RA and Sexual Independence: Part One

Patient Expert

Pain, fatigue, the disease itself, medication side-effects, loss of desire, sexual dysfunction, and changes in relationships affect our sexual health. Humans are created as sexual beings and sometimes illness and disease get in the way of enjoying this aspect of our lives.

So what can we do about it?
In every healthy marriage and relationship, intimacy plays an important role. For those living with disease which causes disability, such as rheumatoid arthritis, maintaining a satisfying sex life can be an arduous task. But don't give up, there are ways to be intimate and adapt to changing needs.

Be open and honest with your doctor. Discuss the physical problems and symptoms you are experiencing and any medications you are taking. If you are not comfortable talking to your current physician about these topics, you may want to find one you feel more at ease with or who specializes in sexual or intimacy-related issues.

The Four-Point Strategy to Maintain a Satisfying Sex Life is presented by Mimi Mosher, an MS patient who helps other patients. Her recommendations are universal and can apply to RA patients as well.

1. Self-confidence is key. Disease and mobility loss can cause feelings of inadequacy and embarrassment that must be overcome for partners to remain intimate. Couples should discuss all issues associated with sex openly, perhaps in conjunction with a therapist.

2. When it comes to sex, it's not the destination that counts-it's the journey. When someone loses the ability to move freely, the mechanics of sex invariably must change. Traditional approaches to intimacy may be uncomfortable or impossible. Understanding limits and using experimentation are essential. To continue to be intimate, focus more on the process of physical intimacy rather than the end result. This mindset helps to minimize performance anxieties and demonstrates how to continue to enjoy intimacy.

3. Make a shopping list. Routinely talk to your doctor about products that could help improve sex. Individually or together, couples should speak candidly with a doctor about options that can enhance sexual fulfillment at any stage of disease progression. You can also get great ideas from different online resources including chat rooms.

4. Practice makes perfect, and don't be afraid if some ideas don't work. As health changes, it is essential to continually experiment and refine technique to remain intimate. When one idea does not work, learn from the experience and try another.

For Men: Erections
Prolonged RA flares can cause hypogonadism (testicle dysfunction) which could then result in altered hormone levels including low testosterone levels. Methotrexate use is known to cause impotence in some men with RA and ankylosing spondylitis (AS). Additionally, men with RA were more likely to report experiencing impotence and decreased libido than men with AS in a 1986 study.

Fortunately medications are available to assist in maintaining an erection, such as Viagra, Cialis, and Levitra. Also available are vacuum pumps which draw blood into the penis and uses an elastic band placed at the base of the penis to help maintain the erection. Many designs are available at adult toy stores.

A tool new to me is the masturbation sleeve for men which enables a person to get a better grip on the penis with their hands. For those of us with arthritis or contractures of the hands, this might be ideal. The sleeve could be used alone or with your partner for shared pleasure. One thing that I noted when reading various message boards was that women who have difficulty with sex still want to please their men and the use of a penis sleeve would add an alternative to intercourse.

For Women: Lubrication
For women who have sensory issues such as pain during intercourse, there are desensitization products which may be found helpful. Originally made for men to slow down their ejaculation by slightly numbing the penis, they can also be used safely on women. The main ingredient for these products is typically benzocaine which is the case with the Playâ„¢ Longer lubricant from Durex.

For women who have difficulty with maintaining natural lubrication, and for those who suffer from lack of sensation, there are many products (gels and oils) on the market to assist. Please know that at any age difficulty with lubrication does not make you less of a woman, but water-based lubricants can revive your sex life. Products are available even in your grocery store, including ones from Astroglide ® and K-Y ® Brand. Avoid using petroleum-based products and never use cooking oils.

If you are experiencing pain during intercourse, bleeding, excessive dryness, thinning, or apparent shrinkage of the vaginal and urogenital tissues (especially if you are menopausal or use methotrexate), please discuss these changes with your doctor. It may be that you are experiencing symptoms of urogenital atrophy or atrophic vaginitis. An estrogen cream inserted vaginally may help.

In Part II, we will explore sex toys, new positions, and sex without intercourse. Please come back and share your own suggestions to increase sexual satisfaction and enjoyment.


Scott, Tom. Intimacy and Multiple Sclerosis A Four-Point Strategy to Maintain a Satisfying Sex Life. United Spinal Association: MS Scene. (published online June 19, 2009)

Gordon D, Beastall GH, Thomson JA, Sturrock RD. Prolonged hypogonadism in male patients with rheumatoid arthritis during flares in disease activity. Br J Rheumatol. 1988 Dec;27(6):440-4.

Gordon D, Beastall GH, Thomson JA, Sturrock RD. Androgenic status and sexual function in males with rheumatoid arthritis and ankylosing spondylitis. Q J Med, 1986 Jul;60(231):671-9.

RA and Sex:

Rheumatoid Arthritis and Sex: Relationships Matter

Rheumatoid Arthritis and Sexual Independence (Part One)

Rheumatoid Arthritis and Sexual Independence (Part Two)