Background/Purpose:

Whereas SLE is uncommon in men, the disease is usually more severe and requires more aggressive immunosuppression in male patients. There are multiple studies regarding sexual aspects in women with SLE, but information about sexual function in male patients is quite scant. The impact that the SLE-associated physical and psychological aspects have in these patients has not been previously addressed.

Methods:

We performed a transversal study in a third-level referral center in Mexico City (between January and May 2018). We included men aged ≥ 16 years who fulfilled ACR criteria for SLE and who were sexually active in the previous six months. Patients with other autoimmune diseases (except for APS) or chronic viral infections were excluded. All subjects answered the International Index of Erectile Function-15 (IIEF-15) and the SF-36 (which determines generic health-related quality of life) questionnaires. Other clinical, serological and demographic variables were measured. Oxidized LDL was quantified by ELISA.

Results:

We included 73 male SLE patients. Mean age was 37.8 ± 2.7 years and disease duration was 9.0 ± 7.3 years. SLEDAI score at the time of the study was 4.3 ± 4.1 points; most patients (87.7%) were taking immunosuppressive therapy. Comorbidities were present in 54.7% of subjects, with dyslipidemia and hypertension being the most prevalent (31.5% each).

Global IIEF-15 score was 56.4 ± 15.2 (range 5-75 points) and global SF-36 score was 70.1 ± 12.9 (range 0-100 points). There was a positive correlation between both scores (see Fig. 1). There was also a weak correlation between oxidized LDL levels and global IIEF-15 (r=0.321, p=0.036). Regarding erectile function, 37 subjects (50%) had some degree of dysfunction. These patients were older (34.7 ± 12.1 vs 40.9 ± 12.7 years, p=0.037), had a lower education degree (p=0.002) and a higher prevalence of type 2 diabetes mellitus (p=0.016) than those without erectile dysfunction. The rest of the variables are shown in Table 1.

Interestingly, 86% of patients said they would be willing to consult a specialist if any degree of sexual dysfunction was detected.

Conclusion:

Global sexual function, and especially erectile function, is impaired in men with SLE. Most patients with sexual dysfunction are young and sexually active, and this should be considered by their rheumatologists, in order to inquire about this issue in regular visits. Further research is required to determine the physiopathogenic mechanisms underlying this condition, but endothelial damage and SLE-associated neuropsychological features could play a role.

Table 1

Figure 1