Symptoms, treatments, and more can make intimacy uncomfortable when you’re living with PsA. Five experts share their best tips to revive your sex life.
Recent research suggests that people living with psoriatic arthritis (PsA) are more likely than those without to experience sexual dysfunction.
That’s because PsA and other chronic conditions tend to disrupt the desire and arousal phases of the sexual response cycle, says Lee Phillips, EdD, psychotherapist, certified sex and couples therapist, and host of the Sex & Chronic Illness podcast.
“Desire is influenced by neurotransmitters, androgens, and the sensory system, as well as psychological factors and the relationship with your sexual partner,” says Phillips. “Therefore, if you become anxious during sex because of your symptoms, blood vessels in the genitals close, and this can cause sexual challenges, such as erectile dysfunction.”
Treatments can also have an effect on libido. When all of this combines, it can lead to low sexual desire.
If you live with PsA and sexual intimacy and pleasure are feeling elusive for you, know that you’re not the only one. Here are some tips to consider.
Sex is all about communication, not performance, says Phillips. He says it’s important to talk about your needs with your partner and to remember that sex doesn’t have to include penetration or an orgasm — just pleasure. This can be achieved with physical touch and intimacy.
But it begins with a potentially uncomfortable (but ultimately crucial) conversation about what you’re feeling and what you think would give you pleasure without prompting anxiety.
If it’s tough to know how to start that talk, begin with what you and your partner find attractive about each other, suggests Suzannah Weiss, sex educator and sexologist for the pleasure product brand Biird.
“Sexual dysfunction may stem from depression, anxiety, or self-esteem issues caused by a chronic illness or side effects of medications used to treat it,” she says.
“Someone may feel as if the illness poses a challenge to their identity or their sense of masculinity, femininity, or confidence. In this case, it may be helpful to focus on the qualities that you still find attractive about yourself and possibly get reassurance from a partner.”
Another aspect of navigating sex with PsA is timing. That means becoming aware of when you tend to feel the most desire, and how that syncs up with your symptoms.
“Since symptoms of PsA include joint pain, stiffness, and swelling, often in the morning, it’s important to find out when you are feeling sexual,” says Phillips. “For example, you may find you’re more sexual in the evenings due to morning stiffness and pain.”
If you usually work out in the late afternoon or early evening, that might be an ideal time for sex since you’ve already established a mental and physical routine, adds Christine Kingsley, APRN, an advanced practice registered nurse with experience in physical therapy.
“Overall, sexual dysfunction can come from self-consciousness and diminished sexual satisfaction,” she says. “When you exercise, you tend to feel more comfortable in your own skin and get blood flowing. Because of that, you may want to swap out your usual workout on some days for a little sexy time so that your body and mind are better conditioned for the activity.”
When dealing with a chronic condition like PsA, healthy lifestyle habits are important for helping prevent flares. Self-care may also improve stress and physical well-being, which play a major role in intimacy, says Vivian Green, PhD, a sex educator, couples therapist, and advisor for the pleasure product brand Sexsi Toys.
“Staying active, eating a healthy diet, getting enough sleep, and managing stress can all help improve overall health and well-being, including physical function,” she says.
“Part of that may be considering physical therapy. Working with a therapist can help you improve flexibility, strength, and range of motion, which can allow sexual activity to become more comfortable.”
As part of communication and awareness, Green suggests being open to experimenting with different sex positions and sex toys, with the aim of decreasing discomfort and boosting pleasure.
“Trying different sexual positions and using lubrication can take away some of the pain you might be experiencing,” she says. “Oral sex and certain sex toys can assist with pleasure, and may help with reaching climax faster, allowing you to enjoy sex more frequently in shorter doses. That could reduce strain on your body.”
Props like pillows and sex wedges can help to position you more comfortably, adds Weiss. For example, a sex toy like a clitoral stimulator that’s hands-free can reduce strain on the wrists, she says.
Getting into the mood for sex can sometimes feel like an obstacle to overcome, but think of it more as a dimmer switch you can gradually adjust — rather than an on-off switch, suggests Weiss. Foreplay can be a great way to dial it up.
“Spend extra time on foreplay, and that can start before you even get into the bedroom,” she says. “For example, it may be helpful to take a bath before sex, possibly with a partner, in order to relax and loosen your muscles. Adding Epsom salts could reduce pain and make you more mobile.”
Often, intimacy with PsA is thwarted due to pain, say Nina Nguyen, sex educator and co-founder of the site Fraulila, which provides information about sexual health. Because of that, it’s important to talk with your health team about pain control, she says. Also, some medications may have decreased libido as a side effect, she adds.
The association between PsA and sexual dysfunction is well established, so your provider is likely well versed in the subject already. Even if you feel embarrassed to bring it up, remember that sexual health is part of your overall health, and that resources and insights are available.
“If you’re struggling with sexual intimacy due to pain or other reasons, it may be helpful to talk with a healthcare professional,” says Nguyen. “They can offer support and guidance to help you find ways to manage your symptoms and improve your sexual relationship.”
Medically reviewed on February 08, 2023
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