How to keep your relationship strong and your sex life exciting.
So how's your sex life? With rheumatoid arthritis, that question may make you sigh instead of smile. Fatigue can kill desire. Fear of hip or knee pain can keep you from trying. Or perhaps emotional pain is holding you back -- you just don't feel as connected to your lover as you used to or you don't feel sexy.
You don't have to suffer through sex -- or without it. Some expert tips can help. And thanks to aggressive treatment with newer advanced medications, some sexual issues that used to be common with RA may be a thing of the past.
"Things are very different now than 15 or 20 years ago because our treatments are much more effective and we're getting to patients earlier," says Nathan Wei, MD, clinical director of the Arthritis and Osteoporosis Center of Maryland. That means that many women may be less severely affected by joint damage from RA than in the past.
But what if you still have pain, morning stiffness, fatigue, or emotional issues? Both experts and women with RA say it doesn't mean you can't work around them. "There are women even with severe rheumatoid arthritis who have very happy, warm, productive, intimate lives," says psychologist Robert Phillips, PhD, founder and director of the Center for Coping in Hicksville, NY. "I tell my patients, 'That means you can too.'"
In fact, sex may actually help relieve rheumatoid arthritis pain, at least temporarily. After sex, the body releases endorphins, which are natural painkillers. Their feel-good effects can last up to several hours.
These tips may help you overcome common hurdles to intimacy when you have RA.
Figure Out Why Sex Is Difficult
The first step in getting your sex life back is to find out what specifically is standing in the way. For women with rheumatoid arthritis, medication-related vaginal dryness, decreased endurance, or loss of desire may be to blame.
What to do? Ideally, talk to your rheumatologist. He or she knows the most about your condition, the medications you are taking, and their possible side effects. Your rheumatologist can also refer you to the right person to help -- for example, to your gynecologist if the problem is vaginal dryness.
Believe it or not, it may be easier to talk to your doctor about sexual issues if you bring your partner along. When making your appointment, let your doctor know that you want to focus on intimacy. That way you all can reserve plenty of time to talk about it.
Just can't imagine talking about sex with your rheumatologist? "Talk with whomever you feel most comfortable talking with," says Wei, whether that's a nurse or therapist or your gynecologist. Just don't suffer in silence.
Talk With Your Partner
When you have RA, both you and your partner may avoid sex instead of talking about it -- and that may harm your relationship. Don't make that mistake.
Though it may be difficult to start the conversation, you'll probably both feel relieved once you do. And talking about it honestly is the only way you'll find ways to keep your romantic life vibrant for both of you. It's important that you both have a basic understanding of the disease and the role that pain plays so you can overcome it together.
Kathy Lubbers, who was diagnosed with rheumatoid arthritis 20 years ago, says good communication with her husband has been critical. Though taking a biologic medication has reduced her symptoms so much that she is able to walk marathons, she says that sexual pain can still be "problematic."
"You need to be open and have conversations about it so you know where you both stand," says Lubbers, 46, president and CEO of Gingrich Communications and a board member of the Arthritis Foundation. "Your partner needs to be aware and considerate of the fact that certain times of day may be more painful for you or you're exhausted. And you have to understand that your partner may be nervous or anxious about causing pain, and standoffish because [of not wanting] to pressure you."
It may be awkward to talk about and try new sexual practices at first. But think about it like this: At its best, rheumatoid arthritis can get you to experiment and expand your sexuality and ways to be intimate together. And that's good for any relationship.
6 Tips for Better Sex with Rheumatoid Arthritis
Building a better sex life with rheumatoid arthritis means experimenting with your partner. Try some of these strategies suggested by women with RA and experts:
Plan ahead. Plan sex for a time of day when you generally feel good and time your medications so they will be at the peak of their effectiveness then. Arrange your day so that you won't be tired from other activity.
Get warmed up. Do gentle exercise to improve your range of motion and relax. Take a warm bath or shower to soothe your joints -- or better yet, take one with your partner and make it part of your lovemaking. Take turns giving each other a gentle massage.
Try new positions. If one position is uncomfortable, get creative -- experiment with new ones. For example, having your partner on top may be painful for some women with RA. Trying lying side by side instead.
Expand your sexual repertoire. Slow down and rediscover foreplay -- leading up to sex or on its own. Stroking and kissing can provide an alternative path to orgasms. Vibrators and oral sex are other options. Remember, too, that both partners don't have to participate equally on any given day. On some days, a warm hug and a gentle joint rub may be all it takes to put you in a state of bliss.
Don't keep your partner guessing. This is not the time for mystery.Let your partner know -- with actions, noises, and words -- what is exciting, comfortable, and painful during sex.
Once you've had some conversations, Lubbers says, you can develop your own language to indicate that the time is right. While planning ahead can be helpful, taking advantage of the moment can be good, too. RA doesn't have to spell the end to spontaneous sex. "You can have a shorthand signal for 'I feel good, so let's fool around,' so you don't have to talk about it," she says, "almost like the signals between the pitcher and catcher, to make it upbeat and fun."
Keeping Your Self-Esteem Strong
Confidence and self-esteem are sexy, and RA can do a number on both. You may find yourself feeling less attractive or youthful than you used to.
"Depending on where it hits you, you can have issues with putting on makeup, doing your hair -- things that may make you feel pretty," says Lubbers. Here, too, talking about it honestly and asking your partner to help can be vital. For example, when Lubbers couldn't raise her hands high enough to dye her hair, her husband helped. "You figure out ways to make it part of being a couple."
M.E.A. McNeil, author of The First Year: Rheumatoid Arthritis: An Essential Guide for the Newly Diagnosed, says that accepting the disease and the changes it brings to your life helped her keep self-image and relationship healthy.
That doesn't mean it was easy. She sought psychological counseling after she was diagnosed with RA in 1993. Her first words to her therapist were: "I can't have this diagnosis." Over time, she discovered that she could fight the disease with denial and anger, or work with it by learning to accept it.
"You may have always had a certain feeling about flaky people and then you have to accept that you yourself are going to become flaky -- inconsistent and undependable sometimes," she says. "Being able to accept those conditions influences your sex life and how you relate to your mate. It's not very sexy to be a whiner -- the sexy part of people is that they have a self-assurance seated within themselves. That's one of the elements of being able to have a good relationship."
Working through negative feelings to develop a realistic acceptance of how your body may have changed can help your partner too. "If a woman is being proactive in dealing with it, that helps her partner deal with it as well," says Phillips.
Phillips says couples counseling can help. Working with a therapist who is knowledgeable about rheumatoid arthritis -- or willing to learn about it -- can be extra helpful.
"Don't look at it as one person's problem, but as an opportunity to learn some strategies to better communicate on issues," Phillips says. "If a couple can communicate effectively, they can deal with anything and everything."
Sex and the Single Woman With RA
Rheumatoid arthritis presents slightly different challenges for women who are single and dating. When should you bring up the subject? There's no rule about when is the right time to talk about rheumatoid arthritis. Unless you're approaching intimacy early in the relationship, Phillips says, you certainly don't need to blurt it out right away -- just as you wouldn't necessarily talk about other personal issues immediately. Get to know each other a bit first.
And when you do bring it up, Phillips suggests a casual approach. Don't apologize or present RA as a problem or tragedy.
"If you do that, a prospective partner may think [it's] a care-giving relationship instead of a romantic relationship," he says. "Just talk about it like it's as much a part of your life as the color of your hair. And let [your prospective partner] know that you're dealing with it -- you'll also get Brownie points because it shows that you are handling something difficult well."
Can Rheumatoid Arthritis Lead to Better Sex?
In the end, the quality of your intimate relationships hinges largely on the quality of your life. Taking care to feel your best with RA -- being consistent with your treatments, exercising, responding to your physical needs -- makes you much more attuned to your body, says McNeil. That allows you to have a much deeper sexual experience. And good sex, in turn, can help you get beyond the pain.
While you may never be happy about having rheumatoid arthritis, accepting it can be transformative, McNeil adds. "It broadens you as a person to have to abandon some aspects of your ego. At that point, some inhibitions go away, and the fewer inhibitions you have, the better your sex. It can make you feel much more alive."
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