Sexual, relationship dysfunction highly prevalent in noninflammatory musculoskeletal pain
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Patients with chronic non-inflammatory musculoskeletal disease often experience sexual dysfunction and negative effects on their relationships because of their condition, according to a meta-analysis published in Arthritis Care & Research.
“Sexual health and relationship harmony are important components of quality of life for many people, yet these topics are not routinely addressed in clinical practice in musculoskeletal pain care,” Andrew M. Briggs, BSc(PT)Hons, PhD, FACP, of Curtin University, in Australia, told Healio Rheumatology.
“Understanding the associations between chronic musculoskeletal pain and impaired sexual function and disrupted relationships is therefore important for informing holistic, person-centered care,” he added. “While some condition-specific studies have been undertaken and some narrative reviews conducted, a rigorous systematic review across the breadth of musculoskeletal pain conditions has not been undertaken previously.”
To examine the association between chronic primary and secondary musculoskeletal pain and sexual and relationship dysfunction, Briggs and colleagues conducted a systematic literature review of four electronic databases. Focusing on the period from Jan. 1, 1990, to Sept. 5, 2019, the researchers analyzed cross-sectional and prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary non-inflammatory musculoskeletal pain, defined by ICD-11 classification criteria. Sexual function and sexual health were defined using WHO criteria.
In all, the researchers included 51 publications in their analysis, including 46 quantitative, three qualitative and two mixed-methods studies. Sample sizes ranged from 13 to 12,377, with a mean age ranging from 32.6 to 69.2 years.
According to the researchers, cross-sectional controlled cohort studies “consistently reported” worse sexual function among individuals with pain compared with those without pain. Among the 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores 26.55 or less for the pain group, suggesting sexual dysfunction. In the four studies reporting the International Index of Erectile Function, pain cohorts demonstrated consistently lower mean subscale scores. The erectile function subscale scores were 25 or less, suggesting erectile dysfunction.
Overall, the meta-analysis revealed three key themes: Impaired sexual function, compromised intimate relationships, and pain impacting sexual identity, body image and self-worth.
“We consistently identified impaired sexual function in people with musculoskeletal pain conditions compared with control group,” Briggs said. “This observation was consistent irrespective of the condition. This finding suggests the issue is significant for people who live with musculoskeletal pain. Second, the nature of the impacts reported extended beyond physiologic function — eg, sexual organ function — to include impacts on functional, social and psychological domains.
“Third, most of the data were quantitative and the outcomes measured tended to be narrow in scope, meaning that there was less information about the lived experience from qualitative studies, which may point to a knowledge gap,” he added. “The data suggest that sexual dysfunction and disrupted intimate relationships are common in people who live with chronic musculoskeletal pain. For clinicians, this means we may need to consider these issues more intentionally in clinical practice in order to provide holistic, person-centered care.”
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