9 Tips for Better Sex With RA

by Sheila M. Eldred Health Writer

If you or your partner have rheumatoid arthritis (RA), you know that the swelling, pain, and exhaustion that come with it are often big-time libido killers. In fact, about a third of people with RA experience some type of sexual dysfunction, from decreased sex drive to premature ejaculation to painful intercourse, says Lynne Peterson, M.D., a rheumatologist at the Mayo Clinic.

But with some open-minded and creative thinking, you can have a satisfying sex life despite RA, says Jennifer Wiessner, L.C.S.W, who's a sex therapist in Cumberland, ME. Bonus: The endorphins released during orgasm may bring hours of pain relief. Ready to get busy? Here are the experts' best advice.

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Make Your Sexual Happiness a Priority

Think about what helps you relax, the times of the day you feel less pain, and what gets you in the mood, Wiessner suggests.

“Getting in touch with your own body is key to knowing when you are ready for sexual intimacy,” she says.

Focus on how you can get yourself aroused, rather than on how your partner can get you there. That could mean sending the kids to the grandparents for the night, taking a bath with your partner, music, candles, erotica, self-touch. “Whatever it is, carve out time for it so your body can acclimate to what you are asking it to do,” Wiessner says.

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Be Honest About How You're Feeling

Because both arousal and pain can change moment to moment, it’s always best to check in with each other before jumping straight into bed, Wiessner says. If your symptoms aren't conducive to sex, maybe you cuddle on the couch so you still have that physical closeness.

“Talking about sex outside the bedroom can relieve the tension and pressure, and it can allow for improved understanding,” Wiessner says. If the conversation feels tricky (totally normal, by the way), consider reaching out to a sex therapist or counselor who works with patients with chronic illness. He or she can help you both communicate more effectively.

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Save Sex for Your Best Time of Day

Yep, you might have to schedule it (at least a little bit!). “Get to know your body’s rhythms and when it functions best, and use those times for sexual intimacy,” Wiessner says. “If your body functions less optimally in the late evening, move intimacy to earlier.” For example, try sex right after taking your meds, when you might be least symptomatic. Warm showers or baths or other relaxing activities prior to sex may also be helpful, she says.

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Men: Ask Your Doctor About Erectile Dysfunction

RA can affect sexual interest, arousal, and function in everyone, but men and women may experience different symptoms. For men, swelling and inflammation can cause erectile difficulty, for example. These symptoms can be caused by the RA itself, or from psychological distress, altered body image, and side effects from various medications, Dr. Peterson says. Erectile dysfunction (ED) in men can also be a clue to cardiovascular disease, which commonly co-occurs with RA. If you're having trouble achieving or maintaining an erection, let your doctor know. Once you're able to pinpoint the underlying cause, you'll be able to discuss the most effective treatment options for you.

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Women: Think About What Gets Between You and Orgasm

For women, RA is more likely to cause difficulty with arousal and orgasm. As with the guys, try to figure out what's getting in the way of getting in the mood: Is it pain? Fatigue? If so, keep in mind those timing tips we mentioned. If you need help reaching orgasm, vibrators with long handles can increase pleasure without too much movement or strain, Wiessner says.

And don't forget to invest in a good-quality lube—free of chemicals, glycerin, and parabens—to counteract vaginal dryness.

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Use Tools to Get Comfortable

File this under obvious-but-worth-repeating: If you’re in pain in certain positions, you probably won’t have a positive sexual encounter, Wiessner says. “Consider new positions that are more body-comfortable, and use pillows, bolsters, rolled up towels, or other sexual aids [for extra support where you need it],” she says. Make a trip to your local adult-sex store and ask for a book or video on positions, she suggests. Books such as Kama Sutra are dedicated to educating on sexual positions, but there are many more options available, too.

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Try These RA-Friendly Positions

Switching up your positions can be fun—and pain-relieving, too. If you’re a person with a penis and have stiff and achy knees, try sex standing up. Brace your hands against the wall with your partner facing the wall in front of you. Enter from behind to avoid kneeling or too much knee bend. You could also try sitting in a chair and having your partner sit on your lap.

If you’re a person with a vulva and in pain from RA, a you may be more comfortable lying on your stomach with your partner on top. A memory-foam mattress can also be gentler on joints and sore spots on heels.

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Ask About the Impact of Your Meds

Once you’ve established an open conversation with your doctor, ask whether your medication could be causing sexual issues, Dr. Peterson says. “Some medications used in patients with RA, such as steroids and antidepressants, can contribute to sexual dysfunction,” she says. If so, it’s possible those prescriptions could be adjusted.

Even if a provider tells you that a certain medication doesn’t impact sex generally, if you notice a change, especially once you start treatment, bring it up, Wiessner says. It’s especially important to speak up if you're taking newer meds, Wiessner notes, because sexual side effects may not yet be known.

Be Kind to Your RA Body

“Remember, being sexual with someone is a very vulnerable experience,” Wiessner says. “Being gentle with oneself and partner—and being mindful of how expectations can interfere with pleasure—is important.” Acknowledging that bodies can’t always respond when and how we want them to can help you move beyond those experiences. If you can do that, Wiessner says, you’ll be able "to live a more sexually vibrant and joyful life."

Sheila M. Eldred
Meet Our Writer
Sheila M. Eldred

Sheila Mulrooney Eldred is a graduate of Columbia’s School of Journalism and a former newspaper reporter. As a freelance health journalist, she writes about everything from life-threatening diseases to elite athletes. Her stories have appeared in The New York Times, Nature, FiveThirtyEight, Pacific Standard, STAT News, and other publications. In her spare time, she and her family love running, cross-country skiing, and mountain biking in Minneapolis.