Monday, December 5, 2011

Secret Post #8: Expert Advice For Improving Your Sex Life With RA

NOTE: This post is part of a series that I wrote in secret during the months before I announced my pregnancy. The series chronicles my pregnancy journey: from weaning off my RA meds, to trying to conceive, to searching for helpful advice and information, to discovering I was pregnant, to the ups and downs of my first trimester. You can read all the posts in this series here.
 This Post Written June 28, 2011

TMI Warning: This post contains details about sex and trying to get pregnant that you may consider to be too much information. For reals, this entire post is about sex. Don't say I didn't warn you!

After reading fifty articles about sex and RA, I have compiled any and all useful information and advice the articles offered about actually improving your sex life when you have RA (and I've left out all the depressing stuff!)  I have grouped that advice into several categories below. While I am not sure I agree with every single piece of advice, this list pretty much covers what "the experts" out there have to say (at least according to my research).

And, if you're brave enough to muddle through all of the horrifying statistics, I have also included links to all the articles I read at the end of this post (some of which were 100% useless). The titles of most of the articles are depressing enough. Read them if you must - but don't say I didn't warn you.

Expert Advice For Improving Your Sex Life With RA

Sex is Not Just Intercourse
(NOTE: This is probably the largest category of advice out there about sex and RA - the general idea being to find other fun activities if the difficulty of having intercourse is too much to overcome. While this advice is pretty much the opposite of useful when attempting to get pregnant, I've included it here because it is certainly relevant if you are just looking to improve the pleasure you get from your sex life.)
  • Remember that sex is not just intercourse. There are many other ways for you and your partner to find pleasure with each other.
  • Other ways to feel satisfied and intimate besides intercourse include: synchronized breathing, eye gazing, fantasizing, guided imagery, visual stimulation, holding hands, hugging, cuddling, touching, kissing, sensual massage, oral contact, stroking, fondling...

Work on Your Relationship
(NOTE: After promoting other forms of sex and intimacy besides intercourse, the next biggest category of advice out there about sex and RA falls into the relationship category. I am certainly not trying to downplay the importance of this advice - the way I see it every relationship should work on these things. APL and I certainly have. But, even when your relationship is strong you may still find that sex with RA can be difficult - hence my search for other useful advice that specifically addresses dealing with RA.)
  • To improve your sex life, make sex a priority.
  • Try to work as a team at all times.
  • Work with your partner to reduce other sources of stress. 
  • Find ways to improve your emotional connection with your partner. 
  • Be patient with yourself and your partner.
  • Stay positive through the process of trial and error.
  • Keep a sense of humor.
  • If you encounter setbacks, try not to become discouraged. 
  • Open and honest communication about your needs, desires, and difficulties is vital.
  • Try beginning your sentences with "I" and not "you." For example: "I feel loved when you hold me close" is more likely to invite dialogue than "you never touch me anymore."
  • Consider outside help - your doctor, couples counseling, etc. - if you have difficulty communicating with your partner about sex.

Incorporating RA Into Your Relationship
  • Make sure your partner understands how RA works and the pain it causes you.
  • Try to think of the difficulties caused by RA as "our" problem - not the sole problem of the partner with RA.
  • Focus on promoting new intimacy and appreciating what you have - try not to have expectations of "good sex" before RA.
  • Remember that both partners do not have to participate equally on any given day.

Things You Can Do To Prepare For Sex
  • Do things that help you feel good about yourself and improve your confidence - a new outfit, a new haircut, a song that makes you feel good.
  • Don't be embarrassed to talk to your doctor about medications that may impact your sex life - or about getting pain medication to assist with your sex life.
  • Your doctor or physical therapist can recommend exercises to help with stamina and mobility.
  • In your everyday life, pay attention to the types of movements you can do without pain and bring those types of movements into the bedroom.
  • Right before sex, do some gentle stretches to improve your range of motion.
  • Consider taking pain medication or muscle relaxants 30 to 60 minutes before sex.
  • Try a warm bath or shower to limber up before sex - perhaps with a partner as foreplay.
  • Have your partner give you a gentle massage as foreplay and to help with stiffness.
  • Use an electric blanket before or during sex to help relieve stiff joints.

  • Plan ahead for sex and arrange your day so you won't be tired from other activities.
  • Try scheduling a nap before sex.
  • Consider what time of day (morning, noon, night) you are least sore/fatigued and have sex at the appropriate times.
  • Be open to having a "quickie," which causes less strain and exhaustion.

  • Try having sex at different times of day to see what works best.
  • Experiment with different positions (see below) and be open to changing positions halfway through if necessary.
  • Be creative and laugh together if it doesn't work.
  • Incorporating shared masturbation can be fulfilling when one partner is unable to be very active. 
  • "Fake it 'til you make it" - focus on enjoying yourself rather than your pain and fatigue and eventually the enjoyment might come naturally.
  • Let your partner know during sex what is working and what is painful with words, sounds, or a gesture you agree upon in advance.

Sexual Aids
  • Use lots of pillows or other pieces of furniture for extra support.
  • The Liberator line of pillows is specifically designed to support you during sex.
  • To ease strain on arms, hands, and jaws try props and toys - like vibrators. You can order on the internet for discretion, or consider visiting a respectable sex shop to make sure you can operate the buttons.
  • Consider using over-the-counter lubrication - such as KY Jelly.

(NOTE: Of the fifty articles I read perhaps four or five had anything specific to recommend concerning positions. These articles primarily talked about the positions in terms of heterosexual relationships and they seemed to assume that the woman was the one with RA. Obviously that is not always the case. However, I have chosen to keep the wording used by the experts in the hopes of clearly communicating the positions they were talking about, but know that these positions can obviously be adapted to any situation.)
  • For back pain
    • Avoid sitting positions.
    • Being on the bottom may reduce back discomfort.
  • For hip pain
    • Avoid being on top.
    • Turning your legs out (i.e. pointing your feet away from each other) is generally more comfortable.
    • Try positions that do not require you to spread your legs too widely.
    • Try having the man approach from behind:
      • The woman lies on her stomach, supported by cushions, and the man lies over her, supporting his own weight and entering from behind.
      • The woman leans her upper body over a chair and kneels on a pillow on the floor (assuming no knee pain) while her partner enters her from behind.
      • Spooning: both partners lay on their sides, with the man entering from behind.
  • For wrist/hand/elbow pain
    • Lying on your back or side is best so you don't have to support your own weight.
    • Try making a fist and keeping the wrist in a neutral position.
    • Support elbows with soft pillows.
  • For ankle/knee/leg pain
    • Maintaining the knees in a straight position is best.
    • Avoid kneeling or bearing too much weight.
    • If on your back, avoid having to lift or support your legs during sex, which can cause strain.
    • Use pillows - such as one under each knee - or your partner's body to support your legs.
    • Spooning: both partners lay on their sides, with the man entering from behind. 
    • Try the "crossways" position: the man lies on his side and the woman lies crossways/sideways against him with her bottom touching his lower thigh and her legs bending over his body.
  • For fatigue
    • Avoid positions where you have to support yourself.
    • Pillows under her hips may make the stimulation greater, allowing for orgasm in less time with less strain.
    • Be open to a "quickie."

      1. WebMD: The pain of RA does not have to mean the end of sexual intimacy.
      2. WebMD: 1 in 3 RA Patients Report Considerable Impact on Sexual Activity 
      3. WebMD: RA and Intimacy: Keeping Relationships Strong
      4. Healthmonitor: Ask the Experts: Sex and RA
      5. Dr. Gail Saltz: Dating, relationships, and sex with RA
      6. HealthCentral: A beginners guide to RA: Love & the Horizontal Tango
      7. HealthCentral: When Satisfactory Biologics Are Not Enough: Satisfying Sex with Rheumatoid Arthritis
      8. UW Medicine: Sex and arthritis
      9. Everyday Health: Rheumatoid Arthritis in the Bedroom
      10. Disabled World: Sex lives of patients are negatively affected by rheumatoid arthritis and SLE - Patients and their partners suffer but most reluctant to seek professional help.
      11. Celebrities with Diseases: Rheumatoid Arthritis can negatively affect sex drive
      12. Love, Sex, and Arthritis
      13. In Sickness and in Health
      14. Guide to Sexuality and Arthritis
      15. How Arthritis Complicates Sexuality
      16. Position Tips for Avoiding Painful Sex
      17. How to Enjoy Sexuality Despite Chronic Pain 
      18. Chronic Illness in a Marriage
      19. Arthritis Today: Health Benefits of a Happy Marriage
      20. Arthritis Today: Playing the Dating Game with Arthritis
      21. Arthritis Today: Marriage and Chronic Illness: One Couple's Story
      22. Arthritis Today: Keeping your Marriage Strong
      23. Arthritis Today: Marriage and your Health
      24. Arthritis Today: Rheumatoid Arthritis and Pregnancy
      25. Arthritis Today: Pregnancy and Arthritis
      26. MDJunction: Rheumatoid Arthritis Sex Newsletter
      27. Mayo Clinic: Chronic Pain Can Interfere with Sexuality
      28. The Johns Hopkins Arthritis Center: The Influence of Rheumatoid Arthritis on Marital Satisfaction
      29. How to Have Pleasurable Sex Despite Painful Arthritis
      30. MyDr: Arthritis: sex and intimacy
      31. Sex and the Married Gimp - A Woman's Point of View
      32. National Rheumatoid Arthritis Society (NRAS): Sex & Rheumatoid Arthritis: "How Was It For You?"
      33. National Rheumatoid Arthritis Society (NRAS): The Effects of Rheumatoid Arthritis on Sexual Activity & Relationships
      34. Arthritis Care: Relationships, Intimacy, and Arthritis (PDF)
      35. Arthritis Care: Body Beautiful
      36. Arthritis Care: 50% of people with arthritis in Wales say pain prevents them from having an intimate relationship, according to a survey by Arthritis Care
      37. Daily News & Analysis: Rheumatoid Arthritis can dampen sex life
      38. Fifty is the new Forty: Dr. Gail Saltz: Rheumatoid Arthritis, Sex & Romance After 50
      39. Sex lives of patients are negatively affected by rheumatoid arthritis and SLE
      40. MSN: Yes, You Can Have an Active Sex Life With Arthritis
      41. Pharma Knowledge Base: Rheumatoid Arthritis and Sex
      42. American College of Rheumatology: Sex and Arthritis (PDF)
      43. e! Science News: Sex lives of patients are negatively affected by rheumatoid arthritis and SLE 
      44. A Woman's Touch Sexuality Resource Center: Rheumatoid Arthritis and Sexuality
      45. Rheumatoid arthritis can dampen sex life
      46. Everyday Health: Ask Dr. Rodanthi Kitridou: Sex with Arthritis
      47. OneIndiaNews: Rheumatoid arthritis can dampen sex life
      48. Living with rheumatoid arthritis: Social life & relationships
      49. lifescript: Don't Let Arthritis Spoil Your Sex Life
      50. Yes, you can have an Active Sex Life With Arthritis


      Stephanie Kay said...

      These are great advice! Personally, taking a hot shower before sex helps a lot with stiffness and joint pain. I always feel great after a shower. Which in turn helps with the mental/emotional aspects of sex.

      ~Mariah~ said...

      STEPHANIE: A hot shower is a good one. And I was pleased that, with a little digging, I was actually able to find some useful advice!