Sex. It’s not easy to talk about. It’s not easy to be confident about, for anyone! If you have arthritis, you might also be worried about what’s going to hurt, which bits of your body you’d rather not show off to a new partner, or how you’ll even find the energy for it!
So we’re going to do the hard work for you. We’re going to get to the nitty-gritty of the matter, and get you thinking about how you can improve or kick-start your own sex life.
We’ve been helped out enormously by expert Victoria Ruffing, a RN Nurse Manager at the Johns Hopkins Arthritis Center in Baltimore, USA. When it comes to arthritic sex (!) she’s heard it all before and doesn’t embarrass easily…
This is the most important step you can take towards having a satisfying sex life. Sorry – but there’s no way around it. You have to find ways to communicate with your partner. Unless you want to have a sex life without a partner… which is, of course, possible, but perhaps not so rewarding.
Victoria says: “You need to make sure you’re communicating with your partner about what it is that works and doesn’t work, what’s comfortable and what’s uncomfortable, saying ‘let’s try this position, let’s try that position’. But people can still be very unwilling to discuss things openly. Sometimes if that’s the case it can be useful to write things down – leave a little Post-it note on your partner’s mirror saying ‘let’s try doing this’ – sometimes that can help break down some of those barriers, so you can speak freely. If you can really work on your lines of communication, that will be the most important thing. Once you can do that, you can feel more confident.”
It may also help to talk to friends and medical professionals to explore different ideas, concerns and feelings before you go to your partner with them. You may also need to help your partner communicate better with you – and become a good listener. “Sometimes the problem is not the person with arthritis – sometimes it might be the partner that needs reassurance that they’re not hurting their partner,” says Victoria. “Sometimes that is the issue – it’s not always the person that has the arthritis that’s stopping it.”
2. Picking your moment
We like to feel that sex is spontaneous – that we’re seized by a moment of overwhelming passion rather than cramming it into our busy schedule. But some things make this more difficult – illness, children, life in general. Spontaneity doesn’t have to go out of the window altogether, though. There is a happy medium. Victoria says: “You really need to be self-aware. You are going to have good days and bad days. Being aware that ‘this is a good day’ so take advantage of these good days – that can keep a bit more spontaneity in an intimate relationship, taking advantage of those times you do feel really well.”
3. Help to prepare your body
There are a number of things you can do to make yourself more physically comfortable before getting down to business. Pain medication is something that can help – just think ahead a little bit. “Sometimes people are more uncomfortable in the evenings, but that might be the only time you can have sex, because of children or other reasons,” says Victoria. “If you use pain medication, you want to take that probably about 45 minutes to an hour before you’re going to have sex, so your medication has enough time to kick in before you start anything.
“Another thing that helps is heat – a nice warm shower or a warm bath will help loosen up the joints and put you in a relaxed state. Using a flannel-type sheet rather than a cold satin sheet can also help. Some people use electric blankets to warm up the bed beforehand.”
4. The importance of foreplay
“Enough can’t be said about the importance of foreplay – for anybody,” says Victoria. “That doesn’t necessarily have to be traditional. If somebody has no real grip strength, the back of the hand is very sensitive – you can use the back of the hand to stroke and touch, which in itself can be very sensual.”
Lubricants can also help – just make sure they are water-based and not petroleum-based. “There are a few medications and also a few conditions that can cause drying of the mucous membranes, so you should make sure there are lubricants handy,” says Victoria. “You don’t want to have to stop because dryness is an issue.” One way to get yourself or your partner into the mood is with the introduction of sex toys which can really heat up the bedroom if you enjoy sexual stimulation of that kind.
This is where you need to get imaginative and open your mind. Sex is not all about the missionary position. There’s a whole world out there and it can be a lot of fun exploring it. Victoria says: “Hip pain, for example, can sometimes be a problem for a woman; if she’s looking for traditional intercourse in a missionary position, that might be very uncomfortable, but that doesn’t mean she can’t be intimate. There is the sitting position in a chair; there’s lying on your side and spooning. If it’s the man that’s having joint issues it may be better for him to be on the bottom.”
Don’t be afraid to use different areas of the house or different aids to make your position more comfortable. “There are some kinds of aids that really will help make sex more comfortable,” says Victoria. “For some people it might be as easy as making a bolster, rolling a towel up or having extra pillows to take some stress off the joints. Perhaps if the woman is lying on her back, it might be easier if she placed pillows under her knees.”
Also remember that satisfying sex doesn’t always have to mean penetrative sex. There are a lot of other ways you can enjoy yourselves – oral sex and manual stimulation being some of the obvious things to try.
“You have to be willing to experiment but again it all goes back to communication, to have a partner you can communicate these issues with,” says Victoria.
If you’d like to find out more about good positions, you might want to read this article about tips and alternatives to reduce the discomfort of painful sex positions. For those of you who have had hip replacements, here’s a useful article about enjoyable sex after hip replacement surgery.
Knowledge is power – so empower yourself! “One way to build confidence is to have in your pocket some ideas of things you can do other than the missionary position,” says Victoria. “Sometimes people see these positions in the movies but they’re not sure how that would work in real life.
“One of my patients, a young woman and her husband, had had a child who was about three. I said to her: ‘Do you think you’ll have any others’ and she said: ‘Not at this point because I haven’t been able to have sex with my husband’. This was a young person who I thought was very savvy but she hadn’t thought about how to have intercourse other than in the missionary position. They had just stopped having sex. I gave her some ideas and she ended up having another baby!
“Another thing you can do is remember that nobody looks like they do in the movies. Do not expect it to be perfect! It’s not going to be perfect. If you can get out of your head what it might look like, and be in the moment and relax with it, that can also build your confidence.”
Victoria says her patients have always been able to work out their issues together – but if there are really serious communication issues, then there is further help available. “If you do have real difficulties communicating then a sexual therapist could help,” she says. Relate has centres around the UK and offers a range of relationship therapy including sex therapy.
You can also be referred to a sex therapist by your GP – sex therapy is available on the NHS in some areas, although not all. Alternatively you can find one privately by looking on the list of registered therapists held by the College of Sexual and Relationship Therapists.
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