Behcet’s disease, a rare autoimmune disorder, can present a multitude of symptoms, including sexual dysfunction in men. This condition, characterized by inflammation of blood vessels, manifests in various parts of the body, leading to painful oral and genital ulcers, skin lesions, and eye inflammation. While the exact mechanisms causing sexual dysfunction in Behcet’s disease are not fully understood, it is believed to be linked to the inflammatory process affecting blood flow and nerve function.

Causes

Sexual dysfunction in men with Behcet’s disease can be attributed to several factors, including:

• Inflammation: Behcet’s disease is characterized by chronic inflammation of blood vessels throughout the body. This inflammation can affect blood flow to the genital area, leading to erectile dysfunction (difficulty achieving or maintaining an erection) or reduced libido (sex drive).
• Genital Ulcers: Painful ulcers may develop in the genital region as a symptom of Behcet’s disease. These ulcers can cause discomfort during sexual activity, leading to avoidance or decreased interest in sexual intercourse.
• Neurological Involvement: In some cases, Behcet’s disease can affect the nervous system, leading to neuropathies or nerve damage. Nerve damage in the pelvic region can interfere with normal sexual function, causing erectile dysfunction or ejaculatory difficulties.
• Psychological Impact: Living with a chronic illness like Behcet’s disease can take a toll on mental health, leading to anxiety, depression, or stress, all of which can contribute to sexual dysfunction in men.
• Medications: Some medications used to manage Behcet’s disease, such as corticosteroids or immunosuppressants, may have side effects that affect sexual function. For example, corticosteroids can cause erectile dysfunction or decreased libido as side effects of long-term use.
• Fatigue: Fatigue is a common symptom of Behcet’s disease due to chronic inflammation and other disease manifestations. Fatigue can significantly impact sexual desire and performance in men.
• Relationship Issues: Dealing with a chronic illness can strain intimate relationships, leading to communication problems, decreased intimacy, or loss of sexual interest between partners.

Diagnosis

Diagnosing sexual dysfunction in men with Behcet’s disease involves a comprehensive evaluation that considers both physical and psychological factors. Here are key steps in the diagnosis process:

• Medical History: The healthcare provider will take a detailed medical history, including specific questions about sexual function, any symptoms related to Behcet’s disease (such as oral or genital ulcers, skin lesions, or eye inflammation), past medical history, and current medications.
• Physical Examination: A thorough physical examination will be conducted to assess for signs of Behcet’s disease, including oral and genital ulcers, skin lesions, and eye inflammation. The healthcare provider may also examine the genital area for any abnormalities or signs of inflammation.
• Laboratory Tests: Blood tests may be ordered to assess for markers of inflammation, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels. Additionally, specific tests for Behcet’s disease, such as HLA-B51 genetic testing, may be considered.
• Specialist Consultation: Depending on the specific symptoms and concerns, consultation with specialists such as a rheumatologist, dermatologist, or urologist may be recommended to further evaluate and manage the condition.
• Psychological Assessment: Given the potential psychological impact of Behcet’s disease and sexual dysfunction, a psychological assessment may be beneficial to evaluate for symptoms of anxiety, depression, or stress that may be contributing to sexual dysfunction.
• Imaging Studies: In some cases, imaging studies such as ultrasound or magnetic resonance imaging (MRI) may be ordered to assess for structural abnormalities or signs of inflammation in the pelvic region that could be contributing to sexual dysfunction.
• Questionnaires: Various standardized questionnaires may be used to assess sexual function, such as the International Index of Erectile Function (IIEF) for erectile dysfunction or the Female Sexual Function Index (FSFI) for overall sexual function in men.
• Follow-Up and Monitoring: Regular follow-up appointments will be scheduled to monitor symptoms, assess treatment effectiveness, and make any necessary adjustments to the treatment plan.

Treatment

Treating sexual dysfunction in men with Behcet’s disease involves a multidisciplinary approach that addresses both the underlying autoimmune condition and the specific symptoms impacting sexual health. Here are common treatment strategies:

Medication Management:

• Anti-inflammatory Medications: Controlling inflammation is crucial in managing Behcet’s disease and its associated symptoms. Medications such as corticosteroids, immunosuppressants (e.g., azathioprine, methotrexate), or biologic agents (e.g., infliximab) may be prescribed to reduce inflammation and alleviate symptoms, which may indirectly improve sexual function.
• Medications for Erectile Dysfunction: For men experiencing erectile dysfunction, phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may be prescribed to improve erectile function by increasing blood flow to the penis.
• Other Symptom-Specific Medications: Medications may be prescribed to manage specific symptoms of Behcet’s disease that contribute to sexual dysfunction, such as pain relievers for genital ulcers or topical treatments for skin lesions.

Psychological Support:

• Counseling or Therapy: Mental health professionals can provide counseling or therapy to address psychological factors contributing to sexual dysfunction, such as anxiety, depression, or relationship issues.
  • Sex Therapy: Sex therapists can offer strategies and techniques to improve sexual function, enhance intimacy, and address any psychological barriers to sexual activity.

Lifestyle Modifications:

• Stress Management: Stress can exacerbate symptoms of Behcet’s disease and contribute to sexual dysfunction. Techniques such as mindfulness, relaxation exercises, or stress management techniques may be beneficial.
  • Healthy Lifestyle: Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep, can help improve overall well-being and sexual function.

Treatment of Complications:

• Management of Complications: Specific complications of Behcet’s disease, such as genital ulcers or neurological involvement, may require targeted treatment to alleviate symptoms and improve sexual function.

Sexual Aids and Devices:

• Devices for Erectile Dysfunction: Men with severe erectile dysfunction may benefit from using vacuum erection devices, penile implants, or other assistive devices to achieve or maintain an erection.
  • Lubricants or Moisturizers: For men experiencing discomfort during sexual activity due to dryness or irritation, the use of lubricants or moisturizers may improve comfort and pleasure.

Regular Follow-Up:

• Monitoring and Adjusting Treatment: Regular follow-up appointments with healthcare providers are essential to monitor treatment effectiveness, assess any changes in symptoms, and make adjustments to the treatment plan as needed.

Summary

Sexual dysfunction in men with Behcet’s disease is a multifaceted issue stemming from the inflammatory nature of the autoimmune condition. Symptoms such as genital ulcers, inflammation, and medication side effects can directly impact sexual function. Psychological factors like stress, anxiety, and depression also play a significant role. Treatment involves a holistic approach, including anti-inflammatory medications, psychological support, lifestyle modifications, and targeted therapies for symptom management. Effective management requires collaboration between doctors and patients to address both physical and emotional aspects, ultimately aiming to improve sexual health and overall quality of life.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE