Figuring Out the Best Sex Positions to Accommodate Psoriatic Arthritis

Anything that complicates sex can feel overwhelming, especially if it’s also affecting our physical well-being, but sex is just as fulfilling if you have a chronic illness; it just necessitates some adjustments. 

Chronic illnesses love to interrupt sex, becoming an orgasm killer that steals intimacy from our lives. But psoriatic arthritis (PsA) doesn’t need to be a bedroom buzzkill because it doesn’t deserve that level of power.

Although sex with chronic illness demands a little more thought and adjustment than most people put into their sex lives, is that really a bad thing?

We could all benefit from thinking about sex from an explorative and considerate perspective, so consider this: figuring out sex with chronic illness is a gift of creativity.

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How does PsA impact sex physically?

A 2023 study investigating sexual dysfunction among patients with PsA found that the condition impaired sexual function, particularly among women, older patients, and those with existing emotional disorders.

“This is because PsA can affect the mood and well-being of a person, and they can lose their self-esteem, losing their sex drive in the process,” says dermatologist Dr. Hamdan Abdullah Hamed. “People with PsA also experience swollen joints, which can affect self-confidence.”

“What’s worse is fatigue linked to PsA can also limit one’s sexual desire,” he adds.

The condition also impacts sexual function due to the associated skin lesions, which may appear around the genitals, thighs, and abdomen.

Nick, who developed symptoms of PsA from age 23 and received a diagnosis at age 25, experiences several sexual interferences due to PsA “that has affected both my relationship with sex and overall sexual confidence.”

“During a flare-up, I can suffer with quite severe genital psoriasis,” he says. “I found this more difficult to deal with when I was in my late 20s and before I met my wife.”

Impact on sexual confidence

The combination of discomfort and the appearance of psoriasis on his genitals demanded a significant mental toll on Nick, eroding his ability to meet new partners confidently.

“Meeting new sexual partners naturally has its own pressures, but being so body conscious of having psoriasis on my private parts and not knowing how people will react to that if people will see it and then naturally have questions or be put off definitely affected my want and need for sex,” he adds.

The physical strain of a flare-up also reduces his sexual desire, affecting Nick’s overall relationship with sex.

“I’m very open about my condition, and now married, have a really understanding wife,” says Nick. “But when I first met my wife or other sexual partners, I would often hide the extent of my condition.”

“During flare-ups, I would avoid sexual encounters due to the shame,” he adds. “Swollen joints I would have would impact my ability to bend my knee or apply any pressure on it for any period of time.”

Navigating the effects

Many people with chronic illness push the condition to one side to live as though it, or its symptoms, don’t exist.

Like so many people with chronic illness, Nick struggled with sidelining his needs before accepting the condition.

“During my late 20s [and] early 30s, I self-neglected my condition and refused all treatment, thinking if I ignored it, then it would go away,” he says. “This was until my symptoms became so severe that I was unable to bend my fingers on my hand, having an impact on simple tasks at work and at home.”

In recent years, Nick has embraced the condition by seeking medical help and using social media to find kinship with others with similar experiences.

“I used these stories to come to terms that although it’s a tough diagnosis to take, it doesn’t mean it has to rule my life or how I live it,” he adds.

Adapting your approach to sex

“When pain is a problem, take pain relievers about an hour before having sex,” suggests NHS general practitioner and GP Medico-Legal Expert Witness Dr. Hana Patel.

“This may not seem very spontaneous, but it’s worthwhile if it makes sex more comfortable,” she continues. “Your joints may also feel more comfortable after a hot bath or shower — why not share one with your partner?”

PsA undoubtedly affects life and your sexual experiences, but ignoring it entirely exacerbates the impact.

Shift your focus from what PsA is stealing from your sex life to how lifestyle changes can rejuvenate it.

“There are ways to help with the effects of PsA on sexual drive and sexual function,” says Hamed. “First is to keep active. Try exercises to maintain muscle strength and help with range of motion and joints.”

Identifying sex positions

“Swelling to my hip and knee often affects my ability to bend my legs or apply any pressure, which can affect certain positions,” says Nick. “To accommodate against this, I try to avoid positions that require pressure to my knees in a direct up position, like doggy style, and positions on my knees, like missionary.”

“I have a very understanding wife who is aware of this, and if I am struggling, will accommodate positions where I am lying down,” he adds.

The key to finding the best positions for your body is to experiment — gently! Start by trying each position for a few minutes and then pausing to see if there’s any strain.

It’s easy to get carried away with how good everything feels, only to discover that we’ve triggered a flare-up due to staying in an uncomfortable position, so approach cautiously.

“Try side-lying spooning, as this sex position can reduce weight-bearing on swollen joints; it also requires minimal movement, which can reduce aggravating joints,” says clinical sexologist and therapist Ness Cooper. “A pillow can be placed between the legs and under the head to give more support.”

Using the right tools

Just like we use sex toys to enhance our sexual experiences, mobility aids can do the same.

Use a cushion, or three, to soften the impact on joints or to lift the belly to reduce pressure on the front or back of the body.

“Sex position support pillows and furniture can help reduce strain on joints when mixing up sex positions,” says Cooper. “Some people with PsA find their body feels dry and may need extra hydration before sex and lubrication during sex.”

“Reducing the tension of how you hold your sex toys can help a lot,” she adds. “I have found many people over grip their sex toys, which can upset their hands and wrists, when in fact these devices just need to be lightly held.”

Communication is crucial

“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,” says Patel.

Keep lines of communication open, and don’t allow shame to become a third party in the bedroom.

There’s nothing wrong with you. Your body is just a little more complex than the next person’s, but it doesn’t diminish your ability to experience and give pleasure.

“We often are led to believe we should only ever talk about the fun parts of sex. When we actually start to talk about times when it was just OK or not so great, it can help us understand how to change things up for the positive when those moments arise in future sex sessions,” says Cooper.

Don’t forget aftercare

Lastly, remember that aftercare could look different with a chronic illness.

We all need emotional soothing in our post-coital haze, but with PsA, you might need some physical care, too.

“Have an aftercare plan,” says Cooper. “Some may like to warm joints up before sex with microwaveable wheat bags but find they need cool packs for afterward; this is OK and can be a great way to reduce the effect of a flare-up.”