title: The association of body image dissatisfaction and pain with reduced sexual function in women with systemic sclerosis.
abstract: OBJECTIVE
  Pain and body image distress are common among women with SSc, but their relative associations with reduced sexual function have not been assessed. The objective of this study was to assess the independent associations of pain and body image distress with reduced sexual function in women with SSc.
  
  
  METHODS
  Female SSc patients completed measures of sexual function (sexual relationships subscale of the Psychosocial Adjustment to Illness Scale-Self-Report), body image dissatisfaction (Satisfaction with Appearance Scale) and pain (visual analogue scale). Multiple regression analysis was used to assess the associations of body image dissatisfaction and pain with reduced sexual function, controlling for sociodemographic and disease variables.
  
  
  RESULTS
  The sample included 117 female SSc patients [33 (28.2%) diffuse; mean age 51.4 (11.9) years; mean time since diagnosis 9.1 (8.5) years]. Unadjusted analyses found that reduced sexual function was associated with pain (r = 0.44, P < 0.001), body image dissatisfaction (r = 0.35, P < 0.001) and being married (r = 0.34, P < 0.001). In multivariate linear regression, disease duration (β = 0.17, P = 0.046), pain (β = 0.29, P = 0.001) and unmarried status (β = -0.23, P = 0.006) were independently associated with reduced sexual function. Dissatisfaction with appearance was not significantly associated with reduced sexual function (β = 0.16, P = 0.067).
  
  
  CONCLUSIONS
  Pain is an important indicator of sexual function among women with SSc. Body image dissatisfaction was not independently associated with sexual impairment and appears to be less important factor than pain in determining sexual function. Future research should focus on isolating specific sources of pain that may be amenable to intervention in order to improve sexual function.
authors.affiliation: Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
authors.forename: Ruby
authors.initials: R
authors.lastname: Knafo
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
authors.forename: Leslie
authors.initials: L
authors.lastname: Heinberg
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Wigley
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
mesh_terms: D000328:Adult; D017677:Age Distribution; D001828:Body Image; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011379:Prognosis; D011584:Psychology; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012649:Self Concept; D012720:Severity of Illness Index; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D016387:Women's Health