Sex is a natural part of life. sexual health and behavior; It is determined by many factors such as family, friends, education, culture and environment. However, some diseases can affect or even impair sexual health and the effort made during intercourse. Asthma has been an issue that has been emphasized since it began to care about patients’ perceptions of quality of life in terms of sexual life. As a basic information, asthma is a chronic inflammatory, periodic, common disease that affects 5% of the population, is characterized by widespread narrowing and obstruction of the terminal branches of the tracheo-bronchial tree, and mediated by bronchoconstriction and mucus production.
The disease develops in attacks and these attacks can be triggered by infections, allergens, various exercises and emotional stress. As a result, people’s physical activities are limited, their work performance decreases, their night sleep is interrupted, they often need to receive medical treatment and sometimes they need to be hospitalized. Quality of life is a term that generally describes the effect of the illness on the physical, psychological and social functions of the person. There are many data obtained by using both generic and disease-specific questionnaires that asthma affects quality of life parameters (1,2).
There are both generic and disease-specific questionnaires examining how the disease affects quality of life parameters (1,3,4). Asthma is a chronic disease that affects the life of patients physically, emotionally and socially, and the evaluation of the disease from this aspect has created a very interesting field in recent years. Sexual life is also a natural and important part of people’s normal life and is affected by many diseases. Sexual life data are important parts of quality of life data. There are studies showing that many diseases affect the sexual quality of individuals apart from the quality of life parameters (5,6). Studies evaluating quality of life, sexual quality of life and their relation with diseases, which are among the areas of interest in recent years, are increasing. Sexual activity (coitus) can trigger asthma in different ways.
Some patients develop asthma and rhinitis attacks accompanied by sexual excitement and anxiety, rarely in some patients due to human seminal fluid allergy (HSPA=Human Seminal Plasma Allergy) alone (7,8) or during condom use. Hypersensitivity reactions may occur due to latex allergy (7.9,10). Postcoital asthma “sexercise induced asthma (SIA)” is an asthma attack caused by any reason other than sexual excitement (11). The dominant feature of the patient and his partners is anxiety and worry. Unlike coital asthma, it is characterized by late asthmatic responses that are seen 4-6 hours after coitus, rather than acute attacks (11). SIA is not a form of exercise-induced asthma. While the PEFR (peak expiratory flow rates) values of the patients decrease significantly from the first minutes of sexual activity, there is no decrease in the PERF values in the stair climbing exercise (which is an exercise that is equivalent to the energy spent during sex) (12). Intense emotional stimuli that occur during sexual activity cause a parasympathetic imbalance on the autonomic nervous system, resulting in the release of mediators from mast cells, resulting in the development of postcoital asthma or rhinitis (11). Coitus-associated asthma conditions should be well defined and differentiated.
HSPA, condom use and SIA; These are conditions that are associated with coitus but each require different treatment approaches. HSPA can easily be confused with vulvovaginitis, while condom-induced local manifestations and asthma status may be confused with non-specific postcoital symptoms. Most cases that can be easily diagnosed are overlooked due to the shyness of patients, hesitancy, or the carelessness of clinicians during their busy outpatient clinic schedule.
However; It is obvious that the most important solution in all these is to take an extremely deep and detailed anamnesis during patient evaluation. Another reason that can affect sexual life in asthma is depression. Organic changes such as hypoxia and limited lung function become evident in the later stages of the disease, while depressive mood and restriction in social activities are seen in the early phase. Depression aggravates the symptoms in asthmatic patients and leads to sexual dysfunction such as low libido and erectile dysfunction (13-16). Patients experiencing shortness of breath and fear of suffocation may avoid sexual contact, and as a result, adjustment problems may occur between spouses (16,17). Physiologically, asthma can affect gonadal steroids similarly to chronic obstructive pulmonary disease (COPD). Hypoxia causes low levels of testosterone, the main hormone associated with libido.
Another effect of hypoxia is that it affects the molecular oxygen levels required for nitric oxide (NO) synthesis and cGMP activity in cavernous tissue, which may cause erectile dysfunction (18). Although the effects of diseases such as COPD, which are similar in terms of the affected system, on sexual life have been documented, adequate studies have not been conducted for asthma (19). However, when sexual effort is considered, it is obvious that such situations will negatively affect the sexual life of an asthmatic patient. In a rough approach, while the population primarily affected by asthma is 5%, this rate can vary dramatically between 10 and 25% if the secondary affected spouse, parent and child population is taken into account. Considering the enormity of those affected, a serious approach is required. In both closed and modern societies, patients and physicians find talking about sexual life as a disturbing subject (20). People with chronic diseases should be encouraged to talk not only about their diseases but also about their sexual lives, and practical applications should be added to medical education on how to approach patients on sexual issues (21,22). Quality of life and therefore sexual functions are also important for the appropriate management of asthma treatment, and we cannot say that patients with limitations in their sexual life have good asthma control. Considering all these data, the necessity of taking an extremely deep and detailed anamnesis emerges when evaluating a patient with asthma. During this interview, physicians should definitely evaluate the patient’s restrictions on sexual life and other quality of life parameters, and evaluate the treatment accordingly. In addition, the positive or negative effects of the treatments applied for asthma on the patient’s sexual life quality should be evaluated at each visit. As with all diseases, asthmatic patients should be considered as a whole.
Sources: 1- Wilson SR, Rand CS, Cabana MD, Foggs MB, Halterman JS, Olson L, Vollmer WM, Wright RJ, Taggart V. Asthma outcomes: Quality of life. J Allergy Clin Immunol. 2012;129(3 Suppl):88-123. 2- Braido F, Baiardini I, Balestracci S, Fassio O, Ravera S, Bellotti M, Canonica GW. The relationship between asthma control and quality-of-life impairment due to chronic cough: a real-life study. Ann Allergy Asthma Immunol. 2008;101:370-4. 3- Ware JE, Sherbourne CD, Davies AR, et al. A short-Form Health Survey (SF-36) I. conceptual framework and item selection. MedCare. 1992;30:473-83. 4- Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis. 1993;147:832-8. 5- Kirmaz C, Aydemir O, Bayrak P, Yuksel H, Ozenturk O, Degirmenci S. Sexual dysfunction in patients with allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol. 2005;95:525-9. 6- Tristano AG. The impact of rheumatic diseases on sexual function. Rheumatol Int. 2009;29:853-60. 7- Kuna P, Kupczyk M, Bochenska-Marciniak M. Severe asthma attacks after sexual intercourse. Am J Respir Crit Care Med. 2004;170:344-5. 8- Shah A, Panjabi C. Human seminal plasma allergy: a review of a rare phenomenon. Clin Exp Allergy. 2004;34:827-38. 9- Turjanmaa K, Reunala T. Condoms as a source of latex allergen and cause of contact urticaria. Contact Dermatitis. 1989;20:360-64. 10- Kawane H. Coitus-induced asthma or condom-induced asthma? chest. 1992;102:327-28. 11- Shah A, Sircar M. Postcoital asthma and rhitinis. chest. 1991;100:1039-41. 12- Andrews JL (Jr). sex and asthma In: Weiss EB, Segal MS, Stein MS, ed Bronchial Asthma; 2nd edn. Boston: Little Brown & Co. 1985;932-33. 13- Kullowatz A, Kanniess F, Dahme B, Magnussen H, Ritz T. Association of depression and anxiety with health care use and quality of life in asthma patients. Respir Med. 2007; 101:638-44. 14- Casper RC, Redmond DE Jr, Katz MM, Schaffer CB, Davis JM, Koslow SH. Somatic symptoms in primary affective disorder: Presence and relationship to the classification of depression. Arch Gene Psychiatry. 1985;42:1098–110. 15- Nicolosi A, Moreira ED Jr, Villa M, Glasser DB. A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men. J Affect Disord. 2004;82:235–43. 16- Başar MM, Ekici A, Bulcun E, Tuğlu D, Ekici MS, Batislam E. Female Sexual and Hormonal Status in Patients with Bronchial Asthma:Relationship with Respiratory Function Tests and Psychologial and Somatic Status.Urology. 2007;69:421-5. 17- Brown ES, Khan DA, Mahadi S. Psychiatric diagnoses in iner city outpatients with moderate to severe asthma. Int J Psychiatry Med. 2001;30:319–27. 18- Cellek S, and Moncada S: Nitrergic neurotransmission mediates the non-adrenergic non-cholinergic responses in the clitoral corpus cavernosum of the rabbit. BrJ Pharmacol. 1998;125:1627–9. 19- Fletcher EC, Martin RJ. Sexual dysfunction and erectile impotence in chronic obstructive pulmonary disease. chest. 1982;81:413-21. 20- Basson R, Weijmar Schultz W. Sexual sequelae of general medical disorders. lancet 2007;369:409–24. 21- Svartberg J, Aasebø U, Hjalmarsen A, Sundsfjord J, Jorde R. Testosterone treatment improves body composition and sexual function in men with COPD, in a 6-month randomized controlled trial. Respir Med. 2004;98:906–13. 22- Blackstock F, Webster KE. Disease-specific health education forCOPD: a systematic review of changes in health outcomes.Health Educ Res. 2007;22:703–17. Wishing you healthy days… Prof. Dr. Cengiz KIRMAZ
