Health 5 WAYS TO IMPROVE INTIMACY Your sex life can suffer when you have arthritis. Heres how to relight your fire WORDS: Georgina Wintersgill I Give yourself the very best chance of having an intimate experience with your partner that feels valuable ts not often talked about, but its hardly surprising: living with arthritis can affect your sex life. In a 2010 French study, 66% of people with rheumatoid arthritis said the disease negatively impacted their sexual relationships. The main problems reported were reduced or absent sex drive (47%), and pain or stiffness in joints (24%). In 2013, an American study found that 67% of people with osteoarthritis who had hip or knee replacements said they had experienced physical problems with sex before having surgery. Again, the main issues were pain (67%), reduced sex drive (49%), and stiffness (36%). Psychological problems were also evident, with 53% reporting a diminished sexual self-image before having surgery. Ammanda Major, head of service quality and clinical practice at Relate, is a trained sex and relationship therapist who has worked with couples affected by arthritis. She says: Pain, stiffness, exhaustion, low self-esteem, and feeling the roles in your relationship have changed all can impact your ability to feel like you used to sexually. But having the intimacy that feels right for you now can be helped by accessing the information and support available. 1 GETTING HELP For more information about couple therapy, visit relate.org.uk. For more information visit versusarthritis.org/sexand-relationships Plan ahead Ammanda says: Give yourself the very best chance of having an intimate experience with your partner that feels valuable and is least encumbered by your condition. Planning ahead may be helpful. Think about the time you choose to be sexual; people quite often have better points during the day. Make sure you are relatively rested. Have a warm bath or shower beforehand perhaps together. Pain medication can be useful. Vaginal dryness can be a problem for women, and there are topical treatments for that. 2 Do things differently 3 Talk about it If your favourite positions are no longer comfortable, try new ones. Use pillows for support if necessary. Ammanda says: People with arthritis can experiment for example, by using sex toys. There are established websites that can provide information and advice, plus the toys, for people with health and disability issues. If youre planning a joint-replacement operation, talk to your surgeon about how long to wait before resuming sex, and which positions are safe. The 2013 American study found that 90% of people reported an overall improvement in sexual function after surgery. Be prepared to talk openly with your partner about your concerns, whether its a physical or emotional problem. Ammanda says: Having that open and honest dialogue can go a very long way to helping them understand what you need. Start small by sharing your feelings. Ammanda recommends using I rather than you, which can sound accusing. Sometimes, we might say, This isnt working because you dont do this. That isnt a conversation; youre blaming them. Instead, turn it round and say, It would be so nice if I could experience this. Youre trying to engage your partner in a conversation that enables them to meet you halfway. Bear in mind that they may also have health problems that need consideration. Where thats the case, that two-way conversation can be very helpful. 4 Define sex 5 Seek help Ammanda says: People often set out with the goal of intercourse. But are there other forms of intimacy that would be equally satisfying and enable you to feel as close to your partner? For some people, being sexual means intercourse; for others, its gentle, intimate stroking or touching. A sexual relationship is not important to every couple, she adds. Some reach a point where they are perfectly loving, but sex doesnt really feature for them any more, and theres nothing wrong with that. The 2010 French research found that 72% of people with rheumatoid arthritis in the study had never discussed the impact of their condition on their sex life with a doctor or health professional. But its worth doing, as they may be able to help. For example, sex drive can be affected by certain drugs, such as steroids. Counselling can also be helpful in maintaining or regenerating a sexual relationship. Ammanda says: Therapists are very adept at helping people to embrace the problem, talk about it and find ways forward. People often set out with the goal of intercourse. But are there other forms of intimacy that would be equally satisfying?