Genital Attacks in Hereditary Angioedema and Their Effects on Sexual Life

Abstract

Background and Objectives: Hereditary angioedema (HAE) is characterized by unpredictable skin and mucosal angioedema attacks. We aimed to find the frequency of sexual-activity-triggered attacks (STAs) and understand how the sexual life of HAE with C1-inhibitor deficiency (HAE-C1INH) patients is affected. Materials and Methods: Adult HAE-C1INH patients were included in this cross-sectional study, which started in March 2020. Demographic information, marriage properties, gender-specific sexual life characteristics, and the HAE-specific histories of the patients were collected. The Hospital Anxiety and Depression Scale (HADS) and the Turkish version of the New Sexual Satisfaction Scale (NSSS) were applied to all participants. Results: Among 42 symptomatic HAE patients, 33 (78.57%) had genital attacks and 17 (42.5%) had STAs. Ten (58.8%) had genital pain, tenderness, or swelling, and five (29.4%) had isolated abdominal and groin pain. Eight (47.1%) patients with STAs experienced a HAE attack during their first time engaging in sexual intercourse. Anxiety/depression scales, NSSS scores, and distribution of other HAE attack localizations were similar in patients with and without STAs, and no gender differences were observed. Compared to the patients without STAs, the ratio of patients who stated that their sexual lives were negatively affected and that they lost their sexual desire was higher in patients with STAs. Conclusions: Genital or abdominal attacks triggered by sexual activity may be more common than thought. Sexual activity should also be questioned for evaluating attack triggers. There is a possibility of triggering an attack with the first and ongoing sexual intercourse, and patients should be informed to keep their attack treatment medications ready in advance.

Keywords: attack triggers; genital attacks; hereditary angioedema; sexual activity; sexual health.

Figure 1

Distribution of genital attacks by gender and HAE type.

Figure 2

Distribution of sexual-activity-triggered attacks by gender and HAE type.

Figure 3

Distribution of sexual activity triggered attacks at first sexual intercourse by gender.

Figure 4

Comparison of C1 inhibitor function levels between patients experiencing sexual-activity-triggered attacks and those who do not. In the box plot, the bottom and top edges represent the first and third quartiles, respectively, while the horizontal line inside the box indicates the median. The lower and upper whiskers extend from the box up to 1.5 times the interquartile range (IQR). Points scattered around the box plot represent the individual measured values of C1 inhibitor function levels for each patient.