One of the main goals of the PRECISION project, showcased in July’s issue of JointHealth™ monthly, is to enable clients to lead a healthy life in the context of their chronic disease. Besides medical adherence, rheumatologists should also express concern about their patient’s sex life and ask, “How’s your sex life?”
In an interview with The Rheumatologist, Alex Shteynshlyuger, MD, a New York urologist, said that more than half of all rheumatoid arthritis patients have difficulties with sex and yet the topic gets little attention from rheumatologists.
There are many factors that may affect a patient’s ability to enjoy sex – fatigue, physical abilities, and medication side effects including ones that reduces libido, suppresses the secretion of natural lubricants, and interfere with fetus development.
According to a research study conducted by distinguished Psychology professor Barry R. Komisaruk at Rutgers University, Newark, N.J., vaginal and cervical self-stimulation can lessen arthritic and other forms of pain in women. The study reports: “Nonsexual self-stimulation boosted pain thresholds by 50%; pleasurable self-stimulation by 75% and (self-induced) orgasm did so by more than 100%.” Further research of neural pathways of genital stimulation leading to orgasm and pain blockage is being conducted.
Pain is one of the major obstacles to a good sex life. Arthritis patients live with hip and knee pain that can make everyday activities like walking difficult and require an extra dose of energy exertion, resulting in fatigue. In younger patients, the physical differences that sometimes come with arthritis can reduce self-esteem. Patients with rheumatoid arthritis (RA) can experience weight gain due to inactivity, inflammation, and acne. When you combine the two obstacles above with societal insecurities, it can lead to depression, which can lead to a lack of interest in sexual intercourse and worsen sexual dysfunction.
A second barrier to good sex is medications, specifically, the side effects of medications. Medications like corticosteroids and antidepressants reduce sex drive. Corticosteroids can change the testosterone-to-estrogen ratios, affecting libido and sexual function. Shtenynshlyuger cautions that the female libido is vulnerable to low testosterone. Women who plan to conceive should be aware that some arthritis medications are not safe during pregnancy. In some cases, you may have to stop taking certain medications several months before you attempt to conceive.
Along with depression, men are also susceptible to erectile dysfunction. Men with RA, compared to those without, are more likely to get erectile dysfunction. Oral PDE-5 inhibitor medications, such as Viagra and Cialis, can help. Talk to your doctor to ensure the medication is suitable with your current therapy.
Back to the original question: “How’s your sex life?” If it took you more than three seconds to answer that, below are some tips that may help improve your sex life:
- Explore sexual options that do not involve intercourse such as role-play, visual stimulation, kissing, hugging, cuddling, fondling, oral sex, or sensual massage.
- Maintain open and honest communication with your partner. Let them know your limitations. Tell them what you enjoy, and when. Help them understand your disease. Be positive. Use “I” rather than “you” statements. An example could be “I love when you fondle me” compared to “you never touch me anymore”.
- Adjust your position during sexual activities, according to your comfort level.
- Utilize tools to assist you during sexual activities, such as using a cushion for back support.
- Time your sexual activities according to your medication schedule. Take advantage of times where your pain level lowest and energy level is highest.
- Talk to your rheumatologist about your concern. They may refer you to experts such as physical and sex therapists.
- Do regular aerobic exercise to help lubricate joints.