Saúde reprodutiva em homens com lúpus eritematoso sistêmico

Abstract

Objective: To assess reproductive health in male systemic lupus erythematosus (SLE) patients and compare them with controls. Methods: Twenty-five male SLE patients were evaluated for demographic data, urologic evaluation (including pubertal parameters, sexual/erectile function), testicular Doppler ultrasound, hormone profile, semen analysis, clinical features and treatment. The control group included 25 healthy men. Results: The current median age was similar in SLE patients compared with controls (26 versus 27 years, P = 0.756). The frequencies of sexual/erectile disfunction were significantly higher (20% versus 0%, P = 0.0001) and the number of spontaneous pregnancies were lower in SLE patients than in controls (20% versus 60%, P = 0.0086). A trend to low contraceptive use was observed in SLE patients compared with controls (48% versus 76%, P = 0.079). Moreover, the frequencies of gonadal dysfunction parameters, such as testicular atrophies measured by ultrasound (36% versus 8%, P = 0.037), elevated FSH and/or LH levels (36% versus 0%, P = 0.002), and sperm abnormalities (48% versus 0%, P = 0.0001), were statistically higher in SLE patients versus controls. SLE patients with sexual/erectile disfunction had no sexual activity in the last month versus 95% of SLE patients without dysfunction (P = 0.0001). On the other hand, no differences were evidenced in SLE patients with or without sexual/erectile disfunction according to demographic data, disease activity, cumulative damage and treatment. Conclusion: This is the first study to identify sexual/erectile and gonadal disfunction in male SLE patients. A multidisciplinary approach is essential in order to offer preventive measures for these patients.

Male fertility potential alteration in rheumatic diseases: a systematic review

“…Lower inhibin B level was correlated with diminished sperm count, concentration and total motility count and with elevated FSH and LH levels ( 13 ). In addition, it was observed that 20% of SLE patients had erectile dysfunction, 36% of testicles were below the normal volume range and 48% had semen analysis abnormalities associated with CYC therapy ( 14 ). The same gonadotoxic effect of CYC was also reported in four patients with juvenile SLE ( 15 ).…”

“…Infertility is an important issue for them nowadays due to better prognosis and quality of life. Six publications reported impaired testicular function and decreased semen production in SLE patient’s and their possible association with disease and treatment ( 11 - 14 , 31 , 32 ). The underlying mechanism for disease induced damage to the testis is not completely elucidated although some authors showed that there is immunopathologic lesion of the testis (and excurrent ducts) occurring through T cell-mediated mechanisms triggered by antigens or pathogens that disrupt testicular immune privilege ( 33 , 34 ).…”

Alterações menstruais em pacientes com lúpus eritematoso sistêmico sob uso de imunossupressores

“…The study concludes that a multidisciplinary approach is essential to offer preventive measures to these patients. 10 Considering the possible gonadotoxic effect, or the interference with the hypothalamus-pituitary-ovary (H-P-O) axis, it is important to verify whether the patients submitted to treatment with ISA present clinical signs of menstrual alterations.…”

Avaliação da reserva ovariana e do anticorpo anti-corpo lúteo em mulheres adultas com lúpus eritematoso sistêmico de início na infância

“…Aumento no desconforto ou dor vaginal durante o intercurso e dificuldade na penetração devido à menor elasticidade vaginal também foram identificados, porém drive sexual, motivação, excitação subjetiva, obtenção do orgasmo e satisfação foram similares aos controles 35 . Recentemente, dois de nossos estudos em FS de pacientes com LES merecem destaque 39,40 . Numa avaliação de 35 homens brasileiros com LES e 35 controles pareados por idade e estadiamento puberal, DS foi evidenciada em 20% dos pacientes versus nenhum dos controles.…”

“…Numa avaliação de 35 homens brasileiros com LES e 35 controles pareados por idade e estadiamento puberal, DS foi evidenciada em 20% dos pacientes versus nenhum dos controles. Além de maiores freqüências de DE, ejaculação precoce, anorgasmia e insatisfação sexual foram reportadas nos pacientes em relação aos controles 39 .O outro estudo avaliou 52 adolescentes do sexo feminino com LES juvenil e 52 mulheres adolescentes saudáveis pareadas por idade e estadiamento puberal. A freqüên-cia de atividade sexual foi significativamente menor nas pacientes com LES juvenil versus controles.…”