Synonyms
SLE
Systemic Lupus Erythematosus
Subdivisions
General Discussion
Systemic Lupus Erythematosus (SLE) is an autoimmune condition that occurs when one’s immune system attacks their own tissues and organs. It can manifest in many ways in the body, some more severe than others, including joint pains, skin rashes, heart disease, or kidney damage. There is emerging evidence that SLE can influence the sexual function of women through both psychological and physical means, and is a less researched and discussed impact of this condition.
Signs & Symptoms
SLE influences sexual function by impacting one’s body image, mental health, and attitudes surrounding sexual activity. Postmenopausal women experience symptoms such as hot flashes, decreased vaginal lubrication, poor sleep, and sexual dysfunction (or any other term suggesting that). Many of these are part of the genitourinary syndrome of menopause (GSM) that affects up to 84% of menopausal women. A sexual function scoring scale showed that women with SLE report decreased lubrication and increased pain with intercourse. Those in acute flares of their disease had a high rate of sexual dysfunction (Liu et al 2022).
Causes
Poor Body Image
Body image has been found to play a crucial role in the sexual function of women with autoimmune diseases like SLE. The use of anti-inflammatory medications commonly used to manage this disease can cause weight gain and skin issues which negatively impact one’s body image. Poor body image has been determined as a significant predictor of impaired sexual function in women with SLE (Shen et al 2015).
Poor Mental Health
Poor mental health and depression worsen sexual desire and function in women with SLE. It has been found that depression can mediate much of the sexual dysfunction found in women with SLE. This is likely connected with the physical manifestations of the disease on the body and the impact of managing a chronic illness.
Affected Populations
SLE, as a disease, has a significantly higher prevalence in women. In a study by Shen et al. in 2015, 64.1% of women with SLE report sexual dysfunction compared to 35.7% of women without SLE. A meta-analysis of eight research studies found that men had a statistically significant increased risk of sexual dysfunction compared to women with SLE in these studies, but further research must be conducted to verify this difference given the limited body of knowledge (Liu et al 2022).
Diagnosis
Standard Therapies
Therapies to address sexual function in SLE first involve optimizing control of symptoms from patients’ disease, such as initiating immune-modulating medications for their disease flares. Secondly, for women managing menopausal symptoms in the context of SLE, utilizing vaginal moisturizers, lubricants during sexual behaviors, and estrogens when deficient to support lubrication can be an option if dryness is a major concern. Patients can also explore pelvic floor physical therapy, which helps to strengthen pelvic floor muscles when they are weak and loosen them when they are too tight. Addressing both of these pelvic floor dysfunctions can play a role in reducing pain with sexual intercourse over time (Lupus 2024).
Investigational Therapies
Counseling
A 2023 research trial utilized the EX-PLISSIT (Permission-Limited Information-Specific Suggestion Intensive Therapy) model as a cost-effective and simple counseling method to improve sexual function in women with SLE. This model utilizes weekly counselling sessions including discussions about individual sexual dysfunction, couples counseling, and discussion of the mechanism of SLE’s impact on sexual function between patients and providers. This form of therapy relies on two-way communication between patient and provider to enhance its benefit. The study showed that this counseling model improved self-reported sexual function in patients with SLE who underwent this therapy by an average of 4.4 points, a statistically significant improvement (Shami et al 2023).
Estrogen Therapy
Systemic estrogen/hormone therapy (ET/HT) is common practice for women without SLE in managing menopausal symptoms such as vaginal dryness which contribute to sexual dysfunction. There has been historical hesitancy to use it in women with SLE due to concerns of strokes caused by estrogen. Recent evidence suggests that women with SLE who struggle with menopausal symptoms and are in remission from SLE flares may benefit from systemic HT in the form of conjugated estrogens and medroxyprogesterone acetate, and perhaps other comparable treatments, without change in their disease activity (Gompel 2019). There is not a strong enough body of evidence investigating usage of HRT in women with more severe manifestations of SLE including active flares or antiphospholipid syndrome. For these patients, using non-hormonal treatment such as SSRIs/SNRIs to modulate pain with intercourse could be a good first option for medical management.
Support Available
Support Groups and Counselors:
American Association of Sexuality educators, counselors and therapists:
https://www.aasect.org/
Autoimmune Association Online Support Community:
https://autoimmune.org/resource-center/online-community/
Informational Articles and Podcasts:
Lupus, Sexuality and Intimacy: https://www.hss.edu/conditions_lupus-
Sexuality-intimacy-beginning-conversation.asp
“Sex and Autoimmune disease” Podcast:
https://www.phoenixhelix.com/episode-132-sex-and-autoimmune-
disease-with-kate-wolovsky/
References
- Gompel, Anne. Australian Menopause Society. MHT and Systemic Lupus Erythematosus. Updated 11 Nov 2019. https://www.menopause.org.au/members/ims-menopause-live/mht-and-systemic-Lupus-erythematosus
- Liu, M., Dou, J. & Wang, Q. Correction: The effect of systemic lupus erythematosus on sexual function in women: an updated meta-analysis based on cross-sectional studies. Adv Rheumatol 62, 26 (2022). https://doi.org/10.1186/s42358-022-00258-z
- Lupus & intimacy. Empowering IntimacyTM. Updated 8 May 2024. https://empoweringintimacy.org/empowering-intimacy-lupus-and-intimacy/
- Serna-Peña G, Colunga-Pedraza IJ, Villarreal-Alarcón MÁ, et al. Sexual function in women with systemic lupus erythematosus: a case-control study. Rheumatol Int. 2021;41(8):1465-1469. doi:10.1007/s00296-021-04895-3
