Current practice and barriers to the management of sexual issues in rheumatology: results of a survey of health professionals.

OBJECTIVES: To explore multidisciplinary health professionals' (HPs) management of disease-related sexual issues in patients with rheumatic diseases, including their perceptions and assessments, and identify factors that prevent HPs from addressing sexuality as a topic with patients. METHODS: A self-constructed questionnaire was sent to 647 nurses, physicians, physiotherapists, occupational therapists, social workers, and psychologists working within rheumatology care. A multivariate logistic regression model of significant determinants for initiating sexual topics with patients was built. RESULTS: The mean age of the responders (n = 274, 42% response rate, 87% female) was 46 years. While 96% considered sexuality a relevant topic in rheumatology care, 71% seldom/never raised the topic. The patient was the main initiator (53%), and 88% of HPs gave the patient responsibility to initiate. The HPs with relevant education in sexuality were significantly more comfortable talking about sexuality (p < 0.001) and raised sexual issues significantly more often (p < 0.001). In the multivariate analyses, higher age [odds ratio (OR) 3.69], having relevant education (OR 3.16), and being comfortable to some extent (OR 3.62) or to a large extent (OR 5.58) remained significant predictors to initiating sexual topics. CONCLUSIONS: Although HPs regarded sexuality as a relevant topic in rheumatic health care, they seldom raised the topic in consultations. Those with further education in sexuality addressed sexual issues more frequently and felt more comfortable. Correspondingly, the majority of respondents requested more education. Such training should be part of the basic HPs' education, as well as part of postgraduate courses.

Perceived influence of health status on sexual activity in RA patients: associations with demographic and disease-related variables.

OBJECTIVE: To examine the prevalence of self-reported problems with sexual activity in patients with rheumatoid arthritis (RA), and associations with demographic and disease-related variables. METHODS: Perceived levels of problems with sexual activity were addressed through question 15 of the Health-Related Quality of Life (HRQoL) instrument 15D. Disease-related variables were determined with the Visual Analogue Scale (VAS), the Arthritis Impact Measurement Scale (AIMS2), the Health Assessment Questionnaire (HAQ), and the Arthritis Specific Self-Efficacy (ASES) questionnaire. RESULTS: Data were available from 830 patients with RA 74% female, mean (SD) age 58.5 (14.2) years, disease duration 13.4 (10.3) years, HAQ score 0.98 (0.72). No impact on sexual activity was reported by 31%, little by 38%, considerable by 21%, 3% reported sexual activity as almost impossible, and 7% reported sexual activity as impossible. When dichotomized, the 'large impact' group had worse health status across all dimensions compared to the group with 'no/little impact' (p<0.001). In the multiple logistic regression analyses, perceived impact on sexual activity was associated with male vs. female gender [odds ratio (OR) 3.18, 95% confidence interval (CI) 2.05-4.94], age (youngest vs. oldest group) (OR 3.56, 95% CI 1.78-7.09), increased levels of fatigue (OR 1.01, 95% CI 1.0-1.02) and mental distress (OR 1.21, 95% CI 1.06-1.38), HAQ score (OR 2.46, 95% CI 1.78-3.39), and low self-efficacy regarding symptoms (OR 0.97, 95% CI 0.96-0.98). CONCLUSION: One-third of the RA patients reported that their health status considerably influenced their sexual activity. Higher levels of fatigue, mental distress, functional limitations, lower levels of self-efficacy, and male gender were independently associated with perceived problems with sexual activity.