How does arthritis affect sexuality?

Arthritis is a chronic illness that causes joint pain, inflammation or redness of joints, and fever. It can change the way you feel about yourself and may increase your dependence on others. It may also limit your physical ability to share affection without the fear of hurting or being hurt.

The degree to which arthritis will affect your sexual function depends on how severe the disease is; the amount of discomfort you suffer; how much you can do physically; and how much pain is caused by touch, movement, and weight-bearing. Other factors that may affect your sex life include the side effects of medication and the effects of surgery or radiation on movement.

Because a couple may fear hurting or being hurt by each other, arthritis can indirectly cause sexual problems by:

• decreasing vaginal lubrication and orgasm in women because of anxiety

• causing the man to lose his erection if he feels he is hurting his partner, or if he is the arthritic partner, if he has pain himself.

The anxiety created in these situations is described well in "Living and Loving: Information about Sex," distributed by The Arthritis Foundation. Both partners are aware of the possibility of causing pain and make the avoidance of pain their top priority. Thus, with the first wince, moan, or word, the sexual encounter ends. The reaction is:

• Desire immediately shifts to compassion.

• Men lose erections and women have decreased lubrication.

What can be done about it?

Medical evaluation, diagnosis, and treatment are essential to control the pain of arthritis.

The solutions for each couple will depend upon the degree of importance that they attach to physical intimacy in their relationship.

A person of any age may have little interest in sex. Low sexual interest may be the result of years of frustration or become a problem only after a crisis appears. Couples who had sexual problems or low sexual interest before the onset of arthritis often use the disease as an excuse to avoid intercourse.

While arthritis may cause one couple to abstain from sex, it may increase the need for closeness and touch in another. Those who have always needed to share emotionally and physically will find ways to meet those needs.

Your doctor or therapist can help you by:

• talking to you about your needs as a couple

• offering suggestions to help you cope with the disability

• helping you understand the physical and psychological changes caused by aging, and any side effects of medical or surgical treatment.

To overcome the frustration of both partners during sexual activity you may:

• Use a simple signal, such as a touch or a cough, before the pain is too severe.

• Use a lubricant such as Astroglide, K-Y, or Lubrin during foreplay.

• Take the emphasis off having intercourse and focus on touch, sharing, and closeness by using:
  • sex play

  • mutual pleasuring to orgasm

  • self-pleasuring (masturbation) with fantasy to orgasm.
• Find positions that are comfortable.

• Use pillows to support and protect joints.

• Look at the diagrams of sexual positions in "Living and Loving: Information about Sex," distributed by The Arthritis Foundation.

• Avoid positions involving weight bearing for the arthritic partner:
  • If the man is on top and the woman has arthritis, he should support his own weight with his hands and knees.

  • If the man has arthritis, the woman should sit astride him or lie beside him supported by pillows.

The partner with arthritis should:

• Avoid sexual encounters after a heavy meal.

• Attempt intercourse only when well rested.

• Take a hot shower or bath and use medication to reduce pain (aspirin or ibuprofen) before sex.

• Relax, perhaps drink an alcoholic beverage such as a cocktail or glass of wine, and play soft background music.