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Sexuality & Scleroderma

An active sexual life is an important component of quality of life for many individuals. Patients with scleroderma are no different, but do face some specific difficulties.

Although scleroderma is dominantly a disorder of women of childbearing age, there has been remarkably little research into the impact of scleroderma on female sexuality. In one study done by our group, we found that women with scleroderma were frequently sexually active and that their level of activity was independent of the various physical burdens imposed upon them by their disease.

Key issues interfering with an effective sexual life included vaginal dryness, cold intolerance and fatigue. Others described issues of musculoskeletal pain and loss of flexibility.

Individuals with psychological problems such as reactive depression tended to be less active sexually. In some instances, couples were afraid that sexual activity may in some way worsen the scleroderma. This is, of course, NOT TRUE.

Many of these issues can be addressed. The first step is to feel free to discuss this sort of highly personal issue with your rheumatologist or gynecologist. Dryness can be dealt with by lubricants or through use of supplemental estrogens including topical preparations when appropriate. Issues of pain or loss of flexibility can be helped with physical therapy or with simple advice about positioning. Counseling about how to cope with chronic illness can help many individuals.

Men with scleroderma face the issue of male erectile dysfunction (MED). In diffuse scleroderma, this occurs in up to 80% but is also a problem in limited scleroderma of longer duration. The cause is thought to be disordered blood flow, which in turn is related to injury to the small nerves that influence blood vessel tone and to the narrowing of blood vessels.

MED can be psychological and situational or it can be part of the disease process. Individuals with psychological issues tend to maintain their ability to have night-time or morning erections.

The first step is to feel free to discuss this sort of highly personal issue with your physician. Many medications can cause MED and the solution may be as simple as revising your treatments. Evaluation by an urologist may be indicated. There are now many FDA approved therapies for MED, all of which are known to be effective for many men with scleroderma.

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