Sexual well-being may suffer in patients with rheumatic and musculoskeletal diseases.Rheumatic and musculoskeletal diseases (RMD) may negatively impact sexual well-being, a study suggests.
“[In our study,] patients with RMD reported lower sexual well-being than those with nRAID*,” said Hannah Maher, a medical student from the University of Minnesota Medical School, Minneapolis, Minnesota, US, at EULAR 2026.
The median SSWBS** score was lower in the RMD vs nRAID group (22.74 vs 23.83; p=0.013), and the SAIRD*** vs inflammatory arthritis (IA) group within the RMD cohort (23 vs 24; p=0.0007). [EULAR 2026, abstract OP020-PARE]
In the pillar analyses, a high median SSWBS score was associated with a high sexual health profile (absence of infertility or HIV infection, engaging in sexual activity, contraception use, low disease burden, absence of multimorbidity) and a high sexual pleasure profile (positive sexual experiences, high social satisfaction, low isolation; p<0.001 for both).
A high median SSWBS score was also associated with a high sexual well-being profile (p<0.001). This profile, which included individuals with optimal mental health, resilience, self-efficacy, and life satisfaction, yielded the highest SSWBS scores.
Conversely, there was a weakly significant inverse association between SSWBS score and a high sexual justice profile, which included individuals residing in countries with maximal gender equality (p=0.003). “[This implies] that structural institutions may not directly correspond to interpersonal dimensions of sexual well-being,” Maher said.
Linear regression analysis
Poorer sexual well-being was significantly associated with older age (unstandardized β, –0.025; p<0.05), functional comorbidity index (unstandardized β, –0.499; p<0.001), and mental comorbidities (unstandardized β, –0.895; p<0.05). “In a healthy population, sex can be a problem as we age; this is holding true for the RMD group as well. This highlights the need to address comorbidity factors as people age,” Maher said.
Better family functioning predicted higher sexual well-being (unstandardized β, 0.821; p<0.001), suggesting that home dysfunction may adversely affect sexual well-being.
Interestingly, there was a significant association between higher sexual well-being and being unmarried and not living with a partner (unstandardized β, 1.447; p<0.001). “This was paradoxical, as one might expect a married or partnered individual to have a regular sexual partner and perhaps a higher sexual well-being. Depending on disease severity, partners may fall into the role of caregiver, which can complicate sexual relationships on top of the disease itself. We can only postulate at this point, but this is an area worth exploring in the future,” Maher said.
Sexual health is important, too
In a landmark paper, Dr Kirstin Mitchell from the University of Glasgow, UK, and colleagues identified four pillars of public health-focused inquiry in relation to sexuality. They conceptualized sexual well-being as a holistic construct overlapping with sexual health, justice, and pleasure. [Lancet Public Health 2021;6:e608-e613]
“Traditionally, public health discussions around sex focus on risk reduction, reproduction, … and avoiding sexually transmitted infections,” Maher explained. “With Mitchell’s framework, sexual health and well-being are so much more, including concepts such as pleasure. We were inspired by their work and wanted to design a study that incorporates their holistic approach.”
Maher and her team used data from the Collating the Voice of Autoimmune Diseases e-survey. A total of 1,882 participants had RMD (1,129 SAIRD and 753 IA), 275 had NRAID, and 861 were healthy controls (HC). The median age in the RMD, NRAID, and HC groups was 47, 38, and 36 years, respectively. A majority of the participants were female (81.9, 86.9, and 56 percent, respectively).
Taken together, the findings underscore the importance of addressing these domains alongside physical health, noted Maher. “Support for sexual health and well-being in the rheumatological setting is very sparse, and patient needs are currently unmet. We hope these data can empower physicians to broach the subject of sex with patients and inspire future studies that may identify evidence-based interventions for improving sexual well-being.”