Hidradenitis suppurativa significantly affects sexual health in women

Women were more likely than men to experience a number of adverse sexual health outcomes associated with hidradenitis suppurativa, according to a systematic review.

Danielle Yee, MD, of University of California, Los Angeles, and colleagues culled 789 relevant citations from PubMed and Embase databases down to 13 papers addressing sexual health in the HS setting. They then investigated gender differences in sexual health in this patient population.

Results indicated that compared with healthy controls, individuals with HS experience significant impairments in sexual function.

For men, lower sexual quality of life as assessed by the Sexual Quality of Life Questionnaire for Use in Men (P < .0001) and lower function as assessed by the International Index of Erectile Function (P = .019) were reported compared with those without HS.

Among women, elevated sexual distress as assessed by the Female Sexual Distress Scale-Revised (P = .002) and lower sexual function as assessed by the Female Sexual Function Index (P = .01) were reported for HS populations compared with no HS.

One of the data sets explored reasons for these outcomes and attempted to understand how men and women experience HS. Compared with men, women were more concerned about physical appearance (89% vs. 79%), having diminished sexual desirability (90% vs. 87%) and vertical transmission of HS (51% vs. 27), while men were more likely to fear transmitting it to their partner (60% vs. 49%).

Significantly higher sexual distress as evaluated by the Frankfurt Body Concept Scale for Sexuality score was reported by women compared with men (P = .02), as was the impact on sex life as a function of HS as assessed by the Numeric Rating Scale (P = .021). Women with HS also had worse overall sexual health according to the Arizona Sexual Experience Scale score (P < .001)

Higher incidence of sexual dysfunction was reported among older men compared with younger men and among women with an older age at disease onset, according to the results.

Zeroing in on the increased impact of HS on women, the researchers suggested that higher rates of sexual distress may be explained by social stigmas, along with body image factors, differences in sexual physiology and arousal, and differences in the way HS is distributed in the body.

It was proposed that psychosocial and cultural expectations for physical appearance are different for women and men. Specifically, women reported correlation between physical disfigurement and sexual parameters. In addition, women felt increasingly pressured to modify behavior based on how HS is affecting their physical appearance.

The researchers suggested that it may be beneficial for both clinicians and researchers to understand the difference between sexual distress and sexual dysfunction. Importantly, distress may indicate psychological harm while dysfunction may indicate physical manifestations of HS.

“HS is a highly burdensome, chronic disease that is significantly associated with impairments in sexual health across various validated instruments in both male and female patients,” the researchers wrote. “Sexual health burden from HS appears to be higher for women.”