Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders, 2021, Van Overmeire et al

ABSTRACT

Background
Fibromyalgia (FM) is associated with sexual dysfunction, though much less is known about the sexual desire, and especially dyadic and solitary sexual desire, among women with fibromyalgia.

Aim
To investigate on the one hand the global sexual desire, the dyadic sexual and solitary sexual desire, and on the other hand the association with depressive symptoms, fibromyalgia symptoms and medication use among women with fibromyalgia in Flanders, Belgium.

Methods
An online survey was spread through the Flemish league for Fibromyalgia Patients to be completed by women with fibromyalgia. The sexual desire inventory-2 (SDI-2) was used to measure sexual desire (global, dyadic, solitary), the VASFIQ for fibromyalgia symptoms, and the PHQ-2 for depressive symptoms, while also including questions on demographic factors (time since FM, age) and medication usage (antidepressants, pain medication, sleeping medication).

Main Outcome Measure
Global sexual desire, dyadic sexual desire and solitary sexual desire were studied in relation to depressive symptoms, medication use and fibromyalgia symptoms.

Results
One hundred and three women with FM answered the survey. Depressive symptoms were significantly associated with a lower global, dyadic and solitary sexual desire, as was the use of antidepressant medication. The association between solitary sexual desire and depressive symptoms disappeared when controlled for antidepressant medication. Age, fibromyalgia symptoms nor time since diagnosis were significantly associated with any form of sexual desire.

Conclusion
Depressive symptoms and antidepressant medication, and not fibromyalgia symptoms, were associated with decreased sexual desire of women with FM. As antidepressant medication and depressive symptoms are associated with a decreased sexual desire, more attention should be paid towards the mental health issues associated with fibromyalgia, as well as the prescription of antidepressant medication. This study is the first to investigate sexual desire among women with fibromyalgia in Flanders, and one of the few internationally to have done so. It is limited by its cross-sectional design, and for not providing information on men with FM.

Open access, https://www.smoa.jsexmed.org/article/S2050-1161(21)00137-9/fulltext

 

Is it just me, or does there seem to be a whole slew of fibro/psych/women interaction studies at the moment? Could fibro be one of the new battlegrounds, along with LC, for the BPS cabal now that they’ve lost the fight over ME, perchance?

 

Yes, sick people, famous for having lots of sex. Could have been informative if they had asked about sexual habits and whether they are affected by their being ill. But that would have been informative and would not have allowed to opine about how sick people with a broken sexual life have less sex: it's because they're moody, of course that's why, can't possibly be because they're sick because the researchers don't believe they are and are therefore studying their own interpretation of reality.

Research detached from context is just pointless. They don't accept the context, making everything that follows useless. Like asking people experiencing a famine why they're not eating and just refusing to consider the context of... you know... the freaking famine.

 

Too early for research prompted by the NICE outcome to be being published. I think researchers across a number of fields would probably say that the impact of illness and disability on sexual function has been a neglected area and that needs to change, it's inevitable that there would be a gender split in research approaches.

In this particular case it would have been clinically interesting if the reported dysfunction had been shown to be associated with physical status rather than mental health status. Nevertheless the results are helpful because they suggest where additional support or changes in medication might help patients and are likely less worrisome than some arcane effect of FM physiopathology. Changes in desire and/or capacity can have a major impact on the very relationships that a chronically ill person most needs to maintain in good health, as such it's area of health worth investing in.

 

It reminds me of a neurologist I consulted at the start of my ME. He knew that I had chronic generalized pain, among other symptoms. Well, he urged me, not without boldness, to have a more active sex life (without knowing anything about my privacy !), because that would lessen my pain (and implying that it would almost cure me !). He was clearly satisfied with the benefits of his own sex life (being his first Monday morning patient) so much, that I was worried he would end up giving me details. Needless to say I was shocked at such a lack of understanding of the impact a disease like ours has on all areas of our lives.

 

Is this a gendered thing? It really seems like it. I can't recall one time a doctor has asked me (male) about my sex life. (in relation to my illness)

 

That’s a lot of study and not matched with aged controls. They seem to have a psychological model for FM (depressive origin). They even found the obvious, the more pain the less likely you have sexual desire and antidepressants make it worse.

Problems with pain in all chronic illnesses can have big impacts on relationships in many people. Might be useful for education of partners.

In mental health I did ask people about their libido as it is a common symptom of depression, often can be very distressing and often get’s partner’s bringing them to their GP for investigation. I didn’t ask any more than than that as they would normally volunteer this was a problem but I would also inform them of the likely sexual SE’s of the medication.

 

I havnt read the paper so could be off track but could the antidepressants not be being primarily used for neuropathic pain?

 

I would guess the latter option ....

 

and

 

Sometimes people are offered a trial of antidepressants for other depressive disorders not just MDD (Major Depressive Disorder), e.g. Dysthymic Disorder, many antidepressants work on pain pathways e.g. tricyclic antidepressants like low dose nortriptyline have good effect. Many people use them for pain and sleep and once used to the side effects, hopefully after a few days/week or so are very pleased with the outcome in my clinical experience.

There have been some trials of moclobemide with FM that have shown some effects for people fulfilling criteria for these disorders but does not work on pwFM without psych disorder. It is up to the patient to decide if they want a trial it is not an assumption that they don’t have a genuine medical illness.

Unfortunately, this female with pain trope is as embedded as anxious housewives needing benzo’s in the 60’s. Now they have thought up CSS, this Central Sensitisation Syndrome, which also has stigmatising effects.

 

HRT and antidepressants are the only treatments available for menopause.

 

Yes....we haven't really come a long way....

 

Anti-depressants (milnacipran--FDA approved for FM, and amyltriptylline) are used to treat FM pain, a first-line treatment, not because FM patients are depressed but rather the anti-depressants can dampen pain sensations. But not in all patients.

Now because of the anti-opioid prescribing guidelines in the US, we are back to anti-depressant use uber alles for FM pain.

The FDA approved drugs for FM pain (Cymbalta--pregabalin; Savella--milnacipran; etc) are not that useful in the majority of patients from the studies I've read. A lot of discontinuation due to weight gain and other side effects plus not much reduction (if any) in pain.

Opioids are not the ideal drug either, so back to the drawing board.

 

There's certainly some evidence to support SSRI use in pain management, though there appears to be different pain reducing effects depending which particular drug is used https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947493/

There is said to be (by online unreferenced sources !) a lot of difference between SSRI's in terms of sedating effect; it is something that can be managed by taking the pill at night, and for those with sleep problems it can be actively helpful.

As far as getting off SSRI's there is a problem for some people, the following paper suggests around a quarter will experience some kind of problem - but then no long term pain killers are risk free so it's a lottery around what helps and what is a source of subsequent problems. https://sci-hub.se/10.1192/bjp.2019.269