Fibromyalgia and Sex

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Since Fibromyalgia predominantly affects women, and many women with Fibromyalgia report various symptoms of sexual dysfunction, a considerable amount of research has been conducted to investigate the association between Fibromyalgia and sexual dysfunction. Using various types of questionnaires and other surveying methods, recent studies have shown that when compared to healthy controls, women with Fibromyalgia experience difficulties with sexual desire, sexual arousal, lubrication, achieving orgasm, and are more likely to experience pain during and after vaginal intercourse. It appears that Fibro-Sex in fact sucks  (no puns intended).

A 2008 study by Orellana and colleagues used a series of questionnaires to evaluate pain, anxiety and depression, and sexual function among 31 Fibromyalgia patients, 40 healthy control women, and 26 patients with rheumatoid arthritis. The study found that 97% of Fibromyalgia patients experienced sexual dysfunction. Furthermore, the researchers found that coexisting depression was significantly associated with sexual dysfunction (Orellana et al., 2008).  97% – Clearly sexual dysfunction is a key factor in driving negative feedback loops involving depression!

A recent study by Ablin et al. evaluated fifty female Fibromyalgia patients to determine their level of sexual dysfunction. All participants underwent a physical exam (including tender point assessment) and completed a questionnaire designed to assess their sexual drive, sexual arousal, vaginal wetting, orgasm, and overall sexual satisfaction. The authors found that women who had increased numbers of tender points tended to have decreased sexual drive as well as decreased levels of sexual satisfaction and decreased arousal (Ablin et al. 2011).

The reasons why Fibromyalgia patients experience increased sexual dysfunction are unclear. Many researchers suggest that depression and anxiety, which are both common among Fibromyalgia sufferers, are causally related to the development of sexual dysfunction (Prins et al., 2006; Monga et al., 1998; Ambler et al., 2001; Orellana et al., 2008; Orellana et al., 2009). However, there is not enough evidence to rule out the possibility that Fibromyalgia itself plays a direct role in the onset of sexual dysfunction (Tikiz et al., 2005), via physical factors such as low pain tolerance or increased pain sensitivity. It is also possible that both psychological and physical factors work together (Stahl & Briley, 2004; Kalichman, 2009; Tristano, 2009). In addition, some research has shown that fatigue may be a predisposing factor. Finally, research has indicated that a woman’s degree of satisfaction with her relationship may also affect sexual functioning. In particular, having a spouse who is more involved in the relationship – while beneficial for the relationship – may have a negative impact on sexual function (Kool et al., 2006).

Treatment of Sexual Dysfunction in Fibromyalgia

Many researchers have suggested that the successful management of sexual dysfunction in Fibromyalgia may help improve the overall quality of life for patients (Orellana et al., 2008; Orellana et al. 2009; Ablin et al., 2011; Kalichman, 2009). Unfortunately, the research related to the treatment of sexual dysfunction in Fibromyalgia sufferers is extremely limited. More research is clearly needed to better understand the relationship between sexual dysfunction and Fibromyalgia in order to develop both prevention and treatment strategies. Some insight can be gleamed, however, from existing studies that address the impact of musculoskeletal pain and other chronic pain disorders on sexual function. For example, Rosenbaum (2010) suggests that both sexual and relationship counseling may be beneficial, as well as input from physical therapists who can provide advice on sexual positioning. For women with coexisting depression, effectively treating the underlying depression may inadvertently improve sexual functioning. Unfortunately, many common antidepressants have the side effect of decreased libido; however, consumption of an extract from the Yohimbe plant has demonstrated effectiveness in combating this unwanted side effect of anti-depressants (Montorsi et al., 1994; Balon 1993; Hollander & McCarley, 1992). Finally, more effective pain management may improve the physical discomfort many Fibromyalgia sufferers experience during intercourse and improve overall sexual satisfaction.

Overall the research indicates that targeting the improvement of sexual function should be a focus that if successful can yield improvements in other critical areas such as depression, anxiety and overall quality of life perception.

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References

1.        Kool MB, Woertman L, Prins MA, Van Middendorp H, Geenen R. Low relationship satisfaction and high partner involvement predict sexual problems of women with Fibromyalgia. J Sex Marital Ther. 2006;32:409–423.

2.        Tikiz C, Muezzinoglu T, Pirildar T, Taskn EO, Frat A, Tuzun C. Sexual dysfunction in female subjects with Fibromyalgia. J Urol. 2005;174:620–623.

3.        Prins MA, Woertman L, Kool MB, Geenen R Sexual functioning of women with Fibromyalgia. Clin Exp Rheumatol. 2006;24:555–561.

4.        Monga TN, Tan G, Ostermann HJ, Monga U, Grabois M. Sexuality and sexual adjustment of patients with chronic pain. Disabil Rehabil. 1998;20:317–329.

5.        Ambler N, Williams AC, Hill P, Gunary R, Cratchley G. Sexual difficulties of chronic pain patients. Clin J Pain. 2001;17:138–145.

6.        Stahl S, Briley M. Understanding pain in depression. Hum Psychopharmacol. 2004;19(Suppl 1):S9–S13.

7.        Kalichman L. Association between Fibromyalgia and sexual dysfunction in women. Clin Rheumatol. 2009;28(4):365-369.

8.        Orellana C, Casado E, Masip M, Galisteo C, Gratacos J, Larrosa M. Sexual dysfunction in Fibromyalgia patients. Clin Exp Rheumatol. 2008;26(4):663-666.

9.        Orellana C, Gratacos J, Galisteo C, Larrosa M. Sexual dysfunction in patients with Fibromyalgia. Curr Rheumatol Rep. 2009;11(6):437-442.

10.     Tristano AG. The impact of rheumatic disease on sexual function. Rheumatol Int. 2009;29(8):853-860.

11.     Ablin JM, Gurevitz I, Cohen H, Buskila D. Sexual dysfunction is correlated with tenderness in female Fibromyalgia patients. Clin Exp Rheumatol. 2011;Nov 30. Epub ahead of print.

12.     Rosenbaum TY. Musculoskeletal pain and sexual function in women. J Sex Med. 2010;7(2 Pt 1):645-653.

13.     Montorsi F, Strambi LF, Guazzoni G, et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology. 1994;44:732-736.

14.     Balon R. Fluoxetine-induced sexual dysfunction and yohimbine. J Clin Psychiatry. 1993;54:161-162.

Hollander E, McCarley A. Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry. 1992;53:207-209.

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