How to Have Better Sex When You Have RA

Medically Reviewed by Melinda Ratini, MS, DO on March 29, 2022
4 min read

Rheumatoid arthritis (RA) is best known for causing pain, inflammation, and swelling in the joints. But, the condition may affect many other parts of your life, including your ability to enjoy sex and intimacy. Living with RA does not mean that you have to settle for less of a sex life. Instead of ignoring the problem, take some time to learn about it and find out what you can do to improve the situation.

Arthritis, including RA, mostly targets the joints. Yet there are both physical and emotional reasons why having moderate to severe RA may interfere with a healthy sex life.

From a physical standpoint, joint pain and stiffness are part of having RA. Both the discomfort and the inability to move your body with ease may make sex and intimacy uncomfortable. In fact, research has shown that people with RA who have worse physical functioning (as measured by a test of handgrip and knee extensor strength) are less likely to be interested in having sex and more likely to be dissatisfied with their sex life overall.

Tiredness is another common RA symptom. It may be difficult to get in the mood when you feel sleepy.

If you’re a woman with RA, your medication might be causing side effects that include vaginal dryness, which can make sex painful. Meanwhile, men with RA may experience erectile dysfunction (ED). This problem seems to be more common in men with RA who also have heart disease (which by itself increases the risk of ED), though research on this topic has been mixed.

There’s also a big mental component to feeling turned on, and here again RA may take a toll. Many people with RA say that managing the condition makes them feel stressed or anxious, or that the disease has harmed their body image, making it harder for them to see themselves as sexy or desirable.

Depression is also common if you have a chronic disease like RA. Being depressed can lower libido and cause sexual dysfunction.

If your moderate to severe RA has led to sex and intimacy issues, there are many things that may help.

Ease pain and stiffness. Talk to your doctor to make sure your disease activity (which includes your joint symptoms, overall functioning, and inflammatory markers) is as well-controlled as possible. If short-acting pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) are part of your treatment regimen, take them about 30 minutes before you plan to be intimate. A warm bath or shower may also help loosen and soothe stiff or tender joints.

Time it right. Many people connect sex with nighttime. But, if you have RA you might find that you’re too tired to be intimate as it gets later. Mornings could also be an issue if you tend to wake up with stiff joints. Think about when you tend to feel your best -- it might be in the afternoon -- and plan your intimate encounters accordingly.

Tell your doctor. You might not want to talk about sex with your internist or rheumatologist, but good sexual functioning is part of overall health. Sharing some specifics about your problem may help your health care provider to find a solution. For example, they might prescribe an estrogen cream for vaginal dryness or an ED medication if you’re a man who’s having trouble getting or keeping an erection. If lack of libido or body image issues are your main concerns, your doctor might refer you to a therapist or recommend antidepressants (though keep in mind that some antidepressants sometimes cause sexual side effects).

Consider physical therapy. Working with a physical therapist to improve your range of motion often translates to better self-esteem and less pain in people with RA. Those improvements, in turn, might benefit your sex life.

Try something new. That includes accepting that sex is not limited to intercourse, letting your partner know what does (and doesn’t) feel good to you, and trying out lubricants, vibrators, or other toys with your partner or by yourself. You might also benefit from testing out some new sex positions. These might turn out to be more comfortable for you.

Some positions might be uncomfortable or even painful if you have arthritis in the hip, knee, leg, or arm. There are many other options that have the potential to feel better and relieve stress on your joints. But everyone’s body is different so plan on experimenting until you figure out what works best for you. Some positions that might be worth exploring:

  • Both of you on your sides, with “top” partner behind; and “bottom” partner (with arthritis) using a pillow between their knees
  • Bottom partner (with arthritis) on stomach; top partner enters from behind
  • Bottom partner (with arthritis) faces a wall and uses hands and forearms for support; top partner is behind
  • Partner without arthritis on their back with a pillow underneath for support; top or bottom partner (with arthritis) on top, using hands and knees to support their own weight
  • Both partners on their sides facing each other
  • Forget about intercourse; try oral sex, manual sex (using your hands), scissoring, or anything else that feels good to you instead.