Sexual Dysfunction Overlooked in Men With Lupus

Marcia Frellick

October 23, 2018

CHICAGO — Sexual dysfunction, especially erectile dysfunction, is common in men with systemic lupus erythematosus, according to data presented here at the American College of Rheumatology (ACR) 2018 Annual Meeting.

However, questions about sexual function don't often come up when men with lupus visit their care providers, said Laura Tarter, MD, from the Lupus Center at Brigham and Women's Hospital in Boston, who was not involved with the study.

"It's really not something we typically ask, but perhaps we should," she told Medscape Medical News. "This study shows the rates of sexual dysfunction are really high."

Results from the study of 73 men, both married and single, who were treated at a referral center in Mexico City from January to May 2018 were presented by investigator Jonathan Campos-Guzmán, a student at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City.

Jonathan Campos-Guzmán presenting at ACR 2018 (Source: Darbe Rotach, Medscape)

Study participants were at least 16 years of age, met ACR criteria for systemic lupus erythematosus, and were sexually active in the previous 6 months. Average age was 37.8 years, average disease duration was 9.0 years, and average Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score at the time of the study was 4.3 points.

Most of the patients — 87.7% — were taking immunosuppressants; 31.5% had dyslipidemia, high blood pressure, or both; and 54.7% had at least one comorbidity.

Half the patients — 37 — had some level of erectile dysfunction, determined with the International Index of Erectile Function-15 and the SF-36 (which determines health-related quality of life) questionnaires.

There were no significant differences between married and single men, Campos-Guzmán told Medscape Medical News.

We know so much less about men with lupus. They tend to be on a lot more medication because they have severe disease.

"This is really interesting and it's important that people are starting to look at quality of life, in particular, in men with lupus. We know so much less about men with lupus. They tend to be on a lot more medication because they have severe disease," Tarter explained.

In fact, the ratio of women to men with is about nine or 10 to one in younger patients and about three to one in older patients, she reported.

Men with lupus might be open to discussing sexual function, however. In the study cohort, 86% of the men said they would be willing to consult a specialist if any degree of sexual dysfunction was detected.

"There could be barriers to patients bring it up, like lack of time and embarrassment. We could be referring people for further evaluation," Tarter said. And patients might not think to ask a rheumatologist about a sexual problem.

More research is needed to determine the reason for the connection between systemic lupus erythematosus and sexual dysfunction, "but endothelial damage and SLE-associated neuropsychological features could play a role," Campos-Guzmán and his colleagues write in their abstract.

In addition, "medications could be playing a role, and the question of endothelial damage is interesting. We just don't know. That's certainly something that should be looked at further," said Tarter.

We're doing a lot to attend to the sexual needs of women and maybe we've ignored the men.

"I think it's a good wakeup call to be thinking of this, ask the question, and provide the correct referrals," said Anca Askanase, MD, from the Columbia University Lupus Center in New York City, who is a member of the Lupus Foundation of America medical–scientific advisory council.

"A lot of the lupus doctors tend to be women, and it's even harder for men to bring up their sexual stories to us," she said.

She said she would like to see extended research on how much sexual dysfunction is related to the depression and anxiety that many lupus patients experience.

"We're doing a lot to attend to the sexual needs of women and maybe we've ignored the men," she told Medscape Medical News.

"It makes perfect sense that there would be sexual dysfunction. There's emotional trauma, anxiety, depression, and medications that can interfere with sexual function. There may even be organic lupus involvement, which we haven't thought of before. If we haven't looked for it, we haven't found it," she pointed out.

Campos-Guzmán, Tarter, and Askanase have disclosed no relevant financial relationships.

American College of Rheumatology (ACR) 2018 Annual Meeting: Poster 719. Presented October 21, 2018.

Follow Medscape Rheumatology on Twitter @MedscapeRheum and Marcia Frellick @mfrellick


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.