WHAT IS SEXUAL HEALTH?
Sexual health is the broadest category of sex, sexuality, intimacy and sexual activity. The World Health Organization defines sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” (WHO, 2010). Sexual function is the single facet of the human condition that is equal parts physical, psychological, relational, and cultural. It is somatic, emotional, intellectual, social and sometimes even spiritual. On the other end side of that experience is sexual dysfunction, a disruption of any component of sexual activity. That disruption can include sexual frustration, painful sex, or reduced sexual pleasure, all of which are overrepresented among patients with chronic disease, especially chronic inflammatory diseases.
People with rheumatic diseases often have pain, restricted joint movement, fatigue and may also experience mood disturbances and a deterioration in self-esteem. Any one of those problems can cause sexual dysfunction. The percentage of arthritic patients who experience sexual dysfunction is reported to range from 31% to 76% (Van Berlo, 2007). A recent study published in Rheumatology International found that 57% of patients with rheumatoid arthritis report difficulty with sexual intercourse (Dorner et al., 2018). Those same high rates of sexual dysfunction are also reported among patients in Mexico (Gonzalez-Lopez et al., 2006) and Brazil (Costa, Silva, Muniz & Da Mota, 2015).
And the shockingly high prevalence rates aren’t limited to western countries with more progressive sexual norms. A recent study in Taiwan reported the prevalence of sexual dysfunction among female arthritis patients to be 67% (Lin et al., 2017). In Persia, 53% of women with arthritic conditions report sexual dysfunction (Mohsen, Gholamzadeh Baeis, & Borzooei, 2016) and in conservative Malay culture, sexual dysfunction including problems with libido, arousal, orgasm and satisfaction are more common among women with rheumatoid arthritis than in healthy controls (Shahar, Hussein, Sidi, Shah & Mohamed Said, 2012). The same is true in Morocco (Khnaba et al., 2016) and Egypt (Gaber, Moghazy, Niazy, & Salem, 2017). In that latter study with Egyptian patients, problems with orgasm, arousal, and satisfaction were the most common reports (Miedany, El Gaafary & El Aroussy, 2012).
The actual frequency of sexual dysfunction is likely even higher. In research, sexual problems are defined differently from study to study. Some settings query “sexual difficulties” and others assess the frequency of specific types of sexual dysfunction. And, in actual clinical practice, sexual dysfunction is often underdiagnosed because patients decline to report the problem because they are ashamed or frustrated and they also fail to report the problem when they aren’t asked about it. In fact, one study reported that 66% of patients were never asked about the impact of arthritis on their sex lives (Hill, Bird & Thorpe, 2003).