Sexual well-being is a key component of overall health, particularly mental health, and health-related quality of life. However, sexual well-being in individuals with axial spondyloarthritis (axSpA) is poorly understood and seldom addressed in clinical practice.

A systematic review and meta-analysis published in Rheumatology reported a high prevalence of sexual dysfunction in this population, affecting both men and women, alongside substantial underdiagnosis, which limits clinical care.

This review evaluated how axSpA and its specific disease features influence sexual function with the aim of synthesizing available evidence and quantifying the associated burden.

The researchers conducted a comprehensive search of major databases, including PsycINFO, CINAHL, Medline, Embase, and Cochrane Central. Of the 342 studies identified before February 2025, 37 published between 1983 and 2025 met the inclusion criteria for the systematic review, and nine were included in the meta-analysis.

Study Characteristics

All the studies included were observational, comprising 23 case-control and 14 cross-sectional studies. Nineteen studies focused exclusively on men, 12 (34%) included both sexes, five (13%) included women only, and one did not specify the participant sex.

The studies originated from 14 countries, most commonly Turkey (n = 14 of 37), followed by China (n = 5), the UK (n = 3), Brazil (n = 3), and Morocco (n = 2). Only four studies reported that the participants were heterosexual, while sexual orientation was not specified in the remaining studies.

The authors noted that this was not the first review to examine the sexual function of patients with axSpA.

A systematic review in 2014 assessed the sexual impact but was limited to men.

The review defined healthy sexual function as progression through sexual desire, arousal, and orgasm, accompanied by subjective satisfaction with sexual activity, either alone or with a partner.

Prevalence and Patterns

Nine studies, representing 24% of the included publications, reported prevalence estimates for sexual dysfunction in axSpA ranging from 32% to 71%. Although few studies included healthy individuals, those that did consistently showed higher rates of sexual dysfunction in individuals with axSpA than in age-matched healthy individuals.

Substantial heterogeneity across studies and limited sample sizes were identified as key limitations of this study.

Among men with axSpA, commonly reported problems include erectile dysfunction, reduced libido, and difficulty achieving orgasm. Premature ejaculation was reported in one study, but the difference was not statistically significant when men with axSpA were compared with healthy individuals. Sexual desire was the only domain that did not show a significant reduction in men with axSpA.

In women, axSpA is associated with impairments across multiple domains, including overall sexual function, arousal, pain during intercourse, lubrication, and sexual desire.

The authors emphasized that these findings likely underestimated the burden of sexual dysfunction in individuals with axSpA and highlighted the need for further studies.

They also noted a substantial underrepresentation of women in studies addressing sexual function in this population.

This story was translated from MediQuality, part of the Medscape Professional Network.