Rheumatism and sexuality: the “taboo” topic that escapes doctors' offices

Rheumatological pathologies, which include a set of more than 200 different diseases, of which the most common are fibromyalgia, osteoarthritis, lupus, rheumatoid arthritis, scleroderma or gout, popularly encompassed under the name of “rheumatism”, have pain in common. of the joints, muscles or tendons, but also a great impact on the work, family and social life of the people who suffer from them.

However, beyond the pain caused by these diseases, specialists have begun to warn about situations that are not usually discussed in medical offices, as it is considered a taboo subject, such as sexuality.

Regarding this, the rheumatologist specialized in clinical sexology, Yamila Chichotky, points out that “up to 70% of patients with rheumatological pathologies manifest some degree of sexual dysfunction, but 80% of the professionals do not evaluate the“ sexuality ”of people. who suffer from rheumatic diseases because it is considered a taboo subject ”.

It should be noted that the World Health Organization (WHO) itself considers that “achieving comprehensive well-being includes aspects related to sexuality”, while the Argentine Society of Rheumatology (SAR) also maintains that “it is a challenge for rheumatologists develop comprehensive care within the complex treatments performed to alleviate these chronic ailments “.

Chichotky, a member of the SAR study group on rheumatoid arthritis, sexuality and quality of life, points out that “80% of rheumatologists do not evaluate the sexuality of patients in any rheumatic disease, and this situation is due to the fact that the sexuality is still a taboo subject, the patient does not feel comfortable talking about it, and the doctor does not ask ”.

“There are actions to help patients if they have muscle or joint pain”

Thus, at the recently held 54th Argentine Congress of Rheumatology, the specialists concluded that “it is necessary to make health teams aware of the need to incorporate the aspect of sexuality in the comprehensive care of patients.”

It should be noted that research reveals that all diseases of the autoimmune spectrum (such as scleroderma, lupus or rheumatoid arthritis, among others) affect sexuality because, among other aspects, they cause pain, joint disorders, vaginal dryness and erectile dysfunction.

“71.7% of women with lupus in Argentina, a rheumatic disease that affects 0.2% of the population and is more common in women, reported having some sexual dysfunction in a study conducted in September 2021, and another on male patients with rheumatoid arthritis, it found that 55% had erectile dysfunction.

“Although now the quality of life has improved a lot – specialists maintain – between 30 or 40% of patients have depression that is not treated because it is possible that the patient feels that he is not depressed and that his state is due to the illness. However, the association between depression and sexual dysfunction was widely documented ”.

“80% of rheumatologists do not evaluate the sexuality of patients”

“Rheumatologists – Dr. Chichotky refers – often fulfill the role of general practitioners and we are responsible for identifying the need for specific referrals, for example to specialists in cardiology or diabetes, however in relation to sexual health, it is something that we are missing. Only two trials were conducted in the world with female patients, one with physical treatment and the other with sexual education, and after subsequent control, objective improvement was found in the evaluation of sexuality. However, they have not yet been implemented because more evidence is needed ”.

The specialist, a rheumatologist with 20 years of experience, highlights that to change this situation, it is necessary to integrate sexuality education into the specialty, because “what is taught in anatomy, what I was taught about sexuality at university, were only reproductive aspects, pleasure was left out. For example, teaching is directed towards how the reproductive system works, unlike sexology, which establishes that the reproductive system also gives pleasure. Today we talk more about a topic that should be part of the training of a doctor, since we only study the physiology of pregnancy and ejaculation to know how an embryo fertilizes, not the process by which this develops ”.

THE ROLE OF EDUCATION

The current president of the Argentine Society of Rheumatology, María Celina de la Vega, states that “when patients are of active age, we notice a great deterioration in the indices that we use to measure quality of life, and we perceive, for example, less attendance at work, retirements and withdrawals at an earlier age, lower level of academic training achieved, lower income level, and deterioration in emotional and sexual aspects ”.

“To combat all this – Chichotky points out – the first tool is education, and it is necessary to continue working on that because there are many shortcomings about the knowledge that both doctors and patients have, for example, of the anatomy of the genital organs. . But despite the limitations, many times just the fact of talking about sexual dysfunction is, for the patient, very important, and he leaves pleased because he was able to talk about it, and thus the issue is decompressed ”.

“Another important problem – he adds – is the distortion in the perception of body image, either as a side effect of treatments such as corticosteroids, which can have adverse effects that affect body image such as increased hair growth, causing diabetes and secondarily impotence. It is one of the many things that rheumatologists try to use as little as possible, and replace them with other less toxic drugs. Because when we talk about sexuality, we are not referring only to the ability to maintain intercourse, but to many other physical and emotional aspects that we have to learn to evaluate and treat to help give responses that improve people’s quality of life. “

Finally, the specialist pointed out that “there are certain actions to help patients if they have pain in their joints or muscles, and thus different positions can be recommended, for example, to avoid pain, for example in the wrists, knees or hips, and A warm bath is also recommended to improve stiffness and improve movement capacity, all with the aim of not overloading that area of ​​pain so that sexual intercourse is pleasant ”.

71,7%

71.7% of women with lupus in Argentina, a rheumatic disease that affects 0.2% of the population and is more common among them, reported having some sexual dysfunction. In male patients with rheumatoid arthritis, 55% had erectile dysfunction.

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