Lynn advises rheumatologists to encourage trust and open conversations between patients and their partners.
Incorporate RA into your relationship. A partner who understands “how RA works and the pain it causes you is more likely to be understanding and accommodating,” Leach writes. Additionally, it can help to think of sex life issues as “our problem,” she says, noting that it’s often easier said than done.
“The partner may fear hurting the [RA patient], and that may affect their view of intimacy,” says Lynn. “That’s a relationship issue the partners need to work on together.”
Prepare for sex. “Talk to your doctor about medications that may impact your sex life. Ask about pain medications or muscle relaxants that may assist with improving your sex life,” Leach writes. Consider gentle stretches to boost range of motion, pain relievers or muscle-relaxing medications, and/or a warm bath or shower in the hour before sex.
Watkins says, “Unfortunately, RA patients have to plan for being intimate, whether it is timing medications, taking a bath beforehand [or having their partner give them a massage.]”
Timing of sex. “Plan ahead for sex, and arrange your day so you won’t be overly tired from other activities,” writes Leach. Lynn suggests timing sex according to when the patient has the best combination of low pain and high(er) energy.
Leach also advises being open to experimenting creatively and imaginatively. “Try to laugh together if something you try doesn’t work,” and make use of sexual aids, from vibrators to over-the-counter lubrication, to pillows or other furniture for support.
“Patients should do regular aerobic exercise to lubricate their joints,” says Schwartzman-Morris.
Initiating the Conversation
All of this, of course, is a sketch of the sort of advice that rheumatologists can provide their patients. But first, you need to invite the dialogue.
That can begin in the waiting room, says Northeastern University’s Watkins, who recommends strategic placement of a handout on sex and RA from the ACR. She also says the Rheumatoid Arthritis Quality of Life Questionnaire, which the patient can fill out in the waiting room, has several questions on whether or not the patient likes to be touched. Gently questioning the patient about any negative answers, particularly whether the questions apply to being intimate with a significant other, is a natural way to get the conversation going, she says.
“Try to be open with your patients,” says Lynn. “Have a nonjudgmental way of talking to them.”
Specific Questions
It’s also possible to dive right into the topic. A question to start with is, “Is there any medication you are taking that you find affects intimacy and sexual relations?” says Watkins. “Sometimes in the clinic, time is of the essence, and just bringing the topic up helps the patient feel supported,” she says.
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.
Or one can take a more delicate approach with single patients, by asking them whether they worry that their condition will affect their ability to find a partner or to have children, says Schwartzman-Morris.