Myasthenia gravis is a multisystem autoimmune disease that results in fatigable muscle weakness. There are various classes of the disease depending on its severity. In mild cases, only the extraocular muscles are involved; in severe cases, the throat and respiratory muscles are involved, leading to breathing difficulties. 

Among the lesser known symptoms of myasthenia gravis are urinary tract symptoms, such as urinary urgency. Sexual dysfunction is a commonly reported problem during clinical reviews; however, some scientists do not believe that sexual dysfunction qualifies as a core symptom of myasthenia gravis. 

This is because a clear line of association between sexual dysfunction and myasthenia gravis remains elusive. Studies have demonstrated how sexual dysfunction can be caused by diseases that affect the central nervous system, such as neuromyelitis optica spectrum disorder. However, scientists suspect that psychological factors, such as anxiety, depression, and fatigue, are the primary mechanisms that cause sexual dysfunction in patients with myasthenia gravis. 

Psychiatric Pathology in Myasthenia Gravis 

In the Journal of Neuroimmunology, Wang and colleagues set out to investigate the prevalence of sexual dysfunction among patients with myasthenia gravis and to identify risk factors associated with sexual dysfunction, including psychiatric impairment. 

The study was conducted in the West China Hospital of Sichuan University. The research team recruited patients who were diagnosed with myasthenia gravis and were above the age of 18 years. They excluded patients who had sexual dysfunction before disease onset. A total of 52 males and 106 females were recruited. The research team obtained detailed clinical information from the participants selected for this study. 

Read more about myasthenia gravis etiology 

The participants were sent 1 of 2 questionnaires to evaluate sexual dysfunction. For females, the questionnaire used was the Female Sexual Function Inventory (FSFI); for males, the questionnaire used was the Chinese Index of Premature Ejaculation-5 (CIPE-5). 

In addition, Wang and colleagues assessed the mental health status of their patients via the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA). They also requested that participants report the impact of myasthenia gravis on their daily activities via the Myasthenia Gravis Activities of Daily Living assessment (MG-ADL). 

The findings of this study demonstrated that more than 42% of male patients had erectile dysfunction and nearly 50% of female patients had sexual dysfunction. These figures are much higher than they are in the general population. Hence, the research team concluded that sexual dysfunction is a considerable problem among patients with myasthenia gravis. 

“[Sexual dysfunction] is a complex psychosomatic condition that reflects to a certain extent the patients’ mental status,” Wang and colleagues wrote. “From our results, [sexual dysfunction] was highly correlated with anxiety and depression.” 

Read more about myasthenia gravis patient education 

Sexual dysfunction can be due to primary, secondary, or tertiary reasons. Primary causes are from neurological defects; secondary causes are from physical changes; tertiary causes are from social and emotional issues. 

The underlying cause of sexual dysfunction in patients with myasthenia gravis can be multifactorial, but one cannot discount the cumulative emotional impact of living with a chronic disease. Anecdotal evidence from patients with myasthenia gravis suggests that the uncertainty and financial burden of living with an incurable, progressive disease is substantial. 

Sexual Dysfunction and Mental Health Care 

The medical community is increasingly aware that mental illness can cause a host of psychosomatic conditions, including sexual dysfunction. 

It is important that sexuality is viewed in a holistic light: it is a complex interaction between sexual desire, hormonal and neuronal connections, emotional health, and the physical ability to copulate. Sexual dysfunction can occur if any link in the chain is broken. Persistent sexual dysfunction can worsen self-esteem and confidence, perpetuating a vicious cycle that patients may find difficult to break free from without psychiatric support. 

“The relationship between [sexual dysfunction] and mental health cannot be ignored, since it may be bidirectional,” Gombert and colleagues wrote in Expert Opinion on Drug Safety. “It is clear that mental health causes [sexual dysfunction] as part of the disease . . . and [sexual dysfunction] causes mental health problems.” 

If a patient with myasthenia gravis complains of sexual dysfunction, it is important that physicians investigate its underlying causes. Because sexual dysfunction can be caused by a large number of conditions, it is vital that an adequate medical and drug history is taken. Physicians should then ask about symptoms of psychiatric illness, such as depression and anxiety, as well as their outlook on their disease. 

“Assuming that sexual function can be a surrogate marker of systemic health, we need to understand the distress and consequences experienced,” Gombert and colleagues wrote. 

If the patient is undergoing a massive depressive episode, the patient’s physicians should refer the patient to psychiatric services immediately. Sexual health can be an indicator of mental health, and if the signal blinks red, physicians have an obligation to take action. 

Mental health and sexual wellness—these are health indicators that matter to everyone, including, of course, patients with myasthenia gravis. Improving these health indicators will go a long way to improving quality of life, which is something that all our patients deserve. 

References

Wang J, Yan C, Zhao Z, et al. Sexual dysfunction in patients with myasthenia gravisJ Neuroimmunol. 2021;358:577669. doi:10.1016/j.jneuroim.2021.577669

Gombert M, Ballester P, Segura A, Peiró AM. Introducing sexual dysfunction in mental careExpert Opin Drug Saf. 2021;20(1):69-79. doi:10.1080/14740338.2020.1849135