Sex and chronic joint pain: how to improve intimacy

Normal sexual function involves several phases from arousal to relaxation, and involves feelings of pleasure, fulfilment and satisfaction. Rheumatic diseases may affect all aspects of life including sexual functioning. Surveys show that the percentage of people with arthritis who experience sexual problems ranges from around one in three (31%) to as many as three out of four (76%).

Yet sexuality is not explored in questionnaires used to assess quality of life, and a survey among rheumatologists found that only one in eight (12%) were asked if they experienced sexual difficulties.¹

There are many medical interventions that may be prescribed, depending on the form of arthritis. But one overlooked part of managing any form of arthritis is a person's food choices.

How arthritis can affect your sex life

Having arthritis can affect your sex life in several ways. Pain can lead to anxiety and stress that dampens your sex drive and prevents relaxation. Joints that are stiff, painful and swollen can lead to difficulty in assuming certain positions, especially if your hip or knee movements are limited. Reduced strength or mobility in your hands or arms can affect foreplay and the mechanics of love-making, too.

Prescribed medications can affect your libido, contribute to erectile difficulties or impair your ability to reach sexual climax. And if that's not enough, you may feel tired and exhausted for much of the time, especially if you have an autoimmune form of arthritis such as psoriatic arthritis, ankylosing spondylitis or rheumatoid arthritis. At least half of women with an autoimmune arthritis also experience vaginal dryness because of an associated Sjogren's syndrome, in which drying up of secretions can lead to painful sex (dyspareunia).

Talk to your partner

While it's something that many people feel embarrassed about discussing, it's important to set aside time to discuss the problem with your partner. Good communication is vital to prevent misunderstandings that may cause you to drift apart.

Sexuality is not just the act of sexual intercourse - it also involves your emotions, how feminine, masculine or attractive you feel. It involves self-esteem and the ability to enjoy a warm, loving and tactile relationship - even if full penetrative sex does not occur.

Your partner may feel apprehensive about initiating intimacy with you if they know you are in pain - just as you may feel anxious about approaching them. Ensure your partner knows that your dwindling sex life is not because you no longer fancy them, but because you find sex difficult or uncomfortable.

Sexual intimacy can take several forms other than traditional penetrative sex, and it's important to continue showing affection through touching, holding, kissing and caressing so your partner doesn't feel isolated or pushed away.

Talk to your doctor

Ensure your joint pain is properly diagnosed and a treatment plan is agreed to help manage your symptoms. NICE (National Institute for Health and Care Excellence) guidelines recommend that doctors offer an individualised management plan based on each person's expectations and goals.

For osteoarthritis, medical treatment might include help with weight loss to ease pressure on your weight-bearing joints, advice on muscle strengthening exercises and aerobic fitness training to protect joints, and psychological support for those experiencing associated stress, anxiety and depression. Although your doctor may not think to raise the topic of sexual relations themselves, don't be afraid to mention any difficulties you are experiencing.

Your doctor may recommend painkillers such as oral paracetamol or a topical non-steroidal anti-inflammatory treatment such as diclofenac gel, but if these do not control your pain other options are available.² The guidelines state that doctors should not recommend 'alternative' treatments such as glucosamine, chondroitin or acupuncture. However, many people do find these helpful and even though your doctor is unable to prescribe them, there is no reason why you should not trial them yourself for 2 to 3 months to see if they help you as an individual.

For rheumatoid arthritis, treatment involves referral to a rheumatologist to confirm the diagnosis, and to arrange physiotherapy and occupational therapy for advice on mobility, pain control and work-related issues.³ Again, if no-one raises the issue of sexual difficulties don't be embarrassed to mention this yourself, just as you might raise problems such as dry eyes, tiredness or neck pain.

Think about your diet

NICE guidelines mention the benefits of a Mediterranean style diet with plenty of fruit, vegetables and fish together with less meat and butter. This way of eating helps to reduce joint inflammation, promote weight loss and helps to lower the long-term risk of cardiovascular disease (heart attack and stroke) which is raised in people with rheumatoid arthritis.

The overall aim of treatment is to help you manage your symptoms, so you can continue to enjoy a good quality of life that is as normal as possible - that that includes physical intimacy.

Ideally, doctors caring for people with different health problems should consider how your health condition or its treatment will affect your sexual desires and activities. But this is often neglected. If your doctor doesn't bring up the topic, don't be embarrassed to mention it yourself - all doctors are used to answering people's questions about sex.

Self-help approaches

• Choose a time for sex when you feel at your best and not tired at the end of a long day.
• If your pain is better at certain times of day, such as an hour or two after taking your medications, or after applying a joint cream or gel, that may be a good time to schedule intimacy - you don't have to stick to your normal routine, such as waiting until you're in bed at night.
• Some doctors advise having sex before a meal rather than after, for example, when blood flow is diverted away from muscles (and joints) to maximise digestion.
• If you experience stiffness in the mornings, then a warm bath or show may ease symptoms sufficiently to allow morning intimacy afterwards.
• Try using a hot or cold pack on an affected joint beforehand to see which brings best relief.
• Experiment with different positions to find which feels most comfortable. Lying on your side is usually more comfortable if you have knee problems, or if one hip is affected.
• If a man has hip or knee problems, then it may be more comfortable for you if your partner is on top.
• Use soft cushions or pillows to provide additional support, if needed. Placing a pillow under your knees can make lying on your back more comfortable, for example.
• If you have a troubling and persistent loss of sexual desire or are experiencing problems such as erectile dysfunction (impotence) or inability to climax, do seek medical advice. Psychosexual counselling to help overcome anxiety surrounding sex is also helpful. In some cases, changing your medication may improve the situation, or a drug such as Viagra (sildenafil) may help.
• For women experiencing vaginal dryness, using an intimate lubricant and taking sea buckthorn oil supplements can help. If these don't solve the problem, ask your doctor whether you might benefit from a prescribed vaginal oestrogen cream.

The important thing is to seek help - don't just put up with the situation through embarrassment or a mistaken belief that nothing can help. In almost all cases, a solution can be found to significantly improve the situation. This may involve improved pain relief, medication to treat depression or erectile difficulties, cognitive behavioural or psychosexual counselling, or in some cases, surgery to replace the affected joint.

If you’re interested in learning more about how to keep your joints healthy, select Joints from the Your health menu above.