8New insights into sexual functioning and fertility in rheumatic diseases
Section snippets
Sexual functioning
Rheumatic disease can impair sexual functioning in several ways (Table 1). Physical problems, emotional problems and partnership difficulties arising from disease-related stress contribute to a less active and often less enjoyable sex life.1 Chronic pain, fatigue and low self-esteem can reduce an individual's sexual interest and thereby reduce the frequency of intercourse. The pleasure of intercourse can become diminished by pain of joint movement, or difficulty in finding positions that do not
Sex hormones and reduction of libido or fertility
Disturbances of sex hormone status can reduce libido and interfere with successful reproduction. In the following, some hormonal alterations occurring in rheumatic diseases and contributing to reproductive problems are presented. Several studies have investigated serum concentrations of hypophyseal, gonadal and adrenal hormones in women and men with rheumatic diseases and compared them to measurements in healthy, age-matched controls. No significant abnormalities in estrogen and progesterone
Fertility
Fertility is usually measured as the ability to conceive a child and fecundity as the time to achieving pregnancy. Rheumatic diseases can impair fertility and, more often, fecundity in several ways as indicated in Table 1. Complex interactions exist between active disease, autoimmunity, hormonal imbalance, sexual function and fertility.
Autoimmunity and reproductive failure
Autoimmune abnormalities have been associated with infertility.56 Antiphospholipid antibodies (aPLs) have received most attention since they were shown to be connected with pregnancy losses.57 aPLs react with negatively charged phospholipids and include the anticardiolipin antibody; lupus anticoagulant; antibodies to phosphatidylserine, phosphatidylinositol, and phosphatidylethanolamine; and antibodies to the cofactor β2 glycoprotein. Studies in mice showed that aPL not only induced pregnancy
Drugs and reproduction
Most antirheumatic drugs have no effect on the gonads. However, some drugs can cause reversible infertility like the nonsteroidal anti-inflammatory drugs (NSAID) in women and salazopyrin or methotrexate in men. Irreversible infertility is observed exclusively after treatment with alkylating agents like cyclophosphamide and chlorambucil (Table 4). Pulse cyclophosphamide combined with high doses of steroids has been shown to be the most effective treatment for lupus nephritis. This treatment is
Summary
Reversible or permanent infertility is multifactorial and includes the disease itself, drugs used to treat the disease, disease of the genital system, hypothalamic-pituitary-axis dysfunction, and autoimmunity. Sexual dysfunction is experienced equally by female and male patients and most often related to pain, fatigue and physical impairment. Disturbances of sexual functioning require open communication between patient and caregivers and adequate information given. Most disease-specific sexual
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