RA and Intimacy 

By Stephanie Watson

Rheumatoid arthritis (RA) can sneak its way into every part of your life, including the bedroom. In a 2014 study published in the World Journal of Orthopae­dics, more than half of the RA study participants reported that their disease had reduced their interest and put limitations on their sex life.

Pain and stiffness are the most common physical causes of sexual issues. Fatigue is another obstacle, and exhaustion from RA can be overwhelming. “By the time I’m done taking care of three children I’m barely upright,” says Mariah Leach, a patient advocate and writer who chronicles life with RA on her blog, From This Point. Forward. “It can also be really challenging to find ways to be intimate that are comfortable.”

For women, RA treatments can also erode libido or cause vaginal dry­ness and make sex painful. The disease is more common in women, and many find it frustratingly difficult to get aroused or to reach orgasm. Men with RA are more likely to have erectile dysfunction, especially if their arthritis is severe or they have coexisting heart disease.  

Emotional Issues and Body Image

Sex has an emotional component, too. If you’re anxious or stressed because of your disease, you may not feel like participating.

“When I was first diagnosed with RA, I felt miserable in my own body, and I carried a lot of guilt about the poor state of my marriage’s sex life, because it felt like it was entirely my fault,” says Leach. 

Complicating intimacy are the effects that RA and its treat­ments can have on body image. “People may not find themselves as desirable now that they have a chronic illness,” says Kathryn Dao, MD, associate professor in the Division of Rheumatic Diseases at UT Southwestern Medical Center.  “Even if the disease is adequately controlled, they can feel like they are defective, and this can be a psychological barrier to a fulfilling sexual relationship.”

Leach says struggles with body image sometimes affects her sex life. “Prednisone can cause you to gain weight or have a moon face,” she says. “Sometimes I feel like my body is the enemy.”  

Asking Your Doctor for Help

A healthy sex life is important, not just for your relationship, but also for yourself. “If you think your medications or your condition are impacting your sexual health, you should bring that up with your doctor,” says Leach.

Your doctor can help you find ways to deal with barriers to sex, like fatigue and stress. They can also refer you to a psychologist or psychiatrist for counseling, or to a sex therapist. An OB-GYN can offer solutions for vaginal dryness, which may include lubri­cants or estrogen cream. This specialist is another good source for a therapist referral.

The trick is working up the nerve to ask your doctor for help. Doctors don’t routinely ask their patients whether RA is impacting their sex life, and many patients are reluctant to bring up the topic. “I think it’s something patients are really embarrassed to talk about,” Dr. Dao says. “It’s usually the last conversation they want to have with their physicians. They leave it to the end of the visit.”

Having a rheumatologist you trust can make the conversation easier. Dr. Dao also recommends bringing your partner with you to medi­cal appointments or therapy sessions, so you can discuss any sexual issues you’re having together. “You clear the air, and if your partner has any questions, the doctor can answer them,” she says.

Keeping the Romance Alive

You don’t have to give up on intimacy with your partner, but you may need to make a few adjustments. “It doesn’t have to be traditional positions, which can cause added pain,” Leach says. Spend time on intimate touch to build the emotional connection and closeness. Then, experiment with positions until you find ones that are comfortable on your joints. Also consider books or talking to a sex therapist about different methods of sexual satisfaction.

To make the experience more comfortable, take your pain medicine about 30 minutes before you plan to be intimate. Soak in a warm bath or take a shower to loosen up stiff joints. Showering together can be a nice way to build the intimate connection.

You might also have to adjust the timing of your romantic encounters. Mornings could find you too stiff to participate comfortably. “But in the evenings, the level of exhaustion may be so profound that who’s thinking about that,” says Iris Zink, MSN, RN, a certified rheumatology nurse practitioner in Lansing, Michigan. She suggests timing sex for when you feel your best, which may be in the afternoon.

Maintaining Open Communication

There are two people in every relationship, and the burden on the partner without RA can be heavy, too. Your partner may pull back from sex out of concern, which can cause a vicious cycle of self-doubt. “[Partners] don’t want to make the pain and fatigue any worse,” says Zink. “And then, the partner with RA feels like he or she isn’t desirable.”

Leach says her disease has caused an undeniable change to the dynamic of her relationship, but she and her husband support each other as a team to work through issues. “We work really hard to treat my RA as our problem that affects both of us, not just me.”

She encourages both parties to speak up about concerns to maintain a healthy relationship.  “It’s really important to be as open and honest as you can,” she says. “If you can treat the issue as a shared problem and work on it together, that can actually promote intimacy.”