Body image and sexual function in women with systemic lupus erythematosus: a cross-sectional study

In 68 Mexican women with lupus, overall body image did not predict sexual dysfunction — partner status, age, and self-esteem did

Journal: Rheumatology International | Published: 2026-05-23 | Type: Cross-sectional study | PMID: 42176027 Authors: Martinez-Espinosa et al., Rheumatology Department, Universidad Autónoma de Nuevo León, Mexico Funding/COI: Funding not listed. Senior author Cardenas-de la Garza is a consultant/speaker for Johnson & Johnson, AstraZeneca, AbbVie, UCB, Leo Pharma, and Boehringer Ingelheim. No remaining authors declare conflicts.

Summary

Sexual dysfunction was reported in 57.4% of 68 women with systemic lupus erythematosus (SLE) in this single-center Mexican study. The central hypothesis — that body image dissatisfaction drives sexual dysfunction in this population — was not supported: global body image scores showed no significant association with sexual function (r = 0.14, p = 0.24). The actual predictors of sexual dysfunction were having a partner (strongly protective), older age, and lower self-esteem.

Claims

• Sexual dysfunction (FSFI-defined) was present in 57.4% of participants (39/68)
• Global body image (Body Esteem Scale) was not significantly associated with sexual function: r = 0.14, p = 0.24
• The sexual attractiveness subdomain of body esteem was lower in women with sexual dysfunction vs. without (3.22 vs. 3.66, p = 0.0125)
• In multivariable logistic regression, independent predictors of sexual dysfunction were:
• Partner status: OR 0.12 (95% CI 0.02–0.49, p = 0.001) — having a partner was strongly protective
• Age: OR 1.09 per year (95% CI 1.02–1.17, p = 0.012)
• Self-esteem (Rosenberg scale): OR 0.75 (95% CI 0.58–0.92, p = 0.018) — higher self-esteem was protective
• Mean participant age: 37.3 ± 13.4 years

Study Quality

This is a cross-sectional survey study, which means it captures associations at a single point in time and cannot establish causality. With 68 analyzed participants across multiple predictors in a logistic regression, the model is underpowered and the confidence intervals are correspondingly wide — the OR for partner status (0.02–0.49) spans nearly two orders of magnitude. All instruments used (BES, FSFI, RSES, SF-36) are validated, which is a methodological strength. However, single-center convenience sampling from one rheumatology outpatient service in Nuevo León limits generalizability to broader SLE populations. Measures of disease activity and medication exposure — both of which could independently affect sexual function — are not reported as model covariates in the abstract, a notable gap.

Red Flags

• Sample size of 68 is small for a multivariable logistic regression with three retained predictors; risk of overfitting
• Primary hypothesis was null: the paper's stated aim (determining whether body image correlates with sexual function) was not supported. The reported findings pivot to secondary predictors
• No causality: cross-sectional design cannot determine whether low self-esteem causes sexual dysfunction or vice versa, or whether both are downstream of disease severity
• Full text data mismatch: the full-text sections provided (Results, Methods, Discussion) describe a completely different study — 215 Chinese patients recruited in Nantong, 2019–2020, using different instruments (BIDQ, HADS, MFI-20, BIQLI). This suggests a data assembly error in the source record and makes independent verification of methodology impossible from the supplied material
• Funding not disclosed despite apparent institutional infrastructure for a multi-investigator study
• Senior author industry ties to multiple major pharmaceutical companies, though this study does not evaluate a drug

Strengths

• Uses validated, widely-adopted instruments (FSFI is the standard measure for female sexual function; Rosenberg is gold-standard for self-esteem)
• Ethics approval documented with specific committee number and date; informed consent rigorously described
• Null primary finding is reported honestly rather than buried
• Multivariable analysis adjusts for age and partner status simultaneously, which is appropriate given their strong confounding potential

Verdict

This paper answers a narrower question than advertised: body image, in aggregate, does not appear to drive sexual dysfunction in women with SLE in this sample, but sexual attractiveness self-perception and self-esteem do show signals worth investigating in a properly powered study. The n=68 makes every OR in the regression model provisional, and the wide confidence intervals should give readers pause before treating these findings as settled. The mismatch between abstract and full-text source material is a serious data integrity concern that the research feed tool introduced — take any methodological detail from the full-text sections as unreliable for this paper. Worth a skim for the null body-image finding and the partner-status effect size; not a study to build clinical inference on.