Sex, relationships and arthritis

Most couples – whether they have arthritis or not – go through phases in their relationship when their sex life is less exciting or satisfying than it was. There may be physical reasons for this but emotional factors and stress often play a part. Emotional upsets, work or money worries can all affect the balance of a relationship.

Arthritis can present a number of challenges in a relationship:

• Pain and fatigue may reduce your enjoyment of sex and other activities and interests that you share with your partner.
• Arthritis may mean that you can’t always manage the household jobs you usually do, or you may need help with them.
• If your arthritis affects your work, it may lead to financial worries.
• Having arthritis may affect your mood and self-esteem.
• Your partner will be concerned about how the condition is affecting you.

Although your relationship may change because of arthritis, it doesn’t have to be a negative change. Many couples find that they become closer by discussing things openly and that their relationship is stronger as a result. Talk about the changing situation and any challenges that you face so you can arrive at a solution that’s right for both of you.

For example, most people with arthritis prefer to keep as much independence as possible, so a partner taking on the role of carer will need to find the right balance between providing help and support without being overprotective. It can be difficult for a caring partner to recognise that their help isn't always wanted.

Some couples find it difficult at first to talk openly, so you need to create a comfortable, relaxed time to talk. But once open communication has started it can be a great relief for both partners.

What if I'm not in a relationship?

Some people with arthritis lose their self-confidence and worry about forming new relationships, especially if they have swollen joints or other visible signs of the condition. But most relationships develop gradually and depend upon shared interests more than physical considerations.

Keep up your social contacts as much as possible and think of new activities to try, especially if there are some that you now find difficult.

Sex itself won’t make your arthritis worse. But because moving a joint affected by arthritis can be painful and because sex can be physically demanding, it may cause discomfort, especially if your hips or back are affected. You can try different positions which may be more comfortable for you and your partner.

Reactive arthritis can be triggered by sexually transmitted infections (STIs) such as chlamydia. If you’ve had this type of arthritis before, you should take special care to avoid getting such an infection (by using a condom, for example) because it could cause the arthritis to return.

There are a number of ways that arthritis can affect your sex life:

• Arthritis can affect your mood and general well-being which, in turn, can affect your sex drive.
• Swollen joints can affect your self-confidence and make you feel less attractive.
• Fatigue associated with arthritis can reduce your sexual desire. Your healthcare team can advise you on ways of managing fatigue and conserving energy – more information is available in our fatigue section.
• Painful joints may make it more difficult to move into a position you’re used to.
• Arthritis sometimes leads to a dry vagina, which may make sex uncomfortable. Water-based lubricating gels such as KY Jelly or Aquagel may help. You can get these on prescription or from a pharmacy, supermarket or online. Oil-based lubricants such as Vaseline or baby oil may irritate your skin or damage condoms. If you're going through the menopause this can cause vaginal dryness – discuss this with your doctor as treatment is available.  

Sex isn't equally important to all couples, but if it has been important to you and your partner then you should try to find ways to meet both your needs.

Most people with arthritis find that their pain can vary from day to day, so you may want to make the most of opportunities on your better days. If you experiment with different positions, you should be able to find some that are more comfortable for your joints.

Most drugs commonly used to treat arthritis are unlikely to affect your sex life, although steroids can sometimes reduce sexual desire or cause temporary impotence. You should discuss your medications with your doctor if you think they may be affecting you in this way.

Drugs commonly used to treat arthritis shouldn’t reduce the effectiveness of the contraceptive pill, but check with your doctor if you’re not sure.

If you’re having a joint replacement operation, the pain from the affected joint may already be interfering with your sex life. The operation may improve your sex life, although it will take some time to recover and for the wound to heal. It's quite common to feel nervous about sex after an operation, but most people feel able to start having sex again about six weeks after the operation.

Following a hip replacement, you need to take care with certain movements for at least 12 weeks after the operation because there’s a risk of dislocating the new joint. These are, in particular, bending the leg up (flexion) and moving one leg towards the other (adduction). It’s best for you to be on the bottom and your partner on top. You also won’t be able to kneel for six weeks after the operation and you’ll have to keep your hips straight, so this may affect some of the positions you can use.

After a knee replacement, you won't be able to kneel for six weeks after the operation, so this may affect some of the positions you can use.

Following a shoulder or elbow joint replacement, you should avoid any forceful or extreme movements of the arm (particularly behind your back), locking it one position or taking weight through the arms. Care should always be taken after a shoulder or elbow joint replacement as the joints can remain a little unstable indefinitely.

When you have the operation your healthcare team will be able to tell you which movements to avoid. Make sure you ask if you’re unsure about anything – they’ll have been asked the same question many times before.

Below are just a few ideas on how to overcome any issues that arthritis may cause for your relationship:

Keep active

Your sex drive and enjoyment is generally greater if you feel fit and active. Exercising will help you keep up your muscle strength and tone and the range of movement in your joints. 

Read more about exercise and looking after your joints.

Talk about it

Be prepared to talk openly with your partner about your concerns, whether it’s a physical or emotional problem. Fear of pain may make you apprehensive about sex, but your partner may also be scared of hurting you. Sometimes worries like this lead couples to avoid sex and physical intimacy.

Let your partner know if something is uncomfortable, but tell them what feels good too. If things don’t get better after you’ve talked to each other, consider involving someone from a professional organisation. Your doctor can refer you.

Plan ahead

When pain is a problem, take painkillers about an hour before having sex. This may not seem very spontaneous but it’s worthwhile if it makes sex more comfortable.

Your joints may also feel more comfortable after a hot bath or shower – why not share one with your partner?

Our information on fatigue can give you more tips about planning and pacing yourself to help you keep doing activities you enjoy.

Relax

Massage can help relax joints and muscles, and this can form part of foreplay.

Try a different position

There are many positions you can try with one or both partners standing, kneeling or sitting. If one position puts a strain on your joints, it’s worth experimenting with others. Or try using cushions, pillows or different pieces of furniture to support you.

Penetrative sex isn’t the only way to achieve sexual satisfaction. Many couples find kissing, caressing and mutual masturbation just as enjoyable. Oral sex can also be pleasurable, although it may cause discomfort if you have a painful jaw joint.

Sex aids such as vibrators are readily available online or from mail-order catalogues (they are usually sent out in discreet packaging). These are used much more widely than many people realise and can be particularly helpful to relax painful joints and muscles as well as for genital stimulation.

Every couple has times when their relationship is less than perfect. Having arthritis can create additional worries. Help is available if you feel that your relationship is changing in a way that you’re unhappy with or if you’re unable to resolve things between you.

Try to discuss problems with someone you feel comfortable with, such as a friend or someone else with arthritis. You can speak to your GP for professional advice or, if you attend a clinic, you may feel more at ease speaking to your nurse specialist or another member of the team.

Organisations such as Relate and Brook have counsellors who are specially trained to help with sex and relationship difficulties. Counselling may also be available through your GP or hospital.

There’s no reason why arthritis should prevent you from having children, but you should discuss it with your doctor before trying for a baby for the following reasons:

• Some drugs, such as sulfasalazine, can temporarily reduce the sperm count in men.
• Some studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of miscarriage if taken around the time of conception.
• Methotrexate and leflunomide can be harmful to an unborn child so need to be stopped at least three months (some doctors recommend six months) before trying to conceive. For leflunomide, you may be able to have a special 'washout' treatment to remove the drug from your body more quickly. It’s important to discuss contraception with a health professional if you're taking one of these drugs.
• Women with lupus and/or antiphospholipid syndrome may have a greater risk of miscarriage, so your condition and the pregnancy may need to be more closely monitored than usual. If you're thinking of having a baby it's best to discuss this with your rheumatology team beforehand.
• Some drugs may pass into the breast milk and could be harmful to your baby so it’s best to discuss with your doctor beforehand which drugs you can safely use if you wish to breastfeed.

Women with arthritis may find they have more discomfort in the back, hips or knees during pregnancy because of their increasing weight. Women with lupus may have flare-ups of their symptoms during pregnancy, but women with rheumatoid arthritis may find their symptoms ease while they're pregnant.

Childbirth can aggravate pain in these joints, but most women can find a position that allows them to give birth naturally.

You can find more information and advice about trying for a baby when you have arthritis in our pregnancy and arthritis section.