Pain and reduced libido are perhaps the biggest obstacles to a good sex life, says Mary Lynn, DO, assistant professor of obstetrics and gynecology at Loyola University Medical Center, Maywood, Ill., and libido takes a major hit from fatigue. “If your hip feels like there’s a knife in it or your fatigue makes it difficult even to walk, there’s not a whole lot you can do to make sex more appealing,” Leach wrote on a website for rheumatology patients.
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Explore This IssueJuly 2014
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RA can diminish self-esteem, further interfering with sex life, says Schwartzman-Morris. Appearance issues, such as weight gain, “puffing up” and acne, are especially difficult for younger patients, she says. “They may not be willing to show their body to a regular partner, or to new people.” They may also be too embarrassed to address these issues with their doctor, she says.
The late George E. Ehrlich, a former president of the ACR, was quoted in a chapter on arthritis in a book about sexuality: “The person who has arthritis often feels insecure and sometimes misinterprets concern on the part of the partner as distaste. … Or a spouse may avoid sexual overtures for fear of hurting the arthritic partner; this may be perceived by the patient as a sign of revulsion.”
Ehrlich went on to advise patients to “be kind, and be specific. Let your partner know what feels good and what hurts.”1
Not surprisingly, RA can lead to depression, which can exacerbate sexual dysfunction, says Shteynshlyuger.
Some obstacles to a good sex life are purely physical and treatable, but sometimes subject to misdiagnosis. For women with Sjögren’s disease, vaginal dryness can accompany dry eyes and mouth, says Schwartzman-Morris. Depending on the patient’s age, they may assume the cause of dryness is menopause or disuse of sex organs. But they may simply need treatment for this form of RA, she says.
Alternatively, they may simply need lubricants, says Schwartzman-Morris. Shteynshlyuger notes that estrogen creams work particularly well on dryness.
Helping a woman approach pregnancy can be particularly complex, says Schwartzman-Morris. “A lot of the medications we use are not safe during pregnancy,” she says. In fact, a woman has to stop taking certain medications several months before attempting conception.
Nonetheless, “when the disease is well controlled, patients should be able to conceive normally and have a normal pregnancy.”
Certain medications can interfere with sex drive. “Corticosteroids can change the testosterone-to-estrogen ratios, which can negatively affect libido and sexual function,” says Shteynshlyuger. “Endocrine management, including management of hypogonadism/low testosterone, may be indicated.” Contrary to popular belief, the female libido is vulnerable to low testosterone.