Rheumatoid Arthritis and Sex

Your sex life (or the lack of one) is probably not high on the list of topics when you're discussing your rheumatoid arthritis (RA) with your doctor. Even if you didn't have a ton of other topics to talk about, such as side effects of your medicines, morning stiffness and pain, and that promising new drug you just read about, talking about sex can be just plain embarrassing.

But the fact is one out of every three people with RA says that rheumatoid arthritis has had a considerable impact on their sexuality. And one out of every 10 people with RA says that sex is out of the question.

But the reason that people with RA often avoid sex has less to do with pain from achy joints associated with this autoimmune disease than the overwhelming fatigue and difficulty moving that are also hallmarks of the disease. That observation comes from research presented in 2006 at the 7th Annual European Congress of Rheumatology in Amsterdam, Netherlands.

But experts tell WebMD that improving your sex life -- and your intimate relationship -- is not only possible, but can also improve your arthritis symptoms.

"The good news," says Ava Cadell, PhD, "is that being intimate will take your mind off of everything else -- including your arthritis." Cadell is a clinical sexologist based in Los Angeles. "There is scientific evidence," she says, "that when you have an orgasm, you release morphine-like, feel-good chemicals that override the pain. Sex is the best prescription for good health."
Martin J. Bergman, MD, is chief of the division of rheumatology at Taylor Hospital in Ridley Park, Pa. He agrees with Cadell and adds, "Sexuality is part of the human experience -- a very important part."

Sex, Intimacy, and RA: Look at the Bigger Picture

"When we think of sex and sexuality," says Paul Dobransky, MD, "we often think of the physical." Dobransky is a Chicago-based psychiatrist and sex therapist and the author of several books including The Secret Psychology of How We Fall in Love. He tells WebMD that the one key for improving your sex life is to consider the emotional and cognitive parts of your relationship. Instead of only focusing on the physicality of sex, you should think about "the quality of friendship you have with your partner."

According to Dobransky, when you have a chronic illness such as RA, improving how you think and feel about your relationship can have a big impact on how sexual you feel. That, in turn, can enhance your sexual performance. It pays, he says, to work on the emotional part of your relationship.

Sex, Intimacy, and RA: Self-Esteem and Depression Affect Intimacy

There's more to RA than pain and fatigue. "It is very common," Dobransky tells WebMD, "to develop anxiety and depression that is secondary to RA." When that happens, the antidepressants used to treat depression can have sexual side effects. That adds another dimension to the equation, Dobransky says.

In addition, people with arthritis can have a poor self-image stemming from their joint deformities or medication side effects. For example, steroids can cause weight gain and facial swelling. And methotrexate can cause hair loss.

Making emotional connections, Dobransky says, can help you feel better about yourself. That, in turn, can help you feel more desirable.

Sex, Intimacy, and RA: Love in the Afternoon?

With RA, people often feel the most stiffness in the morning. As a result, sex may be more pleasurable later in the day. But some people may find that pain worsens at the end of the day.

That can make sex unappealing at bedtime.

"You need to develop teamwork and coordination with your partner," Dobransky says. "Some people with arthritis may be more open to a 'quickie' or daytime sex vs. evening sex." And once again, he points to the importance of the emotional connection. A good emotional connection, he says, "will promote better communication, more compromise, and more teamwork."

One approach he suggests is to say to your partner, "I seem not to have as much pain in the afternoon. I know you like having sex at night, but can we mix it up and try having sex in the afternoon from time to time?'"

If you are not sure when your pain flares or diminishes, Dobransky says you should track it and notice when it is at its lowest level and its highest. "Once you have established a pattern for your arthritis pain," he says, "you can team up with your partner to take advantage of this together."

Sex, Intimacy, and RA: More Than Just Sex

"Remember," Cadell says, "being intimate doesn't have to mean sexual intercourse." Synchronized breathing, eye gazing, hugging, and kissing are also on the intimacy menu.
"The sense of touch is the most healing," she says. "A lot of people with arthritis don't get massages because they feel discomfort. But being touched by their partner, whom they love and adore, can be healing."

Cadell suggests that you start by saying, "I miss you." Then you can ask for little things like a hug. Bringing intimacy up, she tells WebMD, can re-create that bond that's sometimes severed by an illness. "When one person is ill and the other isn't," says Cadell, "the other person feels helpless." As a result, your partner may be afraid to initiate intimacy because your partner doesn't want to hurt you or be rejected.

Talking about your feelings toward your partner helps your partner feel wanted. It can also let him or her know that advances will not be made in vain.

Sex, Intimacy, and RA: The Value of Experimentation

When you have RA, using sexual aids such as the Liberator line of pillows designed to support you where you can't support yourself can help. "These are wonderful props that can take the pressure off where it hurts," Cadell tells WebMD.

Experimenting with positions is another way to improve the quality of your sexual relationship.

Cadell says there are many different sexual positions to try depending on which joints are affected by RA.

Bergman says it comes down to trial and error. "There are certain positions that may be uncomfortable," he says, "but others may be very satisfactory."

Sex, Intimacy, and RA: Managing Your RA Makes a Difference

Bergman tells WebMD that much of the same advice that applies to other aspects of life with RA applies to sexuality. For starters, he says, it's important to take your RA medication regularly. "Skipping medication doses will only increase your pain," he says.

Treating RA early and aggressively can move almost half of all people with this disease into remission, Bergman says. "This approach to treatment means that questions about sex may never come up."