Enhancing sexual health in women with systemic lupus erythematosus (SLE): A mixed-methods systematic review of effective strategies

Introduction Sexual dysfunction is highly prevalent among women with systemic lupus erythematosus (SLE) and significantly impairs quality of life, intimate relationships, and psychological well-being. Despite its clinical relevance, sexual health is rarely addressed in routine rheumatology care, and evidence on effective interventions remains fragmented. Objectives This mixed-methods systematic review aimed to evaluate the effectiveness of pharmacological and non-pharmacological interventions for improving sexual health outcomes in women with SLE while qualitatively synthesizing barriers and patient perspectives to inform multidisciplinary care. Methods This review was conducted in accordance with PRISMA 2020 guidelines (PROSPERO ID: CRD420250652901). PubMed, Web of Science, Scopus, and ScienceDirect were searched for original studies published between 2000 and 2025. Eligible studies included randomized controlled trials and qualitative research evaluating sexual health interventions in women with SLE. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT, 2018). Due to heterogeneity in study populations, interventions, and outcome measures, findings were narratively synthesized. Results Five studies met the inclusion criteria, comprising four randomized controlled trials (RCTs) and one qualitative descriptive study. Non-pharmacological interventions—including Extended Permission, Limited Information, Specific Suggestions, and Intensive Therapy (EX-PLISSIT)–based sexual counseling, supportive–expressive psychotherapy and patient education—consistently improved sexual function and intimacy. Pharmacological interventions demonstrated mixed effects: low-dose dehydroepiandrosterone (DHEA) was associated with improvements in sexual function and mental well-being, whereas transdermal testosterone patches showed no significant benefit. Inadequate communication and lack of routine sexual health assessment by rheumatologists were identified as major barriers to care. Conclusion Sexual dysfunction in women with SLE is common yet underrecognized. Non-pharmacological interventions, particularly psychosexual counseling, appear effective and accessible, while pharmacological evidence remains inconclusive. Integrating sexual health into multidisciplinary rheumatology care through systematic screening, education, and interprofessional collaboration is essential.