissatisfaction
in female RA patients. Ninety consecutive female RA
outpatients were assessed by a gynecologist. After ex-
cluding patients who were not sexually active and those
with genital tract abnormalities, 52 patients were examined
and investigated rheumatologically and given question-
naires assessing sexual performance, desire, and satisfac-
tion, as well as demographic variables, pain, disability,
anxiety, and depression. Following a correlation analysis,
the contributions of demographic, disease, and psycholog-
ical variables to sexual disability and dissatisfaction were
explored by hierarchical and stepwise regression. Thirty-
two patients (62%) had difficulties in sexual performance
including nine patients (17%) who were totally unable to
engage in sexual intercourse because of arthritis. Sexual
desire or satisfaction were diminished in 24 patients (46%)
and completely lost in 24 patients (46%). Sexual disability
was not significantly correlated with any psychodemo-
graphic variables, but with parameters of disease activity
(p<0.001), Health Assessment Questionnaire (HAQ)-dis-
ability (p<0.001), hip (p<0.001) but not knee joint disease,
seropositivity (p<0.05), and diminished desire (p<0.05).
However, HAQ-disability and hip joint disease were the
only independent and significant determinants of sexual
disability in the regression model after controlling for the
effects of age and disease duration. These variables
together explained 64% of the variance of sexual disability.
On the other hand, pain (p<0.001), age (p<0.05), and
depression (p<0.05) were the significant determinants in
the regression model for sexual dissatisfaction, all together
contributing 36% of its variance. More than 60% of female
RA patients experience variable degrees of sexual disabil-
ity and diminished sexual desire and satisfaction. Difficul-
ties in sexual performance are related more to overall
disability and hip involvement, while diminished desire
and satisfaction are influenced more by perceived pain,
age, and depression.
Keywords Depression
.
Disability
.
Dissatisfaction
.
Rheumatoid arthritis
.
Sexual
Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory
disease of unknown cause which primarily affects multiple
joints, inevitably leads to various degrees of disability, and
ultimately has a profound impact on the social, economic,
psychological, and sexual aspects of the patient’s life [1].
Sexuality is a normal lifelong phenomenon. It influences
behavior, defines gender and roles, and in both a physical
and psychological sense, becomes part of the life style in all
ages [2]. Sexual motivation, competence, and expression
are all diminished in RA patients [3–5] leading to marital
unhappiness [6] so that RA may put an end to marriage and
family life when sexual function becomes difficult or
impossible [3].
Although interference with sexual function is an
important problem in RA, there is inadequate information
on this aspect, possibly because both patients and
physicians avoid exploring sexual issues [3]. In a recent
survey of ten rheumatologists, only 12% of patients seen in
their practice were screened for sexual activity [7]. The
reasons given by rheumatologists were time constraints,
discomfort with the subject, and ambivalence whether such
a screening is in their domain [7].
The few studies that have examined sexuality in RA
found that patients experience problems mainly in two
A. M. Abdel-Nasser (*)
Department of Rheumatology and Rehabilitation,
Minia University, 13 Botros Ghally St.,
11341 Heliopolis, Cairo, Egypt
Tel.: +21-10-5073278
e-mail: aabdelnasser@yahoo.co.uk
E. I. Ali
Department of Obstetrics and Gynaecology,
Minia University, Minia, Egypt