Response to Letter to Editor on “Evaluation of sexual dysfunction among women with primary Sjögren’s syndrome using a Female Sexual Function Index: a systematic review and meta-analysis”

We are thankful to the Colleagues who have kindly appreciated our systematic review and meta-analysis on female sexual dysfunction (FSD) among women with primary Sjögren’s syndrome (pSS).1 Sexual health undoubtedly represents one unmet need for women with pSS. The findings from our study highlight, as suggested, that while dyspareunia and vaginal dryness are common complaints for women with pSS, they are only the tip of the iceberg, and many different sexual symptoms might be present at the same time. Such symptoms are often disregarded by clinicians, often owing to poor awareness of FSD and their treatments, and are likewise rarely investigated using validated tools. As an example, at present no study has measured to what extent orgasmic intensity is affected by pSS, despite the availability of the Orgasmometer2 as a rapid psychometric tool validated with the precise aim of measuring this outcome. Following the “the need for a biopsychosocial (BPS) approach”, correctly pointed out by the Colleagues in the letter to the editor, we would like to propose that women with FSD secondary to pSS should be investigated on the basis of a BPS evolved paradigm, named systems sexology (SS),3 in which the different systems—of the body, of the mind, of the society, of experience—combine to modulate the sexual outcomes. The SS approach, derived from the broader one of the Systems Medicine (SM) and sharing with SM the same attention to the role of the behaviors and lifestyles as generators of health and disease and to the role of chronic subinflammation as universal pathogenetic mechanism, could be used in all patients complaining of sexual dysfunction, regardless of sex, gender, orientation, and comorbidities, and might provide further evidence of the interaction between these factors.