Sexual Dysfunctions and Health-Related Impairment in Patients With Chronic Disease

Sexual dysfunctions comprise a lack of sexual desire or interest in sex, impaired sexual arousal, delay or absence of orgasm, and sexual pain. International studies have shown that sexual dysfunction can occur subsequent to physical and psychologic/mental disorders or as a result of the effect of medications and has a large effect on sexual satisfaction, mental health, and the quality of the relationship of those affected (1–3). Our study aimed to report population representative rates of sexual dysfunction in women and men in Germany by allowing internationally established instruments. Furthermore, we studied the effect of impairment caused by chronic disorders.

Methods

The study was a cooperation project of Jena University Hospital, Leipzig Medical Faculty, and the market and social research institute USUMA. Participants were selected according to the random route method. Of 5393 households, about 40% of dropouts were due to absence/non-presence, illness, lacking response, or holiday. 12.3% refused to be interviewed. Sociodemographic data were collected personally, the remaining questions were answered in writing and handed over in a sealed envelope.

2531 persons (46.7% male and 53.3% female) aged 14–95 (m=48.4; 95% confidence interval [47.7; 49.1]) years were surveyed—population representative for Germany—about sexual dysfunction by administering the Female Sexual Function Index (FSFI-d) and the International Index of Erectile Function (IIEF-5) as well as—regarding health and impairment subsequent to chronic diseases—with the “scale of current disorders with associated impairment” of the Self-administered Comorbidity Questionnaire (SCQ).

Results

Of 1350 women, 38.9% reported sexual problems; when current sexual activity was considered the rate was 33.9%. 7.5% of sexually active women had already used preparations to increase/improve their libido. 27.5% of the 1074 men reported mild, 13.9% mild to moderate, 4.4% moderate, and 6% severe erectile problems. About 19% of the men had already taken medications to improve potency.

Health, impairment as a result of chronic diseases, and sexual functioning

13.2% of survey participants reported their health as being excellent, 29.6% as very good, 40.3% as good, 14.1% as less good, and 2.5% as poor. 721 patients (28.5%) reported impairments subsequent to chronic disease. Impairments as a result of hypertension (19.4%), depression (7.2%), diabetes (6.3%), heart disease (5.6%), and rheumatism (4.7%). 76.2% of women and 76.0% of men with at least one chronic disease with an associated impairment reported simultaneously about sexual dysfunction. Furthermore, individual chronic diseases were significantly more commonly associated with sexual dysfunction (Table). For example, 77.8% of all men with impairments as a result of hypertension also reported erectile dysfunction.

Table. Relative (N) and absolute rates (%) of men with erectile dysfunction (determined by means of the IIEF-5) and women with sexual dysfunction (determined by means of the FSFI-d) where an impairment is present as a result of chronic disease and Chi square (χ2) test.

Impairment as a result of …	Of which men with erectile dysfunction			Of which women with sexual dysfunction
	% (N)	χ2	P value	% (N)	χ2	P value
Hypertension	77.8 (154)	66.2	<0.001	78.7 (122)	55.2	<0.001
Heart disease	82.4 (42)	20.2	<0.001	86.0 (37)	21.8	<0.001
Depression	66.7 (40)	5.7	0.017	78.3 (65)	26.5	<0.001
Diabetes	81.0 (51)	23.0	<0.001	87.5 (49)	31.2	<0.001
Inflammatory rheumatism	78.9 (30)	11.7	<0.001	85.4 (41)	23.6	<0.001

The χ² value provides information about the association between the two nominal scale variables. The χ2 value of 66.2 (degrees of freedom df=1) for the simultaneous presence of stress/burdens caused by hypertension and erectile dysfunction in this scenario is clearly above the critical value of 3.84 in the standardized χ² table.

Discussion

Sexual dysfunction is common and increases with age. Additionally, impairments occurring as a result of chronic disease and sexual dysfunction often occur comorbidly (1, 3, 4). Variations in the prevalence are due to the fact that, on the one hand, constructs were not operationalized in the studies in a uniform manner and, on the other hand, different forms of sexual dysfunction can overlap. In clinical practice, distinction should be made between sexual problems and sexual dysfunction. In sexual dysfunction, impaired sexual functioning is aggravated by psychologic strain and relationship problems. Initial signs of sexual dysfunction should be taken seriously as they may indicate a chronic underlying disorder. Our study showed clear associations with sexual dysfunction as we explicitly collected data on chronic diseases. The underlying mechanisms of action are complex. Specific chronic diseases can affect sexual functioning either directly or be masked by, for example, psychologic/mental disorders, relationship problems or medications that can affect the libido, cause erectile dysfunction, or lead to a lack of lubrication (1, 2, 5), especially if these problems are experiences as stressful, as in the present study. Any sexual dysfunction has a substantial effect on sexual activity, satisfaction with the intimate partner relationship, and our patients’ quality of life (2). Many of those affected are not aware that sexual problems are often associated with chronic diseases and their treatment. Unfortunately the different aspects of sexual health in the context of chronic diseases are far too rarely routinely recorded in the medical history. This setting, however, presents the opportunity to tackle the subject in the consultation with fewer feelings of shame as regards impairments caused by specific chronic diseases and possible adverse effects of medications.