Low Body Self-Esteem Linked to Sexual Dysfunction in Lupus

A cross-sectional study published in Advances in Rheumatology identifies low body self-esteem as an independent risk factor for sexual dysfunction in patients with systemic lupus erythematosus (SLE). The research, conducted at a tertiary care center in Mexico City, involved 280 sexually active adults aged 18 and older who met the 2019 EULAR/ACR classification criteria for SLE. The study aims to assess the association between body self-esteem, global self-esteem, and sexual function, addressing a gap in the literature where the direct correlation between these psychological factors and sexual health in SLE patients had remained unexplored.

The researchers utilized validated psychometric tools to measure the variables of interest. Body self-esteem was evaluated using the Body Self-Esteem Scale (BSES), a 26-item instrument that assesses both the cognitive aspect of body satisfaction and the emotional aspect of body attractiveness. Global self-esteem was measured using the Rosenberg Self-Esteem Scale (RSE), a 10-item scale that captures positive and negative feelings about oneself. Sexual function was assessed via the Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14), which evaluates domains such as sexual desire, pleasure, arousal, and orgasm. Sexual dysfunction was defined as a total CSFQ-14 score of less than 41 points for women and less than 47 points for men.

The study population was predominantly female, with 88.6% of participants identifying as women. The median age of the cohort was 39 years, with an interquartile range of 31 to 49. Most participants exhibited low disease activity, as indicated by a median SLEDAI-2 K score of 2 and a SLICC damage index of 0. Despite the generally low clinical severity of the disease in this group, a significant proportion of patients experienced sexual dysfunction. Specifically, 147 patients, representing 52.5% of the total sample, were classified as having sexual dysfunction based on their CSFQ-14 scores.

Statistical analysis revealed significant correlations between self-esteem measures and sexual function. The total BSES score showed a significant positive correlation with the total CSFQ-14 score, with a Spearman’s rho of 0.364 and a p-value of less than 0.001. This indicates that higher body self-esteem is associated with better sexual function. Similarly, the subcomponents of global self-esteem, specifically self-competence and self-liking, demonstrated significant positive correlations with sexual function scores. However, the total RSE score did not show a significant correlation with the total CSFQ-14 score, suggesting that the broader construct of global self-esteem may not be as directly linked to sexual function as body-specific self-esteem.

When comparing patients with and without sexual dysfunction, those with dysfunction reported significantly lower scores on all body self-esteem measures. Patients with sexual dysfunction had lower Body Satisfaction, Body Attractiveness, and total BSES scores compared to those without dysfunction. Furthermore, patients with sexual dysfunction had significantly lower self-competence and self-liking scores, although the total RSE score did not differ significantly between the two groups. These findings suggest that specific dimensions of self-esteem, particularly those related to body image and personal competence, are more sensitive indicators of sexual health in SLE patients.

Sex differences were also observed in the prevalence of sexual dysfunction. Women exhibited a higher prevalence of sexual dysfunction compared to men, with 55.2% of women and 32.3% of men classified as having dysfunction. This difference was statistically significant. The study also found that women had a significantly higher prevalence of sexual dysfunction in specific domains, including pleasure, desire/interest, and arousal/excitement. These results align with the demographic predominance of young women in SLE populations and suggest that female sex is an independent risk factor for sexual dysfunction in this context.

Forward stepwise binary logistic regression was used to identify independent risk factors for sexual dysfunction. The analysis included variables associated with sexual dysfunction in univariate analyses, as well as clinically relevant variables such as age, major depressive disorder, disease activity, and damage accrual. The results indicated that female sex, lower leukocyte count, and lower BSES score were independent risk factors for sexual dysfunction. The odds ratio for lower BSES score was 1.9, with a 95% confidence interval of 1.8 to 2.1, highlighting the strong association between body self-esteem and sexual dysfunction.

The study also examined the relationship between clinical variables and sexual dysfunction. Patients with sexual dysfunction had significantly lower leukocyte counts and neutrophil counts compared to those without dysfunction, although these values remained within the normal range. No significant differences were observed between the two groups in hemoglobin, lymphocytes, platelets, creatinine, complement levels, anti-dsDNA antibodies, or current immunosuppressive treatment. The lack of association between medications, including glucocorticoids, and sexual dysfunction or self-esteem suggests that psychological factors may play a more significant role in sexual function than clinical manifestations or pharmacological interventions.

The authors discuss the implications of their findings for clinical practice. They suggest that self-esteem, particularly body self-esteem, should be evaluated during rheumatology consultations as part of a holistic approach to patient care. The study highlights the need for a biopsychosocial approach to managing SLE patients, considering that sexual dysfunction may be mediated by psychological and social elements rather than strictly clinical manifestations. Interventions aimed at improving body self-esteem, such as early screening for depression and anxiety, and supportive products like cosmetics, may benefit quality of life and sexual function in SLE patients.

Despite the significant findings, the study has several limitations. Its cross-sectional design precludes establishing causal relationships between psychological variables and sexual function. The data relied solely on patient self-reports, without assessments from specialized professionals such as sexologists or psychologists. Additionally, the study only included sexually active patients who had a partner within the previous four weeks, which may have introduced a selection bias. The absence of sexual activity may itself represent a severe manifestation of sexual dysfunction, potentially leading to an underestimation of the true prevalence and impact of sexual dysfunction in SLE patients.

The study was conducted at a single center with a predominantly Latin population, which may limit the generalizability of the findings. The low representation of men, although reflective of SLE epidemiology, may constrain the applicability of the results to male patients. Other factors not fully captured in the study, such as anxiety, fibromyalgia, hormonal factors, and metabolic disorders, may also influence sexual dysfunction. Detailed information on SLE clinical manifestations, antiphospholipid antibodies, and socioeconomic or psychosocial variables was not available, which could act as potential confounders.

In conclusion, the study provides valuable insights into the relationship between self-esteem and sexual function in SLE patients. It demonstrates that low body self-esteem is an independent risk factor for sexual dysfunction, particularly in women. The findings underscore the importance of integrating sexual health screening and multidisciplinary interventions into the management of SLE patients. By addressing psychological and social factors, healthcare providers can enhance patient-centered care and promote overall well-being in individuals living with this chronic autoimmune disease.

Subject of Research: Self-esteem as a determinant of sexual function in systemic lupus erythematosus patients: a cross-sectional study

Article Title: Self-esteem as a determinant of sexual function in systemic lupus erythematosus patients: a cross-sectional study

Article References: Marengo-Rodríguez, D., Espinosa-León, M., Ibarra-Velasco-Siles, M., Vázquez-Cárdenas, P., Cimé-Aké, E., Campos-Guzmán, J., Barrera-Vargas, A., & Merayo-Chalico, J. (2026). Self-esteem as a determinant of sexual function in systemic lupus erythematosus patients: a cross-sectional study. Advances in Rheumatology, 66(1), Article 61. https://doi.org/10.1186/s42358-026-00570-y

Image Credits: AI Generated

DOI: 10.1186/s42358-026-00570-y

Keywords: Self-esteem, determinant, sexual, function, systemic, lupus, erythematosus, patients, cross-sectional, scientific research