Sexual function in ankylosing spondylitis: a study of 65 men

PURPOSE: We evaluated sexual function in male patients with ankylosing spondylitis (AS) using the validated International Index of Erectile Function (IIEF). We also assessed the frequency and association of erectile dysfunction with patient age, disease duration, morning stiffness, laboratory activity, disease severity, depression status and medication use in this patient group. MATERIALS AND METHODS: We evaluated sexual function, in particular erectile dysfunction (ED), using the IIEF in male patients with AS followed regularly at the outpatient clinic of rheumatology and compared results with those in healthy controls. Patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. Affective patient and control states were measured by the Beck Depression Inventory. The Bath AS Functional Index was used to measure functional status in AS cases. RESULTS: To our knowledge this is the first study of the frequency of ED in men with AS (8 of 65 or 12%). Compared to healthy controls patients with AS had significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores according to the IIEF, whereas sexual desire scores were also lower, although not significantly. According to self-reported patient data ED was a prominent characteristic of our population. We were not able to relate any clinical features or laboratory findings to ED except the duration of morning stiffness. The 22 men with a high degree of morning stiffness (greater than 4 hours) had lower erectile function scores compared to the 12 with AS and a low degree of morning stiffness (less than 2 hours) (18.3 +/- 1.6 vs 26.5 +/- 2.4, p <0.05).Of 65 patients with AS 25 (38%) were depressed in our study group according to the Beck Depression Inventory, while no healthy controls were depressed when a score of greater than 13 was used as the cutoff. CONCLUSIONS: ED can be seen in the course of AS. The pathogenesis of ED in patients with AS is thought to be multifactorial with disease and treatment related factors. Thus, male patients with AS, in particular those with a high degree of morning stiffness, should be encouraged to talk about their sexuality.