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Stories for Reprint
Going beyond the Pain
How to deal with the physical challenges of arthritis and enjoy a healthy sex life
By Petya Stoeva, MARRTC Staff
Dr. Carter Multz, a rheumatologist in San Jose, Calif., has seen it too many times -- couples where a spouse is living with arthritis and as a result of the pain and other physical challenges their intimacy is suffering and their relationship is strained. "They get frustrated, they get frightened -- afraid of getting hurt or hurting their partner," he says. "They have to work on that."
Both experts and people living with the disease agree that you can have a healthy sex life with an unhealthy body but you need to work on it by communicating with your partner.
There are plenty of solutions but they all involve the same approach -- talking. "Sexual energy is a warm, magnetic energy," says Dr. Jackson Rainer, a psychologist in Valdosta, Ga., who counsels individuals and couples with chronic disease. "If you can't generate that out of your own sense of friskiness, then a way to really develop attraction with another is to talk intimately -- each tells the truth to the other. Those truths are related to the physical sensations, the emotional feelings and some sense of forecast of the future -- what the individual would like to happen." This talk should occur not after something has gone wrong in bed but when the couple is fully clothed, in an informal setting and with a cup of coffee since that's much less intimidating for discussing hot topics, Rainer says.
The couple should discuss what the person with arthritis can and can't do physically and how to adjust their sex life. The communication would then move into the bedroom and involve every little detail that may create tension. And if the couple does not feel like talking in bed, signs or code words can be used to show pleasure or pain. Both pleasure and pain vary in intensity and sometimes a scale of 1-10 is more precise than just a "yes" or "no" response.
The process of teaching the body map to a partner can be pleasurable and sexual. After all, that's what every couple goes through when they first discover each other sexually and it can rekindle their curiosity and desire to experiment.
"It takes a lot of work on both sides," says Waynette Porter, 28, of Myrtle Beach, S.C., who was diagnosed with juvenile rheumatoid arthritis when she was 7. "There's less spontaneity. There's times that I feel bad because I can't stand to be touched and I feel bad about that and thankfully he [her husband] understands that it's not me rejecting him, it's me rejecting to get more pain." The key to a successful marriage and a healthy sex life for Porter lies in communication and creativity.
One way to circumvent the pain and joint stiffness is to change the time of the day when the couple is sexually active, says Multz. "Usually late in the day fatigue and increased pain are in the way, in the morning there's stiffness, but you can take time before dinner to cuddle," he says. "Do little things that you can do. Love in the afternoon is a solution for people who are too stiff in the morning and too painful in the evening."
Another solution may be to take a dose of painkillers an hour or so earlier. A hot shower or bath before sex will also ease the joints and it can be shared with the partner as part of the foreplay. Pillows could be used to support various parts of the body and thus ease the pressure on the joints. If arthritis medications are causing dryness for women, over-the-counter lubricants can be helpful.
If none of those ideas relief the pain or stiffness, sex can be substituted for a gentle massage with a cream, skin to skin contact, tender touches or just sleeping naked. "We focus too much on our genitals for sex," Rainer says. "It's critical to expand our definition to what is sexual, our biggest sex organ is our skin and our most powerful sex organ is our brain."
Whatever way a couple chooses to maintain intimacy, one thing is certain -- benefits from sex are both psychological and physical. "During sex and especially after orgasm, the hormones released, most importantly oxytocin, act like an endorphin, a pain killer. It's a very significant source of pain relief during delivery and it also relieves the pain of arthritis," says Multz, who recently published a book titled "How to Treat Arthritis with Sex and Alcohol." The physical and emotional benefits from sex can last for up to one or two days, Multz says.
"Going beyond the Pain" is the first story of the four-part series "Sexuality with Arthritis."
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