Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18-70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire-Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire-Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.

Department of Methodology Faculty of Physical Education and Sport Charles University 162 52 Prague Czech Republic

Department of Physiotherapy Faculty of Physical Education and Sport Charles University 162 52 Prague Czech Republic

Department of Rheumatology 1st Faculty of Medicine Charles University 121 08 Prague Czech Republic

Institute of Rheumatology 128 00 Prague Czech Republic

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Denton C.P., Khanna D. Systemic sclerosis. Lancet. 2017;390:1685–1699. doi: 10.1016/S0140-6736(17)30933-9. PubMed DOI

Bruni C., Raja J., Denton C., Matucci-Cerinic M. The clinical relevance of sexual dysfunction in systemic sclerosis. Autoimmun. Rev. 2015;14:1111–1115. doi: 10.1016/j.autrev.2015.07.016. PubMed DOI

Levis B., Hudson M., Knafo R., Baron M., Nielson W.R., Hill M., Thombs B.D., Canadian Scleroderma Research Group (CSRG) Rates and correlates of sexual activity and impairment among women with systemic sclerosis. Arthritis Care Res. 2012;64:340–350. doi: 10.1002/acr.20696. PubMed DOI

Saad S.C., Pietrzykowski J., Lewis S.S., Stepien A.M., Latham V.A., Messick S., Ensz S.L., Wetherell C., Behrendt A.E. Vaginal lubrication in women with scleroderma and Sjogren’s syndrome. Sex. Disabil. 1999;17:103–113. doi: 10.1023/A:1021468216623. DOI

Tzioufas A.G., Liantinioti G., Vlachoyiannopoulos P.G. Practical Management of Systemic Sclerosis in Clinical Practice. Springer; Berlin/Heidelberg, Germany: 2021. Sjogren’s Syndrome (Ss) in Progressive Systemic Sclerosis (SSc) pp. 281–297.

Impens A., Rothman J., Schiopu E., Cole J., Dang J., Gendrano N., Rosen R.C., Seibold J.R. Sexual activity and functioning in female scleroderma patients. Clin. Exp. Rheumatol. 2009;27:S38. PubMed

Bhadauria S., Moser D.K., Clements P.J., Singh R.R., Lachenbruch P.A., Pitkin R.M., Weiner S.R. Genital tract abnormalities and female sexual function impairment in systemic sclerosis. Am. J. Obstet. Gynecol. 1995;172:580–587. doi: 10.1016/0002-9378(95)90576-6. PubMed DOI

Knafo R., Thombs B.D., Jewett L., Hudson M., Wigley F., Haythornthwaite J.A. (Not) talking about sex: A systematic comparison of sexual impairment in women with systemic sclerosis and other chronic disease samples. Rheumatology. 2009;48:1300–1303. doi: 10.1093/rheumatology/kep240. PubMed DOI PMC

Schouffoer A., Van Der Marel J., Ter Kuile M., Weijenborg P., Voskuyl A., Vliet Vlieland C., van Laar J.M., Vliet Vlieland T.P.M. Impaired sexual function in women with systemic sclerosis: A cross-sectional study. Arthritis Rheum. 2009;61:1601–1608. doi: 10.1002/art.24728. PubMed DOI

Knafo R., Haythornthwaite J.A., Heinberg L., Wigley F.M., Thombs B.D. The association of body image dissatisfaction and pain with reduced sexual function in women with systemic sclerosis. Rheumatology. 2011;50:1125–1130. doi: 10.1093/rheumatology/keq443. PubMed DOI PMC

Gigante A., Navarini L., Margiotta D., Barbano B., Afeltra A., Rosato E. Female sexual dysfunction in systemic sclerosis: The role of endothelial growth factor and endostatin. J. Scleroderma Relat. Disord. 2019;4:71–76. doi: 10.1177/2397198318776593. PubMed DOI PMC

Nazarinia M., Esmaeilzadeh E., Khodamoradi Z. Sexual Dysfunction in Female Scleroderma Patients and Its Correlation with Vascular Involvement. Rheumatol. Res. J. 2019;4:93–99. doi: 10.22631/rr.2019.69997.1072. DOI

Rosato E., Gigante A., Barbano B., La Marra F., Molinaro I., Quarta S., Digiulio M.A., Carmelina R., Cianci R., Pisarri S., et al. Clitoral blood flow in systemic sclerosis women: Correlation with disease clinical variables and female sexual dysfunction. Rheumatology. 2013;52:2238–2242. doi: 10.1093/rheumatology/ket305. PubMed DOI

Van Den Hoogen F., Khanna D., Fransen J., Johnson S.R., Baron M., Tyndall A., Matucci-Cerinic M., Naden R.P., Medsger T.A., Jr., Carreira P.E., et al. 2013 classification criteria for systemic sclerosis: An American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65:2737–2747. doi: 10.1002/art.38098. PubMed DOI PMC

Valentini G., Bencivelli W., Bombardieri S., D’Angelo S., Della Rossa A., Silman A.J., Black C.M., Czirjak L., Nielsen H., Vlachoyiannopoulos P.G. European Scleroderma Study Group to define disease activity criteria for systemic sclerosis. III. Assessment of the construct validity of the preliminary activity criteria. Ann. Rheum. Dis. 2003;62:901–903. doi: 10.1136/ard.62.9.901. PubMed DOI PMC

Clements P., Lachenbruch P., Seibold J., Zee B., Steen V., Brennan P., Silman A.J., Allegar N., Varga J., Massa M. Skin thickness score in systemic sclerosis: An assessment of interobserver variability in 3 independent studies. J. Rheumatol. 1993;20:1892–1896. PubMed

Cutolo M., Pizzorni C., Sulli A. Capillaroscopy. Best Pract. Res. Clin. Rheumatol. 2005;19:437–452. doi: 10.1016/j.berh.2005.01.001. PubMed DOI

Miller M.R., Hankinson J., Brusasco V., Burgos F., Casaburi R., Coates A., Crapo R., Enright P., van der Grinten C.P.M., Gustafsson P., et al. Standardisation of spirometry. Eur. Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805. PubMed DOI

Bombardieri S., Medsger T., Jr., Silman A., Valentini G. The assessment of the patient with systemic sclerosis. Introduction. Clin. Exp. Rheumatol. 2003;21:S2–S4. PubMed

Piper B.F., Dibble S.L., Dodd M.J., Weiss M.C., Slaughter R.E., Paul S.M., editors. The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncol. Nurs. Forum. 1998;25:677–684. PubMed

Fisk J.D., Ritvo P.G., Ross L., Haase D.A., Marrie T.J., Schlech W.F. Measuring the functional impact of fatigue: Initial validation of the fatigue impact scale. Clin. Infect. Dis. 1994;18:S79–S83. doi: 10.1093/clinids/18.Supplement_1.S79. PubMed DOI

Beck A.T., Steer R.A., Brown G.K. Manual for the beck depression inventory-II. Psychol. Corp. 1996;1:82.

Fix A.J., Daughton D. Human Activity Profile: Professional Manual. Psychological Assessment Resources, Inc.; Odessa, FL, USA: 1988. 25p

Steen V.D., Medsger T.A., Jr. The value of the Health Assessment Questionnaire and special patient-generated scales to demonstrate change in systemic sclerosis patients over time. Arthritis Rheum. 1997;40:1984–1991. doi: 10.1002/art.1780401110. PubMed DOI

Fries J.F., Spitz P., Kraines R.G., Holman H.R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–145. doi: 10.1002/art.1780230202. PubMed DOI

Ware J.E., Jr., Gandek B. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J. Clin. Epidemiol. 1998;51:903–912. doi: 10.1016/S0895-4356(98)00081-X. PubMed DOI

Heřmánková B., Špiritović M., Oreská S., Štorkánová H., Komarc M., Klein M., Mann H., Pavelka K., Šenolt L., Vencovský J., et al. Sexual Function in Patients with Idiopathic Inflammatory Myopathies: A Cross-sectional Study. Rheumatology. 2021;60:5060–5072. doi: 10.1093/rheumatology/keab397. PubMed DOI PMC

Heřmánková B., Oreská S., Šmucrová H., Mikulášová M., Špiritović M., Štorkánová H., Bečvář R., Vencovský J., Mann H., Tomčík M. Validation of Czech versions of questionnaires assessing functional impairment in patients with systemic sclerosis: Scleroderma Health Assessment Questionnaire (SHAQ), Cochin Hand Functional Scale (CHFS), Mouth Handicap in Systemic Sclerosis (MHISS), UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0 ) Ceska Revmatol. 2020;28:216–230.

Heřmánková B., Štorkánová H., Mikulášová M., Oreská S., Špiritović M., Štorkánová H., Tomčík M. Validation of Czech versions of questionnaires assessing fatigue and physical activity in patients with rheumatic diseases: Fatigue Impact Scale (FIS), Multidimensional Assessment of Fatigue Scale (MAF), Human Activity Profile (HAP) Ceska Revmatol. 2020;28:132–151.

Ptáček R., Raboch J., Vňuková M., Hlinka J., Anders M. Beckova škála deprese BDI-II-standardizace a využití v praxi. Ceská a Slovenská Psychiatrie. 2016;112:270–274.

SOBOTÍKZ Zkušenosti s použitím předběžné české verze amerického dotazníku o zdraví (SF-36) Zdravotnictví v České Republice. 1998;1:50–54.

Šléglová O., Dušek L., Olejárová M., Tegzová D., Vencovský J., Pavelka K. Posuzování funkční schopnosti u pacientů s revmatoidní artritidou; validace české verze Stanfordského dotazníku Health Assessment Questionnaire (HAQ) Čes Revmatol. 2010;18:73–83.

Štorkánová H., Oreská S., Špiritović M., Heřmánková B., Bubová K., Komarc M., Pavelka K., Vencovský J., Distler J.H.W., Šenolt L., et al. Plasma Hsp90 levels in patients with systemic sclerosis and relation to lung and skin involvement: A cross-sectional and longitudinal study. Sci. Rep. 2021;11:1–10. doi: 10.1038/s41598-020-79139-8. PubMed DOI PMC

Rosen C.B.J., Heiman S., Leiblum C., Meston R., Shabsigh D., Ferguson R., D’Agostino R. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J. Sex Marital. Ther. 2000;26:191–208. doi: 10.1080/009262300278597. PubMed DOI

Taylor J.F., Rosen R.C., Leiblum S.R. Self-report assessment of female sexual function: Psychometric evaluation of the Brief Index of Sexual Functioning for Women. Arch. Sex Behav. 1994;23:627–643. doi: 10.1007/BF01541816. PubMed DOI

Quirk F.H., Heiman J.R., Rosen R.C., Laan E., Smith M.D., Boolell M. Development of a sexual function questionnaire for clinical trials of female sexual dysfunction. J. Womens Health Gend. Based Med. 2002;11:277–289. doi: 10.1089/152460902753668475. PubMed DOI

Symonds T., Boolell M., Quirk F. Development of a questionnaire on sexual quality of life in women. J. Sex Marital. Ther. 2005;31:385–397. doi: 10.1080/00926230591006502. PubMed DOI

Heřmánková B., Štorkánová H., Mikulášová M., Oreská S., Špiritović M., Štorkánová H., Tomčík M. Validation of Czech versions of questionnaires assessing female sexual function and pelvic floor function. Ceska Revmatol. 2021;29:30–40.

Rogers R.G., Kammerer-Doak D., Villarreal A., Coates K., Qualls C. A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am. J. Obstet. Gynecol. 2001;184:552–558. doi: 10.1067/mob.2001.111100. PubMed DOI

Barber M., Walters M., Bump R. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7) Am. J. Obstet. Gynecol. 2005;193:103–113. doi: 10.1016/j.ajog.2004.12.025. PubMed DOI

Sampaio-Barros P.D., Samara A.M., Marques Neto J.F. Gynaecologic history in systemic sclerosis. Clin. Rheumatol. 2000;19:184–187. doi: 10.1007/s100670050152. PubMed DOI

Ostojić P., Damjanov N. Different clinical features in patients with limited and diffuse cutaneous systemic sclerosis. Clin. Rheumatol. 2006;25:453–457. doi: 10.1007/s10067-005-0041-0. PubMed DOI

Giraldi A., Rellini A., Pfaus J.G., Bitzer J., Laan E., Jannini E.A., Fugl-Meyer A.R. Questionnaires for assessment of female sexual dysfunction: A review and proposal for a standardized screener. J. Sex Med. 2011;8:2681–2706. doi: 10.1111/j.1743-6109.2011.02395.x. PubMed DOI

Shah D. Healthy worker effect phenomenon. Indian J. Occup. Environ. Med. 2009;13:77. doi: 10.4103/0019-5278.55123. PubMed DOI PMC

Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study