Fibromyalgia, Depression, and Sexual Dysfunction
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville. Dr. Ling reports no financial relationship to this field of study.
Synopsis: Sexual dysfunction, most commonly low libido, is more common in patients with fibromyalgia than in healthy controls.
Source: Aydin G, et al. Relationship between sexual dysfunction and psychiatric status in premenopausal women with fibromyalgia. Urology. 2006;67:156-161.
The authors sought to determine the relationship between psychiatric and sexual status of premenopausal women with fibromyalgia compared to a control group of healthy women. Forty-eight women with fibromyalgia and 38 control patients completed Female Sexual Function Index (FSFI), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI).
The average BDI was significantly greater in the fibromyalgia patients and the mean FSFI was significantly lower. The incidence of sexual dysfunction was 54% in the study population compared to only 16% in the control group. The most common sexual problem encountered in both groups was sexual desire.
Do you treat fibromyalgia in your practice? Do you even believe that it exists? The answer to the first question is a resounding "yes" whether you realize it or not, ie, you are likely seeing patients with fibromyalgia whether they are labeled as such or not. The answer to the second question is up to you. If you don't believe that it is a real clinical entity, then you need to have some explanation for the myriad of pains and symptoms that so many women have. Personally, I'm a big believer, but my bias is that of someone who has an office practice that focuses on pelvic pain disorders. Consider the following:
1. Fibromyalgia occurs in 2-4% of the general population, but it is estimated that up to 90% of patients are female. (That's our practice, by definition).
2. The most characteristic symptoms are generalized pain, stiffness, fatigue, and poor sleep. (Sound familiar?)
3. Fibromyalgia symptoms often follow an episode of infection, trauma, or mental stress. (I think a few of our patients may have some of those episodes, don't you?)
4. Up to 50% of patients with fibromyalgia have a current or past history of depression.
In the generic practice that focuses on women's health, sexual functioning is a major focus, either overtly or at least just beneath the surface. Just asking about it often brings forth an unexpected flood of emotions. In the routine visit, just asking whether the patient has any sexual concerns allows her to discuss it now or gives her permission to ask at a later time. It is well-known that sexual functioning can be compromised by pain syndromes but also poor body image and/or suboptimal health overall.
In this study, we are provided interesting insights into what appears in our practices very frequently. The interplay of chronic pain states and sexual functioning as well as clinical depression is an intricate web that can be overwhelming in a busy practice. The practitioner can be a great source for rational discussion and sort the issues out by recognizing that one often leads to the others.
When we see patients who present with chronic pain, asking about depression or sexual functioning should be included. When a patient complains of sexual problems, inquire into depression and pain.
Remember, where there's smoke, there's fire.