Sexual Difficulties in the Population with Musculoskeletal Chronic Pain: A Systematic Review

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Abstract
Objective: To review the current literature on the nature and prevalence of sexual difficulties in the population with chronic musculoskeletal pain, as well as to identify the biopsychosocial factors that maintain these difficulties. Design: Systematic review. Methods: Studies were found by using multiple electronic databases and examining reference lists. After application of inclusion and exclusion criteria, 10 studies were eligible for review. Data were extracted and characteristics were described for outcomes of interest (i.e., sexual dysfunction, pain condition, pain intensity, psychosocial factors, gender differences). Cochrane Risk of Bias was assessed for all included studies. Results: Ten studies (2,941 participants) were included in the review. Musculoskeletal conditions included low back pain and fibromyalgia. All studies examining sexual functioning found evidence of sexual difficulty among patients with chronic pain. Three studies demonstrated that sexual dysfunction was significantly greater in patients than in healthy matched controls. Nine studies found that greater pain levels significantly correlated with greater sexual dysfunction. Eight studies noted an increased prevalence of sexual difficulties in those with comorbid psychological problems. Heterogeneity between studies was identified, particularly with regard to gender outcomes. The risk-of-bias assessment also highlighted limitations in approximately half of studies. Conclusions: This review reiterates the importance of investigating sexual functioning in the chronic musculoskeletal pain population, given the high prevalence of chronic musculoskeletal pain across all age bands. Given methodological limitations, future research should develop measures that sensitively cater to the various needs of patients with chronic pain. By modifying assessment to include biopsychosocial concerns, practitioners can tailor treatment to address transdiagnostic factors that maintain sexual dysfunction.

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