Female sexuality in patients with fibromyalgia has received little attention in the literature, and published data have mainly relied upon a small sample size with evident heterogeneity. Our aim was to pool the observational studies on the association between fibromyalgia and sexual dysfunction in female patients to reach a more comprehensive and reliable result. The literature search comprised of Pubmed-Medline, Cochrane, and Embase databases. The relevant studies that met the inclusion criteria were gathered and the pooled effect size was calculated. The standard mean difference of the global sexual function score as well as the sub-items scores were calculated using the random-effect size model. Sensitivity analysis was conducted. Publication bias was assessed using Funnel plots and Begg and Mazumdar rank correlation tests. The meta-analysis was conducted in accordance with the MOOSE guideline. The six selected studies contained 919 participants (ranging from 51 to 362). Of those, 578 were patients with fibromyalgia, and 341 were the controls. While four studies evaluated the sexual function using the female sexual function index (FSFI) questionnaire, two used changes in the sexual functioning questionnaire (CSFQ). Patients with fibromyalgia had a decreased total sexual function score [(−5.02 (−7.58 to −2.46), p < 0.0001; Q = 664.28; p-value for heterogeneity = p < 0.0001; I2 = 99.24%)]. All sexual response cycle domains including desire, arousal, orgasm, pain, lubrication, and satisfaction were found detrimental in patients with fibromyalgia compared with the healthy controls. For the sensitivity analysis, omitting any one of the six studies did not produce a significant difference in the original pooled summary effect size. Our meta-analysis provided a clear association between female sexual dysfunction and fibromyalgia, suggesting patients with fibromyalgia should be assessed regarding sexual health, although further, well designed longitudinal studies are needed to establish the causality between fibromyalgia and female sexual dysfunction.
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Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, et al. Work and disability status of persons with fibromyalgia. J Rheumatol. 1997;24:1171–8.
Carmona L, Ballina J, Gabriel R, Laffon A, EPISER Study Group. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis. 2001;60:1040–5.
Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19–28.
Wolfe CDJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62:600–10.
Prady J, Vale A, Hill J. Body image and sexuality. In: Hill J, editor. Rheumatology nursing: a creative approach. Churchill Livingstone, Edinburgh, 1998; p. 109–24.
Wells D. Caring for sexuality in health and illness. Edinburgh: Churchill Livingstone; 2000.
Shaver JL, Wilbur J, Robinson FP, Wang E, Buntin MS. Women’s health issues with fibromyalgia syndrome. J Women’s Health. 2006;15:1035–45.
Seng JS, Clark K, McCarthy AM, Ronis DL. PTSD and physical comorbidity among women receiving Medicaid: results from service-use data. J Trauma Stress. 2006;19:45–56.
Orellana C, Gratacós J, Galisteo C, Larrosa M. Sexual dysfunction in patients with fibromyalgia. Curr Rheumatol Rep. 2009;11:437–42.
Kalichman L. Association between fibromyalgia and sexual dysfunction in women. Clin Rheumatol. 2009;28:365–9.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.
Tikiz C, Muezzinoglu T, Pirildar T, Taskn EO, Frat A, Tuzun C. Sexual dysfunction in female subjects with fibromyalgia. J Urol. 2005;174:620–3.
Aydin G, Başar MM, Keleş I, Ergün G, Orkun S, Batislam E. Relationship between sexual dysfunction and psychiatric status in premenopausal women with fibromyalgia. Urology. 2006;67:156–61.
Yilmaz H, Yilmaz SD, Polat HA, Salli A, Erkin G, Ugurlu H. The effects of fibromyalgia syndrome on female sexuality: a controlled study. J Sex Med. 2012;9:779–85.
Tutuoglu A, Boyaci A, Koca I, Celen E, Korkmaz N. Quality of life, depression, and sexual dysfunction in spouses of female patients with fibromyalgia. Rheumatol Int. 2014;34:1079–84.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.
Orellana C, Casado E, Masip M, Galisteo C, Gratacós J, Larrosa M. Sexual dysfunction in fibromyalgia patients. Clin Exp Rheumatol. 2008;26:663–6.
Rico-Villademoros F, Calandre EP, Rodríguez-López CM, García-Carrillo J, Ballesteros J, Hidalgo-Tallón J, et al. Sexual functioning in women and men with fibromyalgia. J Sex Med. 2012;9:542–9.
Bobes J, Gonzalez MP, Rico-Villandemoros F, Bascaran MT, Sarasa P, Clayton A. Validation of the Spanish version of the Changes in Sexual Functioning Questionnaire (CSFQ). J Sex Marital Ther. 2000;26:119–31.
Stang A. Critical evaluation of the Newcastle-Ottowa Scale for the assessment of the quality of nonrandomized studies in meta-analysis. Eur J Epidemiol. 2010;25:603–5.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–72.
Burri A, Lachance G, Williams FM. Prevalence and risk factors of sexual problems and sexual distress in a sample of women suffering from chronic widespread pain. J Sex Med. 2014;11:2772–84.
Kayhan F, Küçük A, Satan Y, İlgün E, Arslan Ş, İlik F. Sexual dysfunction, mood, anxiety, and personality disorders in female patients with fibromyalgia. Neuropsychiatr Dis Treat. 2016;12:349–55.
Martínez-Lavín M, Hermosillo AG. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum. 2000;29:197–9.
Cohen H, Neumann L, Shore M, Amir M, Cassuto Y, Buskila D. Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum. 2000;29:217–27.
Solano C, Martinez A, Becerril L, Vargas A, Figueroa J, Navarro C, et al. Autonomic dysfunction in fibromyalgia assessed by the Composite Autonomic Symptoms Scale (COMPASS). J Clin Rheumatol. 2009;15:172–6.
Vargas-Alarcón G, Fragoso JM, Cruz-Robles D, Vargas A, Martinez A, Lao-Villadóniga JI, et al. Association of adrenergic receptor gene polymorphisms with different fibromyalgia syndrome domains. Arthritis Rheum. 2009;60:2169–73.
Unlü E, Ulaş UH, Gürçay E, Tuncay R, Berber S, Cakçi A, et al. Genital sympathetic skin responses in fibromyalgia syndrome. Rheumatol Int. 2006;26:1025–30.
McBeth J, Silman AJ. The role of psychiatric disorders in fibromyalgia. Curr Opin Rheumatol. 2001;3:157–64.
Meyer-Lindenberg A, Gallhofer B. Somatized depression as a subgroup of fibromyalgia syndrome. Z Rheumatol. 1998;57:92–93.
Kurtze N, Gundersen KT, Svebak S. The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients. Br J Med Psychol. 1998;71:185–94.
Prins MA, Woertman L, Kool MB, Geenen R. Sexual functioning of women with fibromyalgia. Clin Exp Rheumatol. 2006;24:555–61.
De Costa ED, Kneubil MC, Leao WC, The KB. Assessment of sexual satisfaction in fibromyalgia patients. Einstein. 2004;2:177–81.
Booth BB, Rasmussen A, Jensen JB. Evaluating sexual function in women after radical cystectomy as treatment for bladder cancer. Scand J Urol. 2015;49:463–7.
Lee DM, Nazroo J, O’Connor DB, Blake M, Pendleton N. Sexual health and well-being among older men and women in England: findings from the English Longitudinal Study of Ageing. Arch Sex Behav. 2016;45:133–44.
Bazzichi L, Giacomelli C, Rossi A, Sernissi F, Scarpellini P, Consensi A, et al. Fibromyalgia and sexual problems. Reumatismo. 2012;64:261–7.
No research support or funding was received in connection with this study. The authors have no significant affiliation or involvement, either direct or indirect, with any organization or entity with a direct financial interest in the subject matter or materials discussed.
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The authors declare that they have no conflict of interest.
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Besiroglu, M.D.H., Dursun, M.D.M. The association between fibromyalgia and female sexual dysfunction: a systematic review and meta-analysis of observational studies. Int J Impot Res 31, 288–297 (2019). https://doi.org/10.1038/s41443-018-0098-3
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