When you think of rheumatoid arthritis, you might picture swollen joints, stiffness, pain, deformity, and a lifetime of medications and doctors' visits. Do you ever think of sex? Does your rheumatologist ask about your sex life? Should she or he?
In case you didn't already know, I have both multiple sclerosis and rheumatoid arthritis. Since MS is a neurological disease, the majority of bodily functions can be affected in one way or another. Sexual function is one of those.
As part of a routine neurological office visit, I am asked about symptoms I may be experiencing. Near the end of the list is always - "Are you having any problems with bladder/bowel function, or experiencing any sexual dysfunction?"
Bladder, bowel, sex
Bladder, bowel, sex - the three are related and can be negatively affected by lesions in the cervical spine. I have lesions in the cervical spine. I also have some difficulties at times with each of these body functions.
For the past four years or so, my primary care doctor has also become my substitute gynecologist. She performs my annual Pap smear and asks questions about various aspects of my health. Last year I expressed some concerns regarding neurological problems related to sexual function and she listed a few options I could try to help.
This year I decided to ask about one of the prescription options she had mentioned previously. She asked a few more symptom-related (checklist-type) questions in order to verify the need for the prescription which happens to be a vaginal estrogen cream.
The Diagnosis? Atrophic Vaginitis, a name which sounds terribly horrific if you ask me.
Atrophy of the brain - not good. Atrophy of muscles - not good. Atrophy of the vagina - painful. Seriously, shrinkage and thinning of tissue is involved here as well as dryness. Our friends living with Sjögren's Syndrome unfortunately know about dryness.
Atrophic vaginitis affects 10 to 40 percent of postmenopausal women, of whom only 20 to 25 percent seek medical advice. The condition develops slowly and takes five to 10 years after menopause to manifest. The atrophic changes can also affect the urinary tract, hence, the alternative name, urogenital atrophy.
Hey, I'm not menopausal yet. I'm only 41 years old.
I had been attributing the changes to the lack of nerve communication getting through to my genitals due to MS. But it had not occurred to me that these changes might be due to medication side-effects or the RA itself, until recently.
"In nonmenopausal women, production of ovarian estrogen can be interrupted by radiation therapy, chemotherapy, immunologic disorders and oophorectomy." (Bachmann, 2000)
What got me thinking about RA and medication side-effects?
While researching for a following post related to RA, sex, and relationships, I came across a forum where one woman asks a question about "methotrexate and sexual side-effects" as she was experiencing a lowered sex drive.
One respondent mentions that she had been diagnosed with "genital atrophy" earlier that year, but that her rheumatologist denied it could be related to the medication she uses - methotrexate. Someone else mentions having chronic yeast infections since starting MTX and another woman mentions that MTX can mess with estrogen levels.
Methotrexate and sex
I take methotrexate. However, the only sex-related concern my rheumatologist discussed with me was the strong instruction to use effective birth control while taking methotrexate. If thinking about pregnancy, I would need to be off of MTX for at least three months before trying. Two methods of birth control used simultaneously was preferable.
"The menstrual cycle and sperm production may become irregular or stop permanently.
Women may experience menopausal effects including hot flashes and vaginal dryness.
The desire for sex may decrease during treatment.
Exposure of an unborn child to this medication could cause birth defects.
Effective birth control is necessary during treatment." (OncoLink)
Well, I guess my rheumatologist did instruct me to tell her if I ever started experiencing dry mouth or dry eyes. I honestly do not recall her ever asking about vaginal dryness.
Looking for further scientific discussion of methotrexate and sexual dysfunction, I searched pubmed.gov and found eight references, each focused on males, which discussed impotence, reduction of libido, and gynecomastia (breast enlargement in males). I found nothing regarding MTX use and women, either discussing atrophic vaginitis or menopausal symptoms.
Let me reiterate, methotrexate is known to cause impotence and lower libido in men. But the good news is that it seems to be temporary. Guys, talk to your doctor.
Personally, would I want to stop taking methotrexate to improve my sex life? No Way! It helps my RA too much.
How is the estrogen cream working? I'm not sure. I can't seem to remember to use it 3x each week regularly, meaning I haven't been a compliant patient.
The most interesting medical advice I was given - get more sex!
"Postmenopausal women should be advised to continue regular sexual activity.
Sexual activity improves blood circulation in the vagina, which helps maintain the tissue."
Again with the postmenopausal, but I guess I should let that slide for now. Truly the old adage, "use it or lose it," applies here. I need to do my part (preferably not alone) to try to prevent those tissues from shrinking any further, and to improve my overall health and well-being at the same time.
And as Lene has mentioned previously, "sex is a fantastic painkiller. In addition to making you feel cared for, sexual arousal and orgasm releases endorphins (similar to opiates) that make you feel good, relaxed and in less pain."
Have any of you, male or female, noticed any changes affecting your sex life since being diagnosed with RA or since beginning a specific treatment for your RA? Your story could definitely help someone else today.
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Wylie G, Evans CD, Gupta G.
Reduced libido and erectile dysfunction: rarely reported side-effects of methotrexate.
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J Rheumatol, 2002 Aug;29(8):1793-4.
Thomas E, Koumouvi K, Blotman F.
Impotence in a patient with rheumatoid arthritis treated with methotrexate.
J Rheumatol, 2000 Jul;27(7):1821-2.
Riba N, Moreno F, Costa J, Olive A.
[Appearance of impotence in relation to the use of methotrexate]
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Blackburn WD Jr, AlarcÃ³n GS.
Impotence in three rheumatoid arthritis patients treated with methotrexate.
Arthritis Rheum, 1989 Oct;32(10):1341-2.
Blake DJ, Maisiak R, Koplan A, et al.
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RA and sex:
Rheumatoid Arthritis and Sex: Relationships Matter
Rheumatoid Arthritis and Sexual Independence (Part One)
Rheumatoid Arthritis and Sexual Independence (Part Two)
See more helpful articles:
Vaginal Creams Provide Relief for Dryness
Are My Symptoms RA or Menopause?