The Effects of Autoimmune Disorders on Female Sexual Health

Autoimmune disorders are chronic, genetic disorders that negatively affect everyday life. Many autoimmune disorders tend to predispose and affect women due to their connection with the second X chromosome and because of the way estrogen interacts with the immune system. So, not related to hormone therapy or genetic disorders, but more related to the biology of women.

As a result, autoimmune disorders tend to affect more women than men. Autoimmune disorders can cause a wide range of symptoms but tend to share those of fatigue, pain, problems with moving around, depression, and anxiety.

Some Common Autoimmune Disorders:

Thyroid Disorders

Graves’ disease and Hashimoto’s thyroiditis are highlighted as autoimmune diseases that affect hormonal activity throughout the body, specifically interacting with sex. For example, hypothyroidism (underactive thyroid) often causes low total and free testosterone, reduced libido, and vaginal dryness. Conversely, hyperthyroidism (overactive thyroid) can raise sex hormone-binding globulin (SHBG) and total testosterone, potentially causing fertility issues, low libido, and difficulty with arousal.

Thyroid disorders can cause fatigue and depression (due to chronic disease burden) that can cause low libido (sexual desire) and vaginal dryness.

Rheumatoid Arthritis (RA)

RA is a connective tissue disorder that can cause inflammation, stiffness, swelling, and pain in joints, often making it difficult to do everyday tasks like climbing stairs and working with one’s hands.

One study reported that women with RA may have higher levels of physical disability, pain, depression, and anxiety. These complications can cause sexual dysfunction through low libido and difficulty performing in certain sexual positions (ABDA et al., 2016).

Systemic Lupus Erythematosus (SLE)

SLE is an autoimmune disorder that can present with fatigue, skin rash, arthritis, inflammation in multiple organs, and heart and blood problems.

Several studies have reported that SLE patients tend to have lower sexual functioning related to vaginal pain and discomfort during sex, as well as body image issues, emotional distress, disease activity, and depression (Yin et al., 2017).

Multiple Sclerosis (MS)

MS is a degenerative disease that primarily affects the nervous system, causing pain, inflammation, and trouble with normal movement.

Many women with MS have reported loss of libido, fewer or lower intensity orgasms, vaginal dryness, and loss of feeling in their genitals. However, fatigue and depression appear to be the largest factors contributing to sexual dysfunction in women with MS.

Systemic Sclerosis (SSc)

Sometimes referred to generally as scleroderma, SSc can cause skin tightening, muscle weakness, joint pain, physical deformity, and decreased physical function.

Women with SSc may more often report a lower number and lesser intensity of orgasms. Additionally, skin tightening, heartburn, reflux, and vomiting associated with SSc may cause problems during sex. Chronic pain, fatigue, low self-esteem, and depression may lead to low libido; physical, emotional, and relationship difficulties may lead to sexual inactivity; and joint pain and difficulty finding comfortable sex positions may lead to discomfort and less sexual pleasure.

These complications, as well as dyspareunia (pain with sex), vaginal dryness, and discomfort during sex, may cause overall avoidance of sex.

Potential Treatments

Treating the underlying autoimmune disorder may help alleviate some symptoms and identify whether sexual dysfunction is disorder related. One can then create a treatment plan with their healthcare provider.

Often, treatment will depend on the sexual side effects of the autoimmune disorder. For example, thyroid disorders may be treated with hormone therapy to correct imbalances that may be causing low libido or vaginal dryness and help with any discomfort by recommending lubricants or other well-known solutions.

Some other treatments for autoimmune-related sexual dysfunction include regular exercise, standardized breathing exercises, and physiotherapy, such as pelvic floor muscle therapy. This can all positively impact oxygen and blood flow to the genital area and potentially strengthen libido.

Key Takeaways

• Autoimmune disorders are chronic inflammatory diseases that impact everyday life – including sexual function.
• Autoimmune disorders affect women more often than men.
• While each autoimmune disorder has unique effects on sexual function, they all can influence depression and anxiety in patients. This may be related to the burden of chronic disease or a decrease in sexual intimacy.
• Sexual dysfunction with autoimmune disorders may first be approached from the perspective of treating and controlling the disorder. Then addressing the individual sexual side effects is warranted.
• It may be beneficial to speak with a sexual health professional if you are experiencing sexual dysfunction with an autoimmune disease.

Resources:

ABDA, E., SELIM, Z., TELEB, S., ZAGHIRA, M., FAWZY, M., & HAMED, S. (2016). Sexual function in females with rheumatoid arthritis: Relationship with physical and Psychosocial States. Archives of Rheumatology, 31(3), 239–247. https://doi.org/10.5606/archrheumatol.2016.5838

Baniotopoulos, P., Pyrgidis, N., Minopoulou, I., Tishukov, M., Sokolakis, I., Hatzichristodoulou, G., & Dimitroulas, T. (2022). Treatment of sexual dysfunction in women with systemic autoimmune rheumatic disorders: A systematic review. Sexual Medicine Reviews, 10(4), 520–528. https://doi.org/10.1016/j.sxmr.2022.08.002

Billi, A. C., Kahlenberg, J. M., & Gudjonsson, J. E. (2019). Sex bias in autoimmunity. Current Opinion in Rheumatology, 31(1), 53–61. https://doi.org/10.1097/bor.0000000000000564

Frikha, F., Masmoudi, J., Saidi, N., & Bahloul, Z. (2014). Sexual dysfunction in married women with systemic sclerosis. Pan African Medical Journal, 17. https://doi.org/10.11604/pamj.2014.17.82.3833

Minopoulou, I., Pyrgidis, N., Tishukov, M., Sokolakis, I., Baniotopoulos, P., Kefas, A., Doumas, M., Hatzichristodoulou, G., & Dimitroulas, T. (2023). Sexual dysfunction in women with systemic autoimmune rheumatic disorders: A systematic review and meta-analysis. Rheumatology, 62(3), 1021–1030. https://doi.org/10.1093/rheumatology/keac457

Nazari, F., Shaygannejad, V., Mohammadi Sichani, M., Mansourian, M., & Hajhashemi, V. (2020). Sexual dysfunction in women with multiple sclerosis: Prevalence and impact on quality of life. BMC Urology, 20(1). https://doi.org/10.1186/s12894-020-0581-2

Salari, N., Heidarian, P., Jalili, F., Babajani, F., Shohaimi, S., Nasirian, M., & Mohammadi, M. (2024). The sexual dysfunction in women with thyroid disorders: A meta-analysis. BMC Endocrine Disorders, 24(1). https://doi.org/10.1186/s12902-024-01817-9

Yin, R., Xu, B., Li, L., Fu, T., Zhang, L., Zhang, Q., Li, X., & Shen, B. (2017). The impact of systemic lupus erythematosus on women’s sexual functioning. Medicine, 96(27). https://doi.org/10.1097/md.0000000000007162