Sexual Dysfunction and Rheumatoid Arthritis

Is the Problem Getting Enough Attention?

Sexual dysfunction affects married couple with health problems.
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Sexual dysfunction is not uncommon with rheumatoid arthritis (RA). According to the-rheumatologist.org, more than half of all people with rheumatoid arthritis have some difficulty with having sex. Despite the number of people affected, most doctors and patients don't discuss it.

Sex is an important part of life and of committed relationships. If there is sexual dysfunction, it should not be ignored.

Should we expect doctors to ask if we are having sexual problems? Or, is it the patient's responsibility to disclose what is happening? While a patient's pain level is most likely the primary focus of a rheumatology consultation, either the doctor or patient can opt to discuss the secondary, consequential problems. It doesn't matter who brings it up, as long as someone does.

Much can be done to help people with rheumatoid arthritis. Sex and sexuality should not become a thing of the past or just a memory. Rheumatoid arthritis should not force you to eliminate physical intimacy from your life. The first step is to identify and understand potential problems, and to determine if the sexual dysfunction is due to physical or psychological issues. Then, move on to finding solutions.

Normal sexual function transitions through phases from arousal to relaxation. It should be associated with a feeling of pleasure and with feeling satisfied and fulfilled.

Sexual dysfunction can disrupt the normal process at any point along the way.

Physical Factors Linked to Sexual Dysfunction With Rheumatoid Arthritis

Physical factors tend to affect the actual performance of sexual intercourse. It is sometimes referred to as sexual disability. Factors include:

  • Joint pain (the impact of joint pain on sexual function is related to disease severity)

Psychological Factors Linked to Sexual Dysfunction With Rheumatoid Arthritis

Psychological factors tend to impact the desire to have sexual contact, as well as satisfaction from having sexual activity. Psychological factors include:

  • Depression (associated with having a chronic autoimmune disease; compounded by having sexual difficulty)
  • Poor body image, low self-esteem, negativity (may be related to weight gain or deformities)
  • Anxiety about what their partner is thinking and feeling
  • Decreased sex drive/low libido

The Medication Effect

According to the American College of Rheumatology, usually medications that are used to treat rheumatoid arthritis do not affect sexual function. There have, however, been cases of erectile dysfunction reported in people who were treated with methotrexate, Azulfidine (sulfasalazine), and Plaquenil (hydroxychloroquine). Libido may decrease as a consequence of taking Voltaren (diclofenac) or Naprosyn (naproxen).

Antidepressant medications can be associated with loss of desire and difficulty with orgasm.

Erectile Dysfunction

According to study results published by an Irish research team, which were also highlighted at the 2009 annual meeting of the American College of Rheumatology, erectile dysfunction is more common in men with rheumatic diseases, especially rheumatoid arthritis, compared to the general population. The researchers also linked the finding to the increased risk of cardiovascular disease in people with rheumatoid arthritis. As a matter of fact, researchers called erectile dysfunction "a recognized harbinger" for cardiovascular disease in rheumatoid arthritis patients.

Another study, published in The Egyptian Rheumatologist in 2013, pointed out that rheumatoid arthritis can affect serum androgen levels which may be a cause of erectile dysfunction. The study found statistically significant differences in the levels of serum DHEA (dehydroepiandrosterone sulfate), total and free testosterone when comparing men with rheumatoid arthritis to a group of healthy men.

Treating Sexual Dysfunction Associated With Rheumatoid Arthritis

Communication must precede any treatment plan for sexual dysfunction with rheumatoid arthritis. If solutions are to be found, the patient must be able to disclose specific problems to their doctor. Equally important is open communication with your partner. It will only be possible to overcome such things as fear of causing/adding to your loved one's pain or to discover optimal positions if you discuss it and make the effort.

There are treatment approaches that your doctor will likely recommend, such as taking analgesic medications, heat (hot shower or electric blanket), and muscle relaxants—optimally, within an hour of sexual activity. Consider range of motion exercises, too, which can be taught to you by a physical therapist. Whatever might work to loosen up your body will be helpful.

Sexuality is not solely the act of intercourse. While a willingness to be creative may work in your favor, remember that touching, kissing, holding, and snuggling are all important intimate actions. Don't forget that your emotions are at play, too. If you feel loved and are expressing love, in any way, you are on the right path and can work out most difficulties, in most cases.

2016 EULAR Meeting Addressed Sexual Dysfunction With Rheumatoid Arthritis

At the 2016 European League Against Rheumatism Annual Congress (EULAR), study results were presented that revealed sexual dysfunction is present in more than one-third of rheumatoid arthritis patients who are still sexually active—men and women. While many factors may be involved, there was not a statistically significant association between having sexual dysfunction and rheumatoid arthritis disease activity (i.e., the dysfunction does not affect disease activity). A link was found between not being sexually active and disease activity, however.

Researchers also analyzed precipitating factors, predisposing factors, and maintenance factors related to sexual dysfunction with rheumatoid arthritis. Precipitating factors included:

  • Infidelity (33 percent of women; 6 percent of men)
  • Insecurity (32 percent of women; 16 percent of men)
  • Physical causes (17 percent of women; 3percent of men)

Predisposing factors included:

  • Image changes (14 percent of women; 21 percent of men)
  • Infidelity (13 percent of women; 7 percent of men)
  • Anxiety (2 percent of women and 2 percent of men)
  • Loss of attraction (1.4 percent of women; 10 percent of men)

The maintenance or continuing factors included:

  • Biological or physical causes (11 percent of women; 15 percent of men)
  • Infidelity (9 percent of women; 4 percent of men)
  • Changes in the relationship (9 percent of women; 19 percent of men)
  • Partner's sexual dysfunction (3 percent of women; 0.8 percent of men)
  • Depression or anxiety (1.9 percent of women; 5 percent of men)

The association between precipitating, predisposing, or maintenance factors and disease activity was not statistically significant.

A Word From Verywell

Not only is sexual dysfunction not routinely discussed between doctors and rheumatoid arthritis patients, it does not appear on health questionnaires which are used to assess physical function and quality of life. Clearly, the medical establishment needs to work on that. Your job is to focus on what you can do to overcome sexual dysfunction, after identifying the issues.

Sources:

Holzman, David C. Rheumatologists May Help Patients With Rheumatoid Arthritis Overcome Obstacles to Sex. The Rheumatologist. July 1, 2014.

Leong, Amye, MBA. Sex and Arthritis. American College of Rheumatology. April 2015.

Nasr, Mohamad Mahmoud et al. Sexual Performance in Rheumatoid Arthritis Patients - An Unnoticed Problem. The Egyptian Rheumatologist. (2013)35:201-205.

Stein, Jill. ED, Rheumatoid Arthritis Could Be Linked. Renal & Urology News. December 10, 2009.

Tristano, Antonio G. Impact of Rheumatoid Arthritis on Sexual Function. World Journal of Orthopedics. April 18, 2014: 5(2)107-111.

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