You’ll talk about how hard it can be to chop vegetables or tie a shoelace. And you have no problem detailing the struggles of gardening or getting dressed in the morning when your joints are stiff and hurt like hell. Those are the realities of living day to day with inflammatory arthritis.

But there’s another challenge that often goes unmentioned. And that’s sex.

This is an area of chronic pain that gets too little attention, says Robert Kerns, PhD, professor of psychiatry, neurology, and psychology at Yale University. But sexual problems among people with arthritis are quite common.

An analysis of research recently published in The Journal of Rheumatology found people with rheumatoid arthritis (RA) have a significantly higher risk of sexual dysfunction. In fact, in one study of a group of 231 people with RA, about half of men and women said they had some kind of sexual issue.

It’s understandable that the physical symptoms of inflammatory arthritis (such as RA, psoriatic arthritis, and ankylosing spondylitis) — not just pain, but also fatigue and mental health co-occurrences, like depression — combined with emotional issues, such poor body image, interfere with your sexual health.

Or, as Mariah Leach put it in a blog post on, “if your hip feels like there’s a knife in it, or your fatigue makes it difficult even to walk, there’s not a whole lot you can do to make sex seem more appealing.”

But that doesn’t mean that aspect of your life is has to stay negative or challenged forever. “You can still be intimate and create an amazing bond with your partner,” says clinical sexologist Deb Laino.

Here’s How Inflammatory Arthritis Affects Your Sex Life

Lay much of the blame on pain: When your joints are tender and swollen, when they stiffen up and it hurts to move, sex is likely the last thing on your mind. And it stands to reason that these symptoms also dampen sexual desire. About half of people with RA lose interest in sex during the course of their disease, and even more aren’t satisfied with the quality of their sex life, research shows.

Other ways inflammatory arthritis may put your sex life on simmer:

1. Pure exhaustion: Fatigue is a common symptom of inflammation, says Laino, which leaves you too tired and with no endurance for sex. Sometimes certain medications can also sap energy, adds Laino, who is also a certified sex educator with the American Society of Sex Educators, Counselors, and Therapists. In one study, 56 percent of people with RA named fatigue and pain as the top two factors that limit sex.

2. Low self-esteem: Swollen or misshapen joints, weight gain, or fatigue can affect body image. You may feel less attractive, less youthful, or less confident. Not exactly a recipe for intimacy with your partner.

3. Vaginal dryness for women, ED for men: Some women with inflammatory arthritis may develop another immune disorder that decreases lubrication and makes intercourse uncomfortable. Men with inflammatory arthritis may have trouble getting an erection. Experts aren’t sure exactly why, but they suspect inflammation may affect the blood vessels in the penis. Other sexual problems include difficulty with arousal and inability to orgasm.

4. Depression: Inflammatory arthritis and mood disorders commonly occur together. It’s unclear whether depression and anxiety are a result of physical symptoms, or if depression is yet another symptom caused by chronic, systemic inflammation. What we do know is this: “Inflammatory arthritis conditions can be direct pathways to sexual conditions and dysfunction, and depression and anxiety can also exacerbate those issues,” says Dr. Kerns. In fact, Turkish researchers found the impact of RA on sexual function is worse when women are more depressed.

5. Meds may mess with libido. Though many arthritis medications don’t appear to affect sexual functioning, some drugs (such as cimetidine and diclofenac) may interfere with libido. And common side effects of antidepressants include loss of desire and difficulty with orgasm.

How You Can Have Arthritis and Bring Sexy Back Too

Step one: Change how you define sex, say experts. People tend to hold on to this ingrained idea that sex is only about intercourse, explains Laino; if you’re not doing that, then you’re not having sex, the thinking goes.

“But there are so many different ways you can experience pleasure, without penetration or the pressure of having to perform in a specific way,” says Jennifer Wiessner, licensed clinical social worker and certified sex therapist. “Anything that is intimate can bring pleasure.”

To improve sexual health and strengthen your bond with your partner:

1. Find other ways to connect. It could be an amazing kiss, cuddling, a gentle massage, or simply caressing a forearm; it could be other sexual techniques like oral sex or using sexual devices, says Jane Fleishman, PhD, a certified sexual educator who specializes in sexuality in older adults. For each couple, intimacy may mean something different, adds Wiessner.

2. Talk; then talk more. Open and honest communication about feelings, desires, challenges, and sexual needs is super important. “Tell your partner what feels good and what doesn’t,” says Laino. Being direct can help them better understand your condition and relieve any anxiety or fear about causing you pain.

3. Get busy when you feel good. Your arthritis pain can vary from day to day; or even hour to hour. Take advantage of when you feel less pain or fatigue and use that as an opportunity for intimacy, suggests Wiessner.

She speaks from experience. At 48 years old, Wiessner has been living with the chronic pain of arthritis and other conditions since contracting Lyme disease about 30 years ago. “The biggest thing is to remember that there’s an ebb and flow,” she says. “I’m not always in chronic pain that’s at an eight or 10.” To keep sexuality in her marriage vibrant, she maximizes the time when she feels well.

4. Rethink the importance of spontaneous sex. A little planning can keep arthritis symptoms from getting in the way of pleasure. Some tips:
* Time your pain meds for maximum effect during sex
* Pace your daily activities and incorporate rest to help boost energy
* Take a warm shower or ask for a gentle massage to ease stiffness and soothe muscles
* Grab extra pillows to help support joints
* Use a water-based vaginal lubricant or a vibrator to help initiate arousal

“Like most physical exercise or emotional outbursts, sex requires energy that takes up my precious spoons,” says Eileen Davidson, a woman with RA, osteoarthritis, and fibromyalgia, on her blog. She says she needs to make sure she can nap or sleep after having sex, noting that “it’s usually planned out rather than spontaneous.”

5. Stay active. Your desire and enjoyment of sex is generally greater if you feel fit and active. Light exercise can help strengthen your muscles and improve range of movement in your joints. “I make sure to take care of myself and keep my body moving,” says Wiessner. “That allows me the bandwidth and ability to be intimate.”

6. Experiment. If one position puts strain on your joints, try a new one. Be curious and creative, without putting pressure on yourself or your partner, suggests Wiessner. “Keep it lighthearted,” she says. “If something new works out, great; and if not, that’s ok, too. Laugh about it together.”

7. Accept change. Maybe you’re angry at having arthritis, or resent your disease. Maybe you’re frustrated or embarrassed by how arthritis changed the way you look and how you move, which all impacts self-image. It’s important to understand that body image issues aren’t exclusive to people with arthritis, says Fleishman.

As you age, you have to consider your new normal. Don’t think of yourself in comparison to you in your twenties or thirties, and not in comparison to yourself before your joints really starting feeling pain. Instead focus on today. Over time, you’ll be able to replace negative feelings with a realistic acceptance of how your body has changed.

8. Recognize depression. If you feel a heightened sense of anxiety or mood changes, or lose interest in activities you once enjoyed, talk to your doctor, advises Dr. Kerns. Depression and anxiety disorders often accompany chronic pain, including arthritis conditions and especially inflammatory ones, he says.

Studies show that if depression occurring with rheumatoid arthritis isn’t addressed, the treatment for rheumatoid arthritis itself can be less effective. With medication, support, and a personalized plan of action, depression and rheumatoid arthritis are treatable conditions.

9. Seek help. Talk to your rheumatologist, primary care doc, or other specialist about your sexual health. It may feel a little awkward, but sex and intimacy are part of a healthy lifestyle. Your health care provider may help you figure out challenges and overcome barriers.

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