Sometimes the physical and emotional symptoms of arthritis can affect many different aspects of your life, including your relationships and sex life. However, axial spondyloarthritis (axSpA) does not have to signal the end of an intimate relationship. You can learn ways to make the relationship work.
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.
axSpA can present several challenges in a relationship:
Although your relationship may change because of your 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. Remember, emotional intimacy is equally important for a romantic relationship – trust, honesty and openness help to build a secure intimate relationship.
Some people with axSpA lose their self-confidence and worry about forming new relationships, especially if they have swollen joints or other complications of their 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 symptoms of axSpA worse. But because moving a joint affected by arthritis can be painful 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. Or you can take an analgesic (pain relieving medication) about an hour before sex, to help relieve any associated pain. If you have psoriasis, this may also cause discomfort during sex, depending on where it is on the body. For example, if you have genital psoriasis, the friction involved during sex can aggravate the skin and cause a possible flare. You may also experience pain, bleeding, and a burning sensation during intercourse. However, it is possible to overcome these obstacles and have a fulfilling intimate and sexual relationship.
If you have psoriasis some tips to help manage in an intimate relationship, include:
There are a few ways that axSpA can affect your sex life:
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 medications commonly used to treat axSpA 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.
Medications 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 axSpA may cause for your relationship:
Your sex drive and enjoyment are 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.
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 fear hurting you. Sometimes worries like this can lead couples into avoiding 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.
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.
Massage can help relax joints and muscles, and this can form part of foreplay.
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.
Finding positions that are both comfortable and rewarding will take patience and understanding from you both, but if you work together, you have the potential to reconnect with each other and develop a deeper level of intimacy.
In particular, during this time of trial and error try not to lose your sense of humour as it’s important to ensure you have some fun along the way!
Every couple has times when their relationship is less than perfect. Having axSpA 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 rheumatology nurse or another member of the team.
Counselling or speaking to a psychologist may also be useful.
There’s no reason why your axSpA should prevent you from having children, although it may require extra planning and patience. Some of the medications used to treat axSpA can be taken safely before and during pregnancy, but others should not be used during pregnancy or for a time before trying to conceive. Read Pregnancy and axSpA for more information.
If you or your partner has axSpA, make it a priority to talk to your rheumatologist for advice at least six months before you start trying to conceive.