Rheumatoid Arthritis and Sex

Rheumatoid arthritis (RA) can make its way into every aspect of your life, including your sex life.

Mariah Leach, who was diagnosed with RA in 2008 when she was 25 years old, knows the feeling all too well.

“Joint pain and fatigue can make physical intimacy extremely challenging, and even unpleasant at times,” she says. “When I was first diagnosed and we were still searching for a working treatment, there were days when I struggled to get out of bed and lift a mug of coffee to my mouth — so physical intimacy wasn’t remotely appealing to me.”

You can still have a healthy sex life if you have RA. Sex “is very normal and important part of life. It releases endorphins and can help with pain relief,” says JoAnn Hornsby, MD, an associate professor of rheumatology at WVU Medicine.  But you might have to find different ways that work best for you and your partner.

It’s more than physical.

In one 2018 study, more than half of the people living with RA reported issues related to their sex life like pain during intercourse, low sex drive, and feeling dissatisfied overall with their sexual health.

Common RA symptoms like pain, fatigue, and stiffness could limit your energy and hamper you. Some people with RA “don’t feel up for the physical activity. And they may have decreased strength,” Hornsby says.

Today, Leach, who blogs about her life with RA on From This Point. Forward., says tackling RA-related sexual issues with her husband as a united front has only strengthened their bond. “[It] allows us to turn something negative into a chance for positive relationship building and emotional connection.”

While physical symptoms from RA can affect your intimacy, it’s important to note that it can also take a toll on your mental health. But this is both common and normal when you’re living with a chronic condition. If you or your loved one has been diagnosed with RA, here’s a look at what can happen and simple things you can do to achieve an active, fulfilling sex life.

“RA affects sex … in multiple ways,” says Ravi Prasad, PhD, a clinical professor and director of behavioral health at the University of California, Davis School of Medicine. Limited range of motion, discomfort, and exhaustion can play a part. “People can also have pain in other parts of the body not even involved with intercourse. That can make it uncomfortable, which can also affect their libido as a result,” Prasad says.

Mood and body image issues could stem from certain medications and limit confidence. “RA can also have a broader impact on your self-esteem. For me, some of the medications I took caused weight gain, hair loss, and bruises all over my body, which didn’t exactly make me feel confident in my own skin,” admits Leach.

Besides a drop in sex drive, RA can sometimes also cause sexual problems such as vaginal dryness and erectile dysfunction.

But there are ways to turn things around. If you’re concerned or struggling in this area, make it a point to talk to your doctor.

Prioritize your sex life. “For me it helps to remember that everyone — including me — has a right to sexual health. My sexual health deserves to be addressed, no matter what other health issues I may be facing,” Leach says.

Be open and honest. “Talk to your partner — people can misinterpret. Something like, ‘My knee hurts today’ can be interpreted as, ‘You don’t find me attractive’ by your partner. Instead, say, ‘I love you, I want to see you tonight, but this is a bad day for me with arthritis.’ So that your partner knows where you are coming from and they are not taking it personally,” Hornsby says.

Remember the old saying: It takes two to tango. “My husband and I know that building a healthy sex life takes the participation of two people. So we try to think of any limitations created by my RA as an issue we need to share,” Leach points out.

Don’t keep score. When one partner is caring for a person with RA, sometimes it can feel like an unequal relationship. Overtime, this can “breed resentment,” Leach says.

Instead of focusing on what each person is doing for the relationship, Leach says it’s more beneficial to appreciate the good things each person contributes to the relationship overall.

Conserve your energy. It’s normal to feel tired when you’re living with RA. “Pick times when you feel good. Like anything else, the best time for success is maybe not in the morning when you’re stiff,” Hornsby says.

Time your pain medications before your you engage in sexual activity so that you can get the most out of it. Napping helps, too.

Experiment and keep an open mind. If pain and fatigue keep getting in the way of achieving your sexual goals, it’s good to use it as an opportunity to be creative and try new positions or other forms of intimacy, Leach says. Intercourse doesn’t necessarily have to be the ultimate sexual act to keep it interesting.

Use tools to ease your pain and seek other forms of pleasure that both you and your partner can enjoy like water-based lubricants, vibrators, or even use rolled-up pillows to support your joints.

Keep it light-hearted. Humor can be help in uncomfortable situations. On a practical level, Leach says it helps to smooth over issues faced in the bedroom and helps to overcome them.

“For us, humor is also a really important key to maintaining our intimacy. For one thing, sharing laughter together, helps us remember why we love each other in the first place,” Leach adds.

Try warm baths and massages. Stiffness caused by RA can make it hard to move in different positions. Take a warm shower or bath to help ease the stiffness in your joints. A heating blanket or pad can do the trick, too according to Prasad.

Ask your partner for a massage. This will not only relax your muscles and loosen your joints, but can also act as foreplay.

Talk to your doctor. Sure, it might feel awkward to talk to your doctor about sex. But it’s important they know if something is affecting your overall quality of life after you’ve tried everything else. “Your doctor is the person who can help you get pain and fatigue under control, which can obviously benefit your sex life,” Leach says.

“I do think it’s important that patients are aware that there may be something to do. Lot of times, the assumption is that there isn’t much to change things, but there are things that can be modified or identified,” Hornsby says.