Researchers assessed 113 male patients with radiographic axial spondyloarthritis and compared their experiences with 73 age- and body mass index–matched healthy male controls using the Sexual Experience Questionnaire, a validated instrument that evaluates erectile function, individual satisfaction, and couple satisfaction. Patients with radiographic axial spondyloarthritis scored significantly lower across all 3 domains.
The mean total Sexual Experience Questionnaire (SEQ) score was 41.81 (±8.71) in the radiographic axial spondyloarthritis (r-axSpA) group compared with 50.23 (±8.82) in the control group. Erectile function scores were 14.86 vs 17.66, individual satisfaction scores were 20.37 vs 24.47, and couple satisfaction scores were 6.58 vs 8.09, respectively. All differences were statistically significant (P<.001).
To identify clinical contributors to worse sexual experience, researchers conducted multivariable linear regression analysis. After adjusting for age, disease duration, and body mass index, they found that higher disease activity—measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)—was significantly associated with lower SEQ scores. Additional physical contributors included reduced spinal mobility (Bath Ankylosing Spondylitis Metrology Index), limited chest expansion, increased finger-to-floor distance, and worse physical function (Bath Ankylosing Spondylitis Functional Index).
Psychological and behavioral factors also played a role. Poor sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and elevated anxiety and depression scores, assessed using the Hospital Anxiety and Depression Scale (HADS), were independently associated with lower erectile function and sexual satisfaction scores. Among the 113 patients, 47.8% had an Ankylosing Spondylitis Disease Activity Score (ASDAS) >2.1, indicating active disease status.
The study also employed a two-sample Mendelian randomization analysis to explore whether a genetic liability for r-axSpA increased the risk of ED. Using genome-wide association study (GWAS) data from more than 20,000 individuals of European ancestry, researchers found no evidence of a causal relationship. The inverse variance–weighted odds ratio for ED among those with genetic susceptibility to r-axSpA was 0.973 (95% CI, 0.824–1.149; P=.75). Findings were consistent across sensitivity analyses, including MR Egger (OR, 0.906; 95% CI, 0.684–1.201; P=.50), weighted median, and mode-based models.
Although no genetic association was found between r-axSpA and ED, the disease’s physical and emotional burdens appear to negatively affect sexual health. The authors noted that increased disease activity, impaired mobility, poor sleep quality, and symptoms of anxiety and depression were all significantly linked to poorer sexual outcomes.
The authors acknowledged several limitations, including the study’s cross-sectional design, which precludes causal inference. Medications specifically targeting sexual dysfunction (e.g., phosphodiesterase inhibitors) were not assessed. The SEQ has not been validated in homosexual populations, and sexual orientation was not collected. Additionally, because GWAS data used in the MR analysis came from individuals of European ancestry, the findings may not be generalizable to non-European populations such as the Chinese cohort in this study.
The authors recommended that clinicians routinely assess sexual health in patients with r-axSpA and address modifiable contributors such as inflammation, mobility limitations, poor sleep, and mental health issues. Doing so may improve not only sexual well-being but also overall quality of life.
The authors reported no conflicts of interest.
Source: RMD Open