This week we are going to discuss something that makes some people blush, some people sit up and take notice, and some people very angry. You can put the children to bed and lock the dog and cat away because this week we are going to talk about that three letter word we all love and fear at the same time – sex.“Did he just say sex?” Yes, I did. You see, no one talks about what it’s like for someone who is chronically ill to deal with all the issues that surround sex in all its facets. Even when speaking of normal, healthy, people, sexuality is a topic that most find speaking about awkward at best. Sure, there are deep-seeded reasons for this aversion, but the more immediate cause is that everyone is different. What one person finds attractive might be repulsive to another. It’s these differences that lead to potential embarrassment when discussing sex in all its forms, so many just avoid the topic altogether.Now, imagine you had all the normal reservations that talking about sex brings for a healthy person, and then factor in how much more a chronically ill individual has to think about, talk about, and take into account. Not only is it important to know what extra considerations an illness brings when it comes to sex, but it’s also important to find someone who is comfortable talking about and dealing with such issues.First and foremost, there are the physical aspects of sex itself. Those of you who think sexual intercourse is not a physically taxing activity, it’s time for a wakeup call. Sex burns around 85 calories per half-hour. That’s equivalent to an entire TV dinner if you have sex twice a day, or a run to the gym. Now, those of us who suffer from Rheumatoid Arthritis don’t usually hit the gym for a strenuous workout that makes the joints scream with pain. But vigorous sex can cause the same problems. So, before you burn off an all-you-can-eat-buffet, you need to realize what joints and muscles can be affected.Sex requires a good amount of upper body strength. You are not only going to have to hold yourself up off the bed, but you will possibly have to lift your partner, depending on what positions you engage in. I can tell you from personal experience that it is not necessarily muscle size that is needed, but high muscle endurance. You can help to increase your endurance simply by holding small weights up in the air for as long as you can, and repeating the exercise as many times as possible. Use very low weight so that the stress on the joints is minimal. Sex also requires the use of all the parts of the quads and upper leg muscles. Without getting too graphic, I can tell you that many of the motions experienced during sexual activity require the legs to power them. You can help your leg muscles to work less by using the leg press device at your physical therapy office or at a local gym. Strong leg muscles can be the difference between a painful hip and a good time in the bedroom.While the development of muscles is important, there is one aspect of your physique you will need to exercise above all else – cardio, cardio, and more cardio. Muscles need oxygen to work. To get that oxygen to the muscles, you need to pump blood. This is going to put stress on both the lungs and the heart. If you cannot breathe well or if your heart is not up to pumping faster for a prolonged period of time, you can completely rule out sex for a sustained amount of time. When I recently returned to the bedroom after a hiatus of a few years, I had to stop at least twice because I was soaked with sweat and could hardly catch my breath. I had not realized that having sex on a regular basis kept my body in much better shape than my sedentary lifestyle had kept it. If all of your efforts fail, though, there is one thing above all else that helps to make sexual disaster easier to deal with – an understanding partner. Eventually, there is going to be a time when those who suffer from R.A. or Lupus or any other auto-immune disease are simply unable or unwilling to perform something that their partner requests. When this time comes, it is important to be with someone who not only knows your limitations, but also understands enough about your illness to be able to deal with unexpected problems. Sure, the first time you are intimate with a new partner it will always be awkward. Once you are able to get past the initial trepidation, though, you will have a much better time if you don’t end up hurting yourself in the process. I can assure you, if there is one thing that is sexy to no-one, it is a swollen, inflamed, elbow injured in the middle of a sexual encounter. Work with your significant other once you are comfortable enough to discuss the different things you can do to make sex more fun for both of you. Also talk about what you can do to lessen the chance of making your disease worse.I am lucky enough to have found someone who is not only willing to work with me, but truly cares about my well-being. I can tell you for sure that knowing the person in bed next to you cares just as much about not hurting your joints as you do makes everything that much more special. Not only that, but when you know you won’t be looked down upon or ridiculed if you have to stop in the middle or if you cannot perform certain tasks takes a ton of pressure off the entire encounter. My suggestion to you is to put understanding above all else when finding someone to roll in the hay with. Compassion is the sexiest feature in a partner as far as I’m concerned, and it has taken sex for me from hard time to good time.