Effect of Lupus on Sexual Health of Women

Women with systemic lupus erythematosus (SLE) have important sexual concerns that significantly affect their overall quality of life, but these have not been well studied.
Aim: To assess sexual health (intimate contact and procreation) and its association with disease activity and health status in women with SLE.
Methods: 78 female SLE outpatients at Rush University were asked to complete an IRB-approved survey that included 10 questions related to desire, energy, lubrication, pain, enjoyment or avoidance of intimate contact, concerns about passing SLE to children, effect of medicines on ability to conceive and contraception, and effect of SLE on relationship with the partner. Demographic, clinical, disease activity (SELENA-SLEDAI), disease damage (SDI), and health status (SF36) data were collected. Responses were analyzed by Chi square and ANOVA, and p ≤ 0.05 was considered significant.
Results: Of the 78 patients, 67 consented (57% African American, 27% Caucasian, 3% Asian and 13% Hispanic). The mean (SD) age and disease duration were 43.3± 13.2 yrs. and 11.3± 8.3 yrs., and the mean (SD) SELENA-SLEDAI and SDI were 11.2± 8.5 and 2.9± 2.2, respectively. The following refer to those who answered “most or all of the time”. 36% reported decreased desire for intimacy due to SLE and 45% avoided sex due to SLE flare/s in the past 4 weeks. The latter had worse health status (SF-6D 0.54± 0.09 vs 0.68 ± 0.12, p 0.0001) and higher disease activity (15.8 ± 9.4 vs 7.8 ± 7.0, p 0.001) than those who did not avoid sex. 31% had decreased energy for intimate contact in the past 4 weeks due to SLE. 36% and 33% of subjects noted SLE-related pain and decreased lubrication with intimacy, respectively. The former was associated with poor health status (SF6D 0.56 ± 0.14 vs 0.67 ± 0.12, p = 0.04) and greater disease activity (14.7 ± 11.1 vs 7.9 ± 6.9, p = 0.02). Similarly, those with lubrication issues had greater disease activity (15.1 ± 9.5 vs 8.7, p = 0.03). 35% of subjects felt their relationship was adversely affected by SLE; these subjects had worse health status (SF6D 0.51± 0.10 vs 0.68 ± 0.13, p = 0.001) and greater disease activity (17.3±9.2 vs 7.6 ± 7.8, p = 0.004) than subjects without perceived adverse effects on the partner relationship.
64% of subjects were concerned about their ability to prevent unplanned pregnancy; they were younger (32.9 ± 10.1 vs 49.8 ± 12.3 years, p = 0.0001), with shorter disease duration (5.3 ± 2.9 vs 13.3 ± 8.9 years, p = 0.005), but worse disease activity (15.1 ± 7.2 vs 7.9 ± 8.1, p = 0.01) and emotional health (MCS 43.9 ± 9.0 VS 53.0 ± 6.5, p = 0.008) than those without these concerns. 40% were bothered by the effect of medications on their ability to conceive; they were younger (25.3 ± 4.2 vs 46.2 ± 12.1 years, p = 0.0001) than those without this concern.
Conclusions: Women with SLE have significant sexual and procreation concerns, especially concerning unplanned pregnancies. These concerns are most common in younger women with greater disease activity and poorer health status.

 M. Jolly, None; J.A. Block, None; R. Rodby, None.