Sex and arthritis

Most people with arthritis prefer to stay as independent as possible. If one partner takes on the role of carer, s/he will need to find the right balance between providing help and support and not overprotecting their partner. In some relationships one person plays a dominant role and tends to organize the other. A balance that has been established can be upset by arthritis.

You'll both need to talk about the changing situation and how to make it work. With time every couple can adapt to the challenge of arthritis, although some couples find this easier than others.

What if I'm not in a relationship?

Your self-confidence can be badly affected if you have swollen joints or other visible reminders of arthritis, such as scars from operations. If you're restricted by your arthritis and find it difficult to go out to pubs, clubs or dances, then you may feel unable to form new friendships, let alone a new sexual relationship.

But although sexual chemistry is important, most relationships develop gradually and depend upon shared interests rather than simply the physical side of things. People tend to meet through work, common friends, family, clubs or a church, so keep up your social contacts, even if you feel tired or in pain, and try to find new activities to replace those that you no longer feel able to take part in.

To start with you may feel you need to hide your arthritis from your partner or from yourself. This can be possible if the arthritis isn’t severe, but it won’t work if the arthritis is affecting your physical and sexual function. The best thing is to be open with your partner – you both need to know something about the arthritis and what effects it can have.

Will having sex affect my arthritis?

Anyone with arthritis knows that moving an affected joint can be painful. Sex can be physically demanding and may cause discomfort, especially when the hips or back are involved. However, sex itself is not going to worsen your arthritis. If sex is a regular part of your relationship then you should try to keep it that way.

Reactive arthritis can be triggered by sexually transmitted infections such as chlamydia. If you have had an episode of this type of arthritis you should take special care to avoid getting such an infection, as it could cause the reactive arthritis to come back.

Will arthritis affect my sex life?

Anything that affects your mood or feeling of well-being can influence your sex drive. Like many other illnesses, arthritis may negatively affect your moods and how you feel generally. Swollen joints can make you feel less attractive, and this can give your self-esteem and self-confidence a knock. Discomfort during sex may also reduce your sexual desire or your ability to enjoy sex, as it may be uncomfortable to move joints into a position you are used to.

Possible practical solutions are discussed below. Remember that arthritis can bring a couple closer together if you can discuss the problems openly, and this may actually improve your sex life. Remember, sex is not equally important to all couples. Your aim should be to continue whatever sexual relationship meets your needs and your partner's.

Your appetite for and enjoyment of sex is generally greater if you feel fit and active. Doing some form of exercise will help you maintain your muscle strength and tone, and also the range of movement in your joints. It will also help you to remain sexually active.

For general advice and specific exercises that will help you keep active, see Exercise and arthritis.

Talk about it

Be prepared to talk openly with your partner about your concerns. Some psychological problems are common. You may have low self-esteem and feel unattractive or undesirable because of your arthritis. Fear of pain may make you apprehensive about sex, or your partner may be scared of hurting you. Sometimes worries like this lead couples to withdraw from any physical contact so that even kissing and cuddling stop.

Let your partner know if something is uncomfortable but also make it clear what feels good too. If you can't resolve things yourselves, then consider involving someone from a professional organisation. Your general practitioner (GP) can refer you.

Plan ahead

When pain is a problem, take painkillers about an hour before having sex. This may not be very spontaneous but it is worthwhile if it makes sex more satisfying. Your joints may also feel more comfortable after a hot bath or shower – why not share one with your partner?

Relax

Massage can help relax joints and muscles, and this can form part of foreplay.

Try a different position

The 'missionary' position (man on top, woman below, face to face) may be uncomfortable or difficult for people with arthritis if it puts strain on painful joints. There are numerous positions in which sex is possible and enjoyable – for example, with one or both partners standing, kneeling or sitting.

Try something else

Penetrative sex isn't the only way to achieve sexual satisfaction. Many couples find kissing, caressing and mutual masturbation rewarding and this may be a good alternative if vaginal sex is difficult or uncomfortable. Oral sex is also widely practised, although a painful jaw joint can cause discomfort.

You can also use sex aids. Vibrators are readily available from mail-order catalogues or in shops in larger towns or cities. These are used much more widely than many people realise, and they can be particularly helpful to relax painful joints and muscles as well as for genital stimulation. They are especially useful when vaginal and oral sex are not possible.

In women, arthritis sometimes leads to a dry vagina, which may make sex uncomfortable. Water-based lubricating gels such as KY Jelly or Aquagel may help. These are available from any pharmacy and many health shops. Oil-based lubricants such as Vaseline or baby oil may irritate your skin or damage condoms. Age may also cause drying, which can be helped with oestrogen creams.

• Many people with arthritis will need to take medicines that can temporarily reduce the ability to conceive a child. For example, sulfasalazine can reduce the sperm count in men, and methotrexate and leflunomide can be dangerous to an unborn child.
• Some drugs can make the contraceptive pill less effective – ask your doctor about this.
• Some drugs, notably those used to treat high blood pressure or depression, can reduce sexual desire (libido) and lead to temporary impotence. But apart from steroids, this is rarely a problem with drugs used for the treatment of arthritis.

Find out more about how arthritis and related conditions, as well as medications for arthritis, may affect your plans to have a baby.

Following a hip replacement you need to take care with certain movements because there is a risk of dislocating the new joint. These are, in particular, bending the leg up (flexion) and moving one leg towards the other (adduction). When you have the operation your nurses, physiotherapists and occupational therapists will be able to tell you which movements to avoid. Make sure you ask if you're unsure about anything – they will have been asked the same question many times before.

Many people are reluctant to discuss their sex life with others. Try to discuss any problems you're experiencing with someone you feel comfortable with, such as a friend or someone else with arthritis. Consider speaking to your GP for professional advice or, if you attend hospital, you may feel comfortable speaking to your doctor, nurse, physiotherapist or occupational therapist.

Counselling may be available through your general practice or hospital. Other organisations, including Relate and Brook, have trained counsellors who should be able to help.