RA and Sex: Relationships Matter

Patient Expert

In a previous post, we discussed how hormonal changes or medication side-effects could negatively affect your sex life when living with RA or any other disease.   For example both men and women are subject to potential sexual dysfunction due to methotrexate use.   Today we will explore any differences in men and women living with rheumatoid arthritis when it comes to sexual functioning, and how RA and sex affect relationships.

Male/Female Differences

Studies repeatedly acknowledge that there are differences concerning the sexual health between women and men with RA, as noted in a literature review published in 2009 focused on the sexual health of women living with RA.   Investigating areas categorized as general sexual problems, sexual satisfaction, sexual desire, sexual performance, and sexual functioning, researchers share that RA affects the sexual health of women as a result of pain, reduced joint mobility, fatigue, depression, and body image alterations.   Very few solutions were offered in the literature with the most common being the need for increased information and communication, as well as physiotherapy.

Among 52 female RA patients who participated in a 2006 study, 62 percent reported difficulties in sexual performance, of whom 17 percent were totally unable to engage in sexual intercourse because of arthritis.   Sexual desire or satisfaction were diminished in 46 percent of patients and completely lost in another 46 percent.   Sexual disability correlated with disease activity, hip (but not knee) joint disease, seropositivity, and diminished desire.   Pain, age, and depression were significant determinants for sexual dissatisfaction.

So far we have pain, reduced joint mobility, disease in the hips, disease activity, younger age, fatigue, depression, altered body image, and diminished desire as contributors to sexual dysfunction in women with RA.

A 2008 study involving 830 RA patients (74 percent female), echo the findings above.   No impact on sexual activity was reported by 31 percent of patients.   However 31 percent reported that RA affected their sex lives considerably, including 10 percent for whom sexual activity was impossible or nearly impossible.   The latter group had worse health status overall as compared to the group who experienced little/no impact on sexual activity.   Higher levels of fatigue, mental distress, functional limitations, lower levels of self-efficacy, and male gender (3.18:1) were associated with perceived problems with sexual activity.

More discussion of fatigue, functional limitations, and lower belief in one's abilities.   Add mental distress and being male to the contributing factors.

In a separate survey of 57 RA patients, 35 percent thought that their disease strained their relationship with their partner, and reasons for this included curtailment of daily and social activities, changes in the balance of the relationship, emotional changes and changed financial circumstances. Over half (56 percent) of the patients found that their arthritis placed limitations on sexual intercourse and the principal reasons cited were fatigue and pain. Sexual ability was important to a small majority of the participants (58 percent), although increasingly less important as patients aged.

Again fatigue and pain are culprits, as are changes that put strain on a relationship.

Patients were reluctant to approach health professionals and vice versa.   However when asked, 39 percent would consider talking to a nurse or doctor if they thought they had a problem.   Poor communication between the RA patient and his/her health professional is a common problem that needs to be addressed.     Even surveyed nurses felt that while contraceptive advice for patients treated with cytotoxic drugs was discussed in depth, the patient's sexual relationship was not discussed at all.

Is sexual satisfaction all about sex?

In a 2000 study of patients (76 percent female) and spouses found that persons were generally satisfied with their marriages.   However lower marital satisfaction was associated with certain passive coping styles, including escape into fantasy and finding blame, in patients and spouses.   Female spouses were less likely to be satisfied in their marriages than male spouses.

A later study which set out to determine predictors of marital and sexual satisfaction in patients with RA and their spouses, 59 patients and their spouses completed questionnaires independent from each other. Multiple correlations were found, however the results indicated that psychological distress and social support are more important than objectively assessed disease status in determining marital and sexual satisfaction in patients with RA.

Certainly any discomfort and disability arising from RA can cause psychological distress, not to mention the potential depression which is often associated with chronic disease.   It is important to recognize all aspects of being a human which includes being a sexual human being.

**So what should we do as patients?  **

Bring up the topic.   Discuss sex with your rheumatologist and primary care physician.   Discuss how RA is affecting your ability to enjoy all aspects of living, including sexual activity.   Discuss how RA is affecting your relationships.

Don't be shy, this is something that maybe your rheumatologist isn't in the habit of discussing with RA patients.

The next post will cover some other things you and I can discuss with our partners to help improve the quality of our sex lives despite having RA.

SOURCES: Areskoug-Josefsson K, Öberg U.   A literature review of the sexual health of women with rheumatoid arthritis.   Musculoskeletal Care, 2009 February;7(4):219-226.

Abdel-Nasser AM, Ali EI.   Determinants of sexual disability and dissatisfaction in female patients with rheumatoid arthritis.   Journal of Clinical Rheumatology, 2006 March;25(6):822-830.

Helland Y, Dagfinrud H, Kvien TK.   Perceived influence of health status on sexual activity in RA patients: associations with demographic and disease"related variables.   Scandinavian Journal of Rheumatology, 2008;37(3):194-199.

Hill J, Bird H, Thorpe R.   Effects of rheumatoid arthritis on sexual activity and relationships.   Rheumatology, 2003;42:280-286."¨

Hilll J.   The impact of rheumatoid arthritis on patients' sex lives.   Nurs Times, 2004 May 18;100(20):34-5.

Ryan S, Wylie E.   An exploratory survey of the practice of rheumatology nurses addressing the sexuality of patients with rheumatoid arthritis.   Musculoskeletal Care, 2006 January;3(1):44-53.

Bermas BL, Tucker JS, Winkelman DK, Katz JN.   Marital satisfaction in couples with rheumatoid arthritis.   Arthritis Care Res. 2000 Jun;13(3):149-55.

van Lankveld W, Ruiterkamp G, Näring G, de Rooij DJ.   Marital and sexual satisfaction in patients with RA and their spouses.   Scand J Rheumatol, 2004;33(6):405-8.

RA and Sex:

Rheumatoid Arthritis and Sex: Relationships Matter

Rheumatoid Arthritis and Sexual Independence (Part One)

Rheumatoid Arthritis and Sexual Independence (Part Two)