Abstract
Background 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.
Methods We performed a longitudinal study in a third-level referral center in Mexico City (January–November 2018). We included men aged 16 years who fulfilled ACR criteria for SLE and who were sexually active in the previous six months. All subjects answered the International Index of Erectile Function-15 (IIEF-15), the SF-36 (which determines generic health-related quality of life) and the HAQ in two visits. Other clinical, serological and demographic variables were measured. Oxidized LDL was quantified by ELISA.
Results We included 108 male SLE patients. Mean age was 37.2±1.1 years and most patients (87.9%) were taking immunosuppressive therapy. Comorbidities were present in 58.3% of subjects, with dyslipidemia and hypertension being the most prevalent (34.2% and 28.7%, respectively).
The prevalence of sexual dysfunction (SD) was 53.7%. In the basal visit, the only significant differences between the patients with SD and those without SD were a lower education degree (p=0.007) and persistent lymphopenia (p=0.01). There was a positive correlation between global IIEF-15 score (gsIIEF-15) and global SF-36 score (r=0.459, p=0.0001). The physical function domain had the highest correlation (r=0.509, p=0.0001). Likewise, there was a weak negative correlation between gsIIEF-15 and HAQ score (r=−0.252, p=0.012). Also, the gsIIEF-15 had a weak correlation with the absolute lymphocyte count (r=0.273, p=0.005) and oxidized LDL (r=0.310, p=0.04).
In the follow-up visit the only significant differences between the patients with SD when compared with subjects without SD was a low absolute lymphocyte count (1031±89 vs 1458±119, p=0.005); the correlations mentioned in the baseline visit remained significant. Regarding erectile function, 44% of the subjects had some degree of dysfunction. The rest of the variables are shown in table 1.
Conclusions Sexual function is affected in men with lupus (mostly young and with adequate functional capacity), regardless of comorbidities and treatment. Interestingly, lymphopenia is persistently associated with an impaired sexual function, which could be related to the role it plays in endothelial dysfunction and atherosclerosis. The patients disease perception, which is influenced by their academic level and physical role in their daily activities, seems to affect their sexual performance and quality of life. These findings reinforce the need of a multidisciplinary approach for male SLE patients with sexual dysfunction.
Funding Source(s): None
