You take medication for your rheumatoid arthritis (RA) so you will feel better and be able to live more fully. But what if one of those medications starts affecting your sex life?
Quality of life includes sex
One of the ways rheumatologists assess the efficacy of a given treatment is by its effect on your physical symptoms of RA. Another is by asking you to talk about your quality of life. But very few rheumatologists ask about your sex life. Also, sexual functioning is not part of the questionnaires usually used to assess quality of life.
And that’s a shame, because intimacy and sex play a significant role in how much you enjoy your life. RA affects many aspects, including your sexuality. You may experience too much pain and fatigue to feel sexual or to be able to express yourself sexually. As well, your partner may be afraid of hurting you. But if you can find a way to be gently intimate, adapting positions and using supportive cushions, it can bring the two of you closer and make you feel better about yourself.
RA medications and birth defects
If you are taking methotrexate or Arava, you must not get pregnant. Both are linked to serious birth defects. If you are sexually active, it is recommended that you use effective birth control. You may even want to double up, for instance, a condom and the pill, an intrauterine device (IUD) and a condom, and so on.
These medications stay in the body for a long time and both women and men should be off them for quite a while before getting pregnant. This is should be three months in the case of methotrexate and up to two years with Arava. However, you can complete a washout regimen to flush it out faster. If you want to get pregnant or to father a child, talk to your doctor about stopping or switching medication.
Sex drive and impotence
The desire to have sex is a complicated phenomenon, depending not just on what’s going on in your body, but also your mind, your emotions, and your life in general. If you are taking medications for high blood pressure — potentially caused by RA meds — your libido may be affected. Several RA drugs, including methotrexate, sulfasalazine, and hydroxychloroquine, may also be associated with male impotence.
Methotrexate especially appears to have the potential to cause sexual dysfunction and even impotence in men with RA. Women who take methotrexate for longer than 6-12 months have also been found to experience a loss of libido, especially when also taking ibuprofen and experiencing depression. Loss of sex drive associated with methotrexate is rare, though. According to U.S. Food and Drug Administration reports, only 0.01 percent of individuals taking methotrexate report loss of libido. Whether this is because they don’t experience it or because there are limited conversations about sex in a doctor’s office was not clarified.
One study indicated that Biologics appeared to decrease rates of sexual dysfunction in both men and women.
Menstruation, dryness, and more
Some RA medications have the potential to affect the menstrual cycle, and can cause dryness. Usually, this is described as dryness of the mouth or eyes, but it can also affect the vagina. Using lubrication during sex can help in this case.
Several RA medications are also linked to an increased risk of yeast infections in women. They include steroids, non steroidal anti-inflammatory drugs (NSAIDs), and immunosuppressant drugs, such as methotrexate and the biologics. Although the medications do not cause these infections themselves, they may make you more susceptible to developing an infection.
Weigh your options
Differentiating between the effects of RA and the effects of RA medication may be difficult. For instance, RA itself can affect your interest in sex and ability to have it. You’re more interested in sex when you feel good — not just physically, but also in terms of your self-esteem and body image and RA may affect both of these.
The lack of conversation about RA and sex isn't limited to your doctor's office. There is also very little in the research literature, hardly anything about RA medications and their potential impact on your sexuality, and next to nothing about the effect on women. But protecting the quality of your sex life isn’t just about adapting to your RA. It can also include an awareness of symptoms that might indicate sexual side effects from RA medication.
If you think your lack of libido or other symptoms that affect your sex life might be connected to your medication, talk to your doctor. These days, there are many options for treatment. There is a very good chance that by modifying your treatment, you’ll be able to live your life to the fullest, including having a healthy sex life.