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Sexual Health in Patients With Rheumatic Disease: How to Ask Sensitive Questions in a Clinical Setting

Sexual Health in Patients With Rheumatic Disease: How to Ask Sensitive Questions in a Clinical Setting

It is not easy to ask our patients about sexual health and functioning. The European Alliance of Associations for Rheumatology (EULAR) 2022 meeting held in early June had an interesting abstract on using the Changes in Sexual Functioning Questionnaire (CSFQ)-14. This questionnaire was used as a means to assess sexual functioning in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Researchers interviewed 188 patients (RA, PsA, and healthy controls) and measured 4 different domains: pleasure, desire, arousal, and orgasm. Based on responses to the CSFQ-14, almost 50% of patients with RA and 30% with PsA had scores indicating sexual dysfunction, as compared with 6% of healthy controls. Sexual dysfunction was evident across all 4 of the measured domains and statistically significant in rheumatic diseases as compared to healthy controls.

This study and similar previous studies have shown patient age, gender, perceived health, employment situation, and economic status to be related to the risk of suffering from sexual dysfunction. The researchers concluded that these factors should be considered, in addition to the CSFQ-14, for exploration and management of sexual health in patients with rheumatic disease.

I've found that clinicians of my generation (ie, trained in the late 1970s) rarely discuss sexual health with their patients. They may do so if there is a diagnosis in question, for example, if a sexually transmitted infection (STI) is seen in disseminated gonococcal arthritis. Among newer clinicians, I have noticed an increase in sexual health discussions. In Connecticut—where I teach physician assistants/physician associates—they use Objective Structured Clinical Examination (OSCE) training to learn how to discuss a patient's sexual history in a professional and respectful manner. One of the major points to professionally and respectfully having these discussions is to ensure privacy—other medical providers and/or family members should not be present without patient approval. In doing this, the patient can be assured of privacy and confidentiality.

Sexual health is an important aspect of care and a sensitive area of discussion that can be vital for a patient's overall health and wellbeing. Rheumatology practitioners, along with primary care and other providers, should know how to appropriately ask about a patient's sexual health and open the door for discussion. One resource I discovered while drafting this post is a CDC article titled, "Discussing Sexual Health with Your Patients." Though it is on an HIV-specific resource page, I found it helpful and easily employable in a general medical interview, regardless of disease state.

References
  • Centers for Disease Control and Prevention. Discussing sexual health with your patients. www.cdc.gov/hiv/clinicians/screening/discussing-sexual-health.html. Accessed August 4, 2022.
  • Valera-Ribera C, et al. Impact of chronic joint diseases on the sexual sphere with regards to a healthy population: a multicenter study. Presented at EULAR 2022; abstract OP0139

Filed under: Miscellaneous, Rheumatology

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