Intimacy

John and Claire have been married for three years. When Claire was diagnosed with rheumatoid arthritis (RA) 10 months ago, the satisfying sex life they had come to know came to a screeching halt. Claire was in almost constant pain, and her fatigue was overwhelming. Fortunately, her rheumatologist was able to help her find the right combination of treatments, and she feels like her old self again. John, however, still remains distant in the bedroom. Neither of them is sure how to approach the subject.

Steve has worked as a longshoreman for 30 years. The physical demands of his job have left him with osteoarthritis (OA) in the knees and hips. He still desires an intimate relationship with Alicia, but his physical discomfort overpowers that desire. He is too embarrassed to talk about this issue with Alicia or with his doctor.

The effects of arthritis

The scenarios described above are not uncommon. The pain, stiffness, fatigue, lack of mobility, and joint disfigurement that can accompany arthritis can make sex difficult or unappealing for many people. This may especially be the case when arthritis affects the back, knees, hips, hands, wrists, feet, or ankles. People who have had surgery on their joints may also find sex difficult, and medicines used to treat arthritis can have side effects, such as fatigue or vaginal dryness, that can interfere with a person’s interest in sex. Furthermore, people with arthritis may perceive themselves as less sexually attractive. All these issues can prevent people with arthritis from relaxing and enjoying the experience of sex, bringing added anxiety into the bedroom.

The situation can also be difficult for the partners of people with arthritis. If you have arthritis, your partner may not be aware of the changes it causes to your body and may not completely understand how it makes you feel. He or she may become frustrated or frightened of hurting you. The result can be a breakdown in communication.

In the case of John and Claire, the idea of a regular physical relationship is no longer on John’s mind. His fear is that sexual activity may actually be the cause of additional pain or distress for his wife. For Steve, embarrassment and frustration are preventing him from working with Alicia to solve their deepening estrangement. In both cases, some communication and a little know-how can help improve matters. This article looks at ways people with arthritis, and their partners, can regain intimacy in their relationships.

Communication

Feelings and attitudes toward sex are quite complicated. Many people find the subject terrifying, embarrassing, or even comical and would rather not discuss it. Others may consider the subject taboo because of ingrained social or religious attitudes. But when painful arthritis becomes a factor in a couple’s sex life, verbal communication between partners is the key to preventing relationship problems such as those described above. When your sex life is no longer fulfilling, it is possible to lose the powerful emotional connection to your partner. Discussing the sensitive issue of sex openly and honestly is the only way to ensure that the problem is solved to the satisfaction of both partners.

For some people, broaching the subject is a tall order. It’s never easy to admit that your sexual relationship needs help. To help you prepare for a conversation about sex, you may want to examine your own feelings first. Ask yourself questions such as these:

  • Do I react negatively when my partner wants to have sex?
  • What are my preferred sexual activities? What are my partner’s?
  • Am I willing to try new positions that will put less stress on injured or painful joints?

Your answers to these questions can help you clarify the issues involved and come up with possible solutions.

You may also want to make notes to have available during the conversation, especially if the subject makes you particularly nervous or anxious. And if you feel simply unable to talk about these matters, communicating with your partner through writing may help open the door. It is often easier to put down on paper what is too hard to say aloud. Leaving letters for each other may be the answer for some couples.

If none of these options seem good to you, it can be helpful to talk to someone else first. Caregivers, doctors, nurses, physical therapists, and other health professionals are often busy dealing with the medical condition at hand and so do not raise with their patients the subject of intimacy. This means you may have to raise the subject with them. Doing so can be difficult, but there are good ways to bring it up. You may want to say something like, “My arthritis is affecting me in ways I hadn’t anticipated. My husband and I are having problems with intimacy; can we talk about that?” Nurses can be especially helpful in this type of counseling.

When it comes time to sit down and talk with your partner, there are some tips to keep in mind to help make your communication more effective.

Be honest and open. You must be honest with your partner about your arthritis. Remember, your partner is not a mind reader. He or she can’t know where or when it hurts unless you say so. Chances are, your partner will be relieved to know how you feel and what he or she can do to help you. Be sure to let your partner know what feels good as well as what causes discomfort.

You should also be honest and open about your feelings, sexual needs, and desires. You might ask whether your partner is willing to redefine intimacy through new positions, sexual aids, and different techniques. These issues may take effort to resolve — building mutual connection requires time and thoughtfulness and cannot be accomplished in a day. But these conversations can have surprising and helpful results. For example, you might find that what works for you — a romantic movie, for instance — puts your partner to sleep. On the other hand, candlelight and champagne may be your partner’s preferred way of getting in the mood, while the idea is a turn-off to you. Knowing about these issues can help you both become better at responding to the other’s needs and creating an atmosphere of intimacy.

Schedule time for lovemaking. Or just schedule time alone in an intimate setting. These should be times when you are both relaxed and comfortable and when you will not be interrupted. Kissing, caressing, and petting, even if it doesn’t end in intercourse, may help restore lost intimacy and help both of you relax.

Take advantage of your good days. It’s important that you take advantage of your good days. Alternatively, if you are really feeling bad, be honest with yourself and your partner. Postpone the sex until you are feeling better. By communicating and sharing your feelings with your partner, you are expressing affection and showing that you are still interested in sex — just not right now. A loving partner will understand this and appreciate your honesty. Partners who share the goal of regaining sexual function are most likely to succeed. If your partner doesn’t fully understand the effects of your arthritis, you may want to talk to the physician together to get an objective ear. In some cases, it may be helpful to seek the assistance of a professional sexuality therapist or counselor. (To learn more about sexuality therapy, go to the Web site of the American Association of Sexuality Educators, Counselors, and Therapists.)

Setting the stage

Environmental factors play an important role in your sex life. Once you have planned a block of time for lovemaking, the next step is to set the stage. First, make sure that you are well-rested. You might take a short nap after dinner. (Let the dishes wait until tomorrow!) Or take a warm bath or shower before sex; this not only warms the joints but aids in relaxation. In general, avoiding cold temperatures is a good idea. Warm the bed by replacing cotton sheets with flannel sheets, or turn on an electric blanket for a few minutes before getting into bed.

The power of touch

Simple touching is a great way to regain intimacy. In addition to kissing and caressing, try massage. Many women can be very aroused just by being held and stroked. Spend more time with foreplay, kissing the neck or caressing the breasts, for example. Find ways to be creative. If your hands are painful, you can try using the backs of your hands to caress your partner. Caressing your partner’s genitals with your hands or engaging in manual sex are other alternatives to sexual intercourse. Some couples may want to try using the hands or mouth to help the partner achieve orgasm.

Medicines and more

The relationship between medicines and intimacy may not be obvious, but what medicines you take and when you take them can have an effect on your sex life. Learn to manage your pain medicine and other medicine to your advantage. Plan to take your medicine so that your pain is controlled at the time when you may be having sex. Pain is usually at its lowest ebb about 2–4 hours after taking a pain medicine.

You should also discuss any possible sexual side effects of medicines with your pharmacist or physician. If a medicine lowers your sexual desire (as some drugs can), talk with your doctor about possibly switching medicines or changing the dose. If a medicine you take causes vaginal dryness, you may want to try a water-based lubricant such as Astroglide, K-Y jelly, Replens, or Wet Original. (Never use petroleum-based lubricants; they can irritate vaginal tissues, and they damage condoms, cervical caps, and diaphragms.) These water-based lubricants are also helpful for women who have vaginal dryness because of Sjögren syndrome, which often accompanies rheumatoid arthritis, lupus, scleroderma, and other autoimmune conditions.

Comfort is key

The sex positions you used before you had arthritis may no longer be possible because of the stress that they now place on stiff and painful joints. Modifying these positions or trying completely new positions may help you rejuvenate your sex life. Remember that if excessive movement triggers arthritis pain in one partner, the partner without arthritis should be the one who provides the movement during sex. Also, some couples find that if sexual arousal is more difficult because of arthritis, using a vibrator can be helpful.

Although there are many sex positions, most are variants of a few basic positions. Everyone’s needs are different, so when reviewing the following examples of modified positions, you will have to decide which will work best for you and your partner. Take into consideration your comfort level, personal inhibitions, and overall sexual satisfaction.

The modified missionary position. A woman who is unable to move her legs wide apart, has stiff knees, or has had a hip replacement can lie on her back with a pillow supporting her hips and thighs. The man can then lie on top of her, supporting his own weight on his elbows, hands, and knees.

Spoon position. When the woman has painful hips or has had a hip replacement, she can lie on her side with her partner lying closely behind her. Imagine spoons stacked side by side in your silverware drawer. Putting a pillow between her knees will help her open her legs while allowing her to relax. The man can enter her vagina from behind.

Standing. This position works well when both partners are bothered by stiff or aching hips and knees. Both partners stand. The woman uses a table or other piece of furniture for support. The woman faces the table and bends over it. The man stands behind the woman and can enter her from behind.

Kneeling. This is similar to the standing position. A woman who has hip stiffness or has had a hip replacement can kneel on a pillow, supporting her arms and chest on a low piece of furniture. The man kneels behind the woman and can enter her from behind.

Sitting. For women with back or hip stiffness and pain, this is a good position that offers support without any weight on top. With the man sitting in a comfortable chair, the woman sits in his lap. Many find this position to be more comfortable than sitting in bed.

Lying down. When a man has painful hips, back, or knees, or when he has had a knee or hip replacement, he can lie on his back, using a pillow under his neck for support. The woman straddles him, supporting herself on her knees or leaning forward and supporting herself on her elbows.

Keep in mind that no one’s lovemaking looks the way it does in the movies, so don’t use that as a standard — even if you thought it was like that for you before. Take your time. Relax. This is a new road to travel with your partner. Try to enjoy the journey.

Victoria Ruffing is a Nurse Manager at the Johns Hopkins Arthritis Center in Baltimore.

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