Previous studies of inflammatory arthritides have shown that pain, physical disability, joint deformity and concomitant depression are all associated with sexual dysfunction. New research indicates that gout may also significantly affect relationships and intimacy with a spouse or significant other. The formative research by Jasvinder A. Singh, MD, MPH, professor of medicine and epidemiology at the Birmingham VA Medical Center, Alabama, was published online in BMC Rheumatology on Feb. 28.1
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The single-center study included 44 people who had previously been evaluated for gout at a community-based clinic. Half of the patients were male, 68% were African American and 43% were retired. The mean patient age was 61.7 years old, and the mean gout duration was 11.8 years. Half of the patients were currently married, and 94% were using allopurinol and/or febuxostat. Approximately one-third (39%) of the study participants had experienced no gout flares in the previous six months. The patients participated in 14 nominal groups: seven male-only groups, six female-only groups and one group with people of both sexes.
The nominal group moderator presented individuals with the question: “How has gout affected your relationships?” Moderators collected verbatim responses from the groups and had the patients discuss the responses. Next, patients were asked to rank their top three responses. The top five responses in the group accounted for 75% of votes. A participant’s sex did not seem to affect which concern was top ranked.
Dr. Singh found that, with 28% of votes, the physical effect of gout on intimacy was the top-ranked concern across all groups. This physical effect was primarily related to acute and chronic joint pain. The research also documented an emotional effect of gout on intimacy (17.4%) and disability (12.9%). Study participants noted they experienced a loss of trust and/or understanding with their spouse (10.6%) and significant social life interference (6.8%). Some patients lost relationships due to active gout, and others had difficulty entering relationships.
“Considering that we invited a convenience sample of consecutive patients with gout (not people with diagnosed sexual health problems), the proportion of people reporting and discussing the impact of gout on relationships with [their] spouse/significant other and sexual dysfunction was much higher than expected. With the exception of a few [participants], almost everyone reported some impact,” writes Dr. Singh in his discussion. “Sexual problems were a hallmark of gout flare associated severe pain. A majority of the nominal groups reported frequent sexual dysfunction due to chronic joint pain [caused by] gout, most notably difficulty performing sexually due to gout-associated pain. The study findings demonstrate the physical impact of acute and chronic pain of gout and associated disability on intimacy and sexual function.”
The results reflect the growing understanding that sexuality is a multi-faceted phenomenon affected by organic, hormonal and psychosocial factors. In the discussion, Dr. Singh writes that a patient-physician dialogue is necessary to understand if gout is affecting a patient’s sex life. Additionally, he suggests further studies be performed to determine if optimal gout control can improve the sex lives of gout patients.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
- Singh JA. Gout and sexual function: Patient perspective of how gout affects personal relationships and intimacy. BMC Rheumatol. 2019 Feb 28;3:8. eCollection 2019.