Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects women of childbearing age and has been reported to cause sexual dysfunction in women. However, there are few qualitative studies to delve deeper into the impact of changing sexuality in women with SLE on themselves and their intimate relationships.
Objective
To assess the current sexual status and changes in sexual thoughts, attitudes, behavior, and psychology of female SLE patients to provide targeted health guidance.
Methods
A phenomenological research method was used to select 18 female SLE patients from the Department of Rheumatology and Immunology of a tertiary hospital in Hefei City, Anhui Province, to conduct semi-structured in-depth interviews, and the data were analyzed using the Colaizzi seven-step analysis method and the Nvivo11Plus software.
Results
The analysis of the interview data summarized 3 themes and 12 sub-themes, which were changes in sexual life and relationship (change in sexual physiology, change in sexual psychology, couples face changes in their relationships), multiple factors affecting sexual life and relationships (effect of disease, effect of age, effect of emotions, effect of economic, effect of medication, effect of body image), coping strategies for sexuality changes (avoidance and neglect, communication and acceptance, compromise and submission).
Conclusion
Female SLE patients in this study experienced sexual physiological distress and positive or negative psychological experiences, and healthcare professionals should strengthen their attention to patients’ sexuality issues and provide targeted professional guidance to patients to improve their quality of life.
TianJZhangDYaoX, et al.Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study. Ann Rheum Dis2023; 82: 351–356. https://doi.org/10.1136/ard-2022-223035
2.
ZharkovaOCelharTCravensPD, et al.Pathways leading to an immunological disease: systemic lupus erythematosus. Rheumatology2017; 56: i55–i66. https://doi.org/10.1093/rheumatology/kew427
3.
LiSGongTPengY, et al.Prevalence and incidence of systemic lupus erythematosus and associated outcomes in the 2009–2016 US Medicare population. Lupus2020; 29: 15–26. https://doi.org/10.1177/0961203319888691
4.
UngprasertPSagarVCrowsonCS, et al.Incidence of systemic lupus erythematosus in a population-based cohort using revised 1997 American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinics classification criteria. Lupus2017; 26: 240–247. https://doi.org/10.1177/0961203316657434
5.
Gonzalez LuceroLBarbagliaALBellomioVI, et al.Prevalence and incidence of systemic lupus erythematosus in Tucumán, Argentina. Lupus2020; 29: 1815–1820. https://doi.org/10.1177/0961203320957719
6.
GergianakiIFanouriakisARepaA, et al.Epidemiology and burden of systemic lupus erythematosus in a Southern European population: data from the community-based lupus registry of Crete, Greece. Ann Rheum Dis2017; 76: 1992–2000. https://doi.org/10.1136/annrheumdis-2017-211206
7.
MagroRBorgAA. Characterisation of patients with systemic lupus erythematosus in Malta: a population based cohort cross-sectional study. BioMed Res Int2018; 2018: 1–7. https://doi.org/10.1155/2018/2385386
8.
Al DhanhaniAMAgarwalMOthmanYS, et al.Incidence and prevalence of systemic lupus erythematosus among the native Arab population in UAE. Lupus2017; 26: 664–669. https://doi.org/10.1177/0961203316678677
YılmazRKarpuzSAkdereE, et al.Evaluation of sexual dysfunction in females with neck and upper back myofascial pain syndrome: a cross-sectional study. Rheumatol Int2023; 43: 1723–1732. https://doi.org/10.1007/s00296-023-05359-6
KlingJMSidhuKRulloJ, et al.Association between alcohol use and female sexual dysfunction from the data registry on experiences of aging, menopause, and sexuality (DREAMS). Sex Med2019; 7: 162–168. https://doi.org/10.1016/j.esxm.2018.11.009
13.
YiQGuZLirenL, et al.Study on the status of sexual dysfunction and influencing factors in female patients with systemic lupus erythematosus. Chinese Family Medicine2016; 19: 4187–4195.
14.
YazdiFShakibiMRGharavi RoudsariE, et al.The effect of suffering from rheumatoid arthritis, systemic lupus erythematosus, and back pain on sexual functioning and marital satisfaction in Iran. International Journal of Rheumatic Diseases2021; 24: 373–379. https://doi.org/10.1111/1756-185X.14061
15.
PintoBGroverSDhooriaA, et al.Sexual functioning and its correlates in premenopausal married Indian women with systemic lupus erythematosus. International Journal of Rheumatic Diseases2019; 22: 1814–1819. https://doi.org/10.1111/1756-185X.13675
16.
MoralesMGRubioJCPeralta-RamírezM, et al.Impaired sexual function in women with systemic lupus erythematosus: a cross-sectional study. Lupus2013; 22: 987–995. https://doi.org/10.1177/0961203313500370
17.
DaleboudtGMNBroadbentEMcQueenF, et al.The impact of illness perceptions on sexual functioning in patients with systemic lupus erythematosus. J Psychosom Res2013; 74: 260–264. https://doi.org/10.1016/j.jpsychores.2012.11.004
18.
Sadeghi BahmaniDMotlRW. Rate, burden, and treatment of sexual dysfunction in multiple sclerosis: the case for exercise training as a new treatment approach. Mult Scler Relat Disord2021; 51: 102878. https://doi.org/10.1016/j.msard.2021.102878
19.
JinZYangCXiaoC, et al.Systemic lupus erythematosus and risk of sexual dysfunction: a systematic review and meta-analysis. Lupus2021; 30: 238–247. https://doi.org/10.1177/0961203320974081
20.
Serna-PeñaGColunga-PedrazaIJVillarreal-AlarcónMÁ, et al.Sexual function in women with systemic lupus erythematosus: a case–control study. Rheumatol Int2021; 41: 1465–1469. https://doi.org/10.1007/s00296-021-04895-3
21.
VerschurenJEAEnzlinPDijkstraPU, et al.Chronic disease and sexuality: a generic conceptual framework. J Sex Res2010; 47: 153–170. https://doi.org/10.1080/00224491003658227
22.
YanHU. How to conduct systematic evaluation and meta-integration of qualitative research. Shanghai Nursing2020; 20: 1–5.
23.
HochbergMC. Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725. https://doi.org/10.1002/art.1780400928
24.
LiuM. Application of Colaizzi's seven steps in analysing data for phenomenological research. Journal of Nursing2019; 34: 90–92.
25.
WangXQianLIANGXiaoweiNI, et al.Progress of sexual dysfunction in female patients with systemic lupus erythematosus. Rheumatology and Arthritis2023; 12: 56–61.
26.
HuangD. Effect of Rhinoceros Horn Dihuang Tang treatment on inflammatory factors and immunoglobulins in patients with systemic lupus Erythematosus skin damage. Electronic Journal of Modern Medicine and Health Research2020; 4: 71–73.
27.
MoghadamZBRezaeiEFaeziST, et al.Prevalence of sexual dysfunction in women with systemic lupus erythematosus and its related factors. Reumatologia2019; 57: 19–26. https://doi.org/10.5114/reum.2019.83235
YanLTingZXianxianM, et al.Effects of systemic lupus erythematosus on ovarian function and its treatment in traditional Chinese medicine. Chinese Journal of Traditional Chinese Medicine2021; 36: 1500–1503.
30.
MangerKWildtLKaldenJR, et al.Prevention of gonadal toxicity and preservation of gonadal function and fertility in young women with systemic lupus erythematosus treated by cyclophosphamide: the PREGO-study. Autoimmun Rev2006; 5: 269–272. https://doi.org/10.1016/j.autrev.2005.10.001
31.
TongJZhangCZhuL, et al.Sexual dysfunction in perimenopausal women based on a national epidemiological survey in China. Climacteric2019; 22: 190–194. https://doi.org/10.1080/13697137.2018.1547699
32.
TrentoSRSSMadeiroARufinoAC. Sexual function and associated factors in postmenopausal women. Rev Bras Ginecol Obstet2021; 43: 522–529. https://doi.org/10.1055/s-0041-1735128
33.
ZhangLWuBYeJ. Fatigue have impact on the sexual problems in Chinese females with systemic lupus erythematosus. BMC Womens Health2022; 22: 266. https://doi.org/10.1186/s12905-022-01854-3
34.
AnyfantiPPyrpasopoulouATriantafyllouA, et al.Association between mental health disorders and sexual dysfunction in patients suffering from rheumatic diseases. J Sex Med2014; 11: 2653–2660. https://doi.org/10.1111/jsm.12672
35.
HuangLHuangQ. Effects of short-term power orientation psychotherapy on anxiety and depression conditions, psychological resilience, adherence, and well-being in gout patients. Chinese and foreign medical research2023; 21: 76–80.
36.
HearnJHCrossA. Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review. BMC Neurol2020; 20: 32. https://doi.org/10.1186/s12883-020-1619-5
37.
ChurchDStapletonPVasudevanA, et al.Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions: a systematic review. Front Psychol2022; 13: 951451. https://doi.org/10.3389/fpsyg.2022.951451
ShenBHeYChenH, et al.Body image disturbances have impact on the sexual problems in Chinese systemic lupus erythematosus patients. J Immunol Res2015; 2015: 1–6. https://doi.org/10.1155/2015/204513
RottmannNHansenDGLarsenPV, et al.Dyadic coping within couples dealing with breast cancer: a longitudinal, population-based study. Health Psychol2015; 34: 486–495. https://doi.org/10.1037/hea0000218
42.
MilburyKLiYDurraniS, et al.A mindfulness-based intervention as a supportive care strategy for patients with metastatic non-small cell lung cancer and their spouses: results of a three-arm pilot randomized controlled trial. Oncologist2020; 25: e1794–e1802. https://doi.org/10.1634/theoncologist.2020-0125
43.
JiaguiLWangXLiuJ, et al.Effects of mindfulness and companionship on spousal self-efficacy in treated breast cancer patients. Chinese Nursing Journal2020; 55: 1185–1188.
NakopoulouEPapaharitouSHatzichristouD. Patients’ Sexual Health: a Qualitative Research Approach on Greek Nurses’ perceptions. J Sex Med2009; 6: 2124–2132. https://doi.org/10.1111/j.1743-6109.2009.01334.x
46.
RaoKPengGY. Revised interpretation of the north American international nursing diagnosis definition and classification (2018-2020). Chinese Nursing Education2020; 17: 285–288.
47.
MohammadiZMaasoumiRVosoughiN, et al.The effect of the EX-PLISSIT model-based psychosexual counseling on improving sexual function and sexual quality of life in gynecologic cancer survivors: a randomized controlled clinical trial. Support Care Cancer2022; 30: 9117–9126. https://doi.org/10.1007/s00520-022-07332-8
