How Autoimmune Diseases Like Arthritis Can Affect Your Sex Life

Certain rheumatoid diseases - and their treatments- can lead to symptoms of sexual dysfunction. But there are options available.

with Elaine Furst, BSN

If you are seeing a rheumatologist for your autoimmune disease, it’s unlikely that he or she is asking you about your sex life—but perhaps they should be. Only 37% of specialists talk to their patients about sexual activity compared to 63% of OB/GYNs, according to Elaine Furst, BSN, a nurse educator who serves as the outreach director (and past chair) of the Scleroderma Foundation in Los Angeles. She recently spoke to a group of clinicians in Chicago as part of the 2018 meeting of the American College of Rheumatology/Association of Reproductive Health Professionals, and has lectured at colleges across the country.

Doctors tend to give many reasons given for not discussing the subject with their patients, she shared, ranging from discomfort or lack of awareness to feeling that such conversations belong under the purview of other physicians. However, not addressing the subject does a disservice to those individuals who don’t quite understand the connection between their rheumatic condition and possible sexual dysfunction. Difficulties may include, for example, a lack of desire, inability to orgasm, or pain during penetration or intercourse.

Studies going back to the 1960s reveal that rheumatic diseases, such as rheumatoid arthritis, increase the risk of sexual dysfunction, with little insight into how to help those suffering, explained Furst. Unfortunately, sexuality is not often part of the physician’s assessment toolbox, and yet, having pleasurable experiences of all kinds, including sex, increases quality of life, from boosting immunity to decreasing reports of pain, she said.

Source: 123RFSome rheumatic conditions can lead to symptoms of sexual dysfunction.

The Facts about Sex and Autoimmune Disease

According to research cited by Furst, sexual dysfunction in those with rheumatoid arthritis, in particular, may be related to limited mobility, pain, fatigue, depression, muscle weakness, and more. In another study, women with scleroderma, 30% were shown to be less likely to be sexually active and nearly twice as likely to have impaired sexual activity compared to those without the chronic condition. Scleroderma, also known as systemic sclerosis or crest syndrome, involves a tightening of the skin and connective tissues, and thus includes inflammation and joint pain.

Menopause also plays a major role, said Furst.  “If you look at the symptoms (eg, increased vaginal dryness, loss of libido, depression), they certainly do get in the way of having a satisfying sexual experience,” she explained. “When you have a chronic illness and add pain to all of this, it makes it worse.” She pointed out that the average rheumatologic patient is 40 to 60 years old, the prime menopausal age, and yet, menopause is not always considered in clinical assessments or treatment plans. Rheumatic diseases, often also categorized as autoimmune diseases, can include everything from various forms of arthritis and scleroderma to fibromyalgia and lupus.

Certain medications used to manage rheumatic conditions and their related symptoms can also affect sexual function. Selective serotonin reuptake inhibitors, known as SSRIs, and tricyclic antidepressants, for example, may inhibit arousal and delay or prevent orgasm, and impair lubrication. Steroids can decrease vaginal lubrication while narcotics, including morphine, can decrease desire. Beta-blockers and calcium channel blockers can impair lubrication in women and cause erection problems in men. Even NSAIDs (eg, ibuprofen) can lower desire and cause vaginal dryness, shared Furst.

“Chronic autoimmune disease equals in one form or another, or one level or another, depression, decreased libido, fatigue, and pain,” Furst explained. “Add age and medications to the mix, and the combined physical and emotional impact is quite high.”

How to Talk to Your Doctor about Sexual Pain

Most patients, not to mention most clinicians, may not make these connections. But having an open conversation with your healthcare provider can unlock new information and help to improve your quality of life. If you have a rheumatic disorder and are experiencing increased anxiety, stress, flares, or relationship changes, share those with your doctor as well. While the dialogue may initially seem awkward, you may find a solution together that can help ease the impact of your condition on your sex life.

Finally, be aware that you have options! For instance, shared Furst, rheumatoid arthritis patients with mobility difficulties can try changing positions or using heat and relaxation exercises before a sexual encounter, while those with dyspareunia (ie, pain during intercourse) can try lubricants and estrogen cream. Some of Furst’s course patients have reported success with devices as well, or in talking to their doctors about helpful medications that can be taken in advance of sexual activity.

Remember, stay positive and take small steps toward intimacy. At the end of the day, “more sex equals more sex,” said Furst, and that is likely a good thing.



Updated on: 11/07/18
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