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SSc Sexual Dysfunction — SCE Rheumatology MCQ

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ModerateSystemic SclerosisSSc Sexual DysfunctionSCE Rheumatology

A 50-year-old premenopausal woman with diffuse cutaneous systemic sclerosis has progressive skin tightening, Raynaud phenomenon and fatigue. She takes no medication newly associated with sexual dysfunction. Over the past year, she has developed reduced sexual arousal, vaginal dryness and dyspareunia. Which pathophysiological model best explains her sexual dysfunction?

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Reveal the answer and explanation

Correct answer: C — SSc-related vascular and local tissue changes with lubrication, pain and psychosocial contributors

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

E is correct. Sexual dysfunction in systemic sclerosis is common and multifactorial rather than solely psychological or medication-induced. In women, impaired lubrication, vaginal dryness or discomfort, dyspareunia, pain, fatigue, physical restriction and body-image, mood or relationship factors may interact; altered clitoral blood-flow indices also support a vascular contribution. In men, erectile dysfunction is particularly common and predominantly reflects SSc vasculopathy and endothelial dysfunction, with corporal fibrosis potentially contributing. Her premenopausal status and absence of a new culprit medication make isolated menopausal atrophy or an adverse drug effect less likely. B is incorrect because both sexes are affected, while C and D disregard established disease-related physical and vascular contributors.

Reference: Gao R, Qing P, Sun X, et al. Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review. Sexual Medicine. 2021;9:100392. https://pubmed.ncbi.nlm.nih.gov/34280592/