Pillow Talk

Is arthritis putting a chill on your love life? Learn  how to rekindle the fire and why it’s worth the effort.  

Joint pain and arthritis-related issues can force new approaches to sexual intimacy. Motivation tends to deteriorate along with mobility. Research indicates that it’s common for sexual activity to ebb as discomfort and stiffness increase, says Maureen K. Watkins, an assistant professor of physical therapy, movement and rehabilitation sciences at Northeastern University in Boston. 

 Not only can sex can be painful for patients, but partners may hold back for fear of inflicting hurt. Sexual activity is often considered an essential part of a well-balanced life and, thus, worth redefining and committing to, say health care professionals and people living with these conditions. That’s especially true when partners are also caregivers – a healthy sex life helps prevent the relationship from centering around the disease. 

 Also, physical intimacy has a hormonal upside: Sexual satisfaction releases painmitigating endorphins and, according to a small study conducted by neuroscientist Barry R. Komisaruk, PhD, it also can block pain. “Vaginal or cervical stimulation has a pain-blocking action, with or without orgasm,” says Komisaruk, professor of psychology at Rutgers University. “It works against headache pain, arthritic pain, menstrual cramps.” 

 However, the physical and psychological benefits of sex are often overlooked by medical professionals. 

 Advice & Assumptions 

Though 61 percent of patients report that their conditions affect intimacy, only 12 percent of rheumatologists discuss intimacy with their patients, according to a study published in 2014 in the World Journal of Orthopedics. 

 This is gradually changing as more people in their 40s and 50s get joint replacements, says Matthew Hepinstall, an attending orthopedic surgeon and associate director of the Center for Joint Preservation and Reconstruction at Lenox Hill Hospital in New York City. “It’s typically younger patients who bring it up.” 

 It’s probably up to you to broach the subject with your doctor or your physical or occupational therapist. That includes discussing and demonstrating the biomechanics, understanding the daily factors – as both the disease and its remedies can sap energy and enthusiasm – and how to collaborate with your partner. 

 “How do you have fun? How do you work things out with your partner? It’s about exploring together how you can be an active participant,” says Kim Steinbarger, who has had rheumatoid arthritis since her early 20s and is director of clinical education for the physical therapy department of Husson University in Bangor, Maine. 

 Energy & Expectations 

Talking with your partner about your expectations, disappointments and hopes for intimacy is an essential component of figuring out the logistics, says Steinbarger. 

 Patients often tell her that fatigue is a bigger barrier than specific joint issues. “Any time you’re compensating, it takes energy,” says Steinbarger, who has found that understanding begins with ongoing communication about energy management. 

 “It can be difficult for a partner who’s not affected to understand that this is something you have to plan,” she says. “We all want to be spontaneous, but you might want to conserve your energy during the day to have a good night. It’s not romantic, but it’s a reality.” 

 Together, map your respective daily rhythms to determine where energy and enthusiasm intersect, recommends Emily Barr, an associate professor of occupational therapy at Nebraska Methodist College in Omaha. If you start slowly in the mornings but your stamina ramps up in midday, that could frame discussions about when to set the stage for romance. Owning the sex schedule as a couple is essential for breaking out of the caregiver-patient dynamic. 

 The Biomechanics of Love 

Still, even the best intentions can stall if the logistics can’t support your mutual ambition. Exactly how is this going to happen, and for how long, and at what level of intensity? Different positions put different demands on each partner. 

 Skin conditions, scars and joint disfigurement are unwrapped as intimacy intensifies, and those moments can be disheartening for those who are selfconscious, says Barr. Many concerns can be alleviated with a frank discussion with your partner. And a trusted physical or occupational therapist (they’ve seen it all) can provide tips such as modified positions or applying heat to vulnerable joints. 

 A good time to broach the topic with your doctor and therapists is when reviewing your goals for a drug regimen, surgery or physical or occupational therapy. 

 Define sex as an activity on your list of “daily living tasks,” like walking, gardening and other lifestyle goals, says Nicholas Frisch, MD, an orthopaedic surgeon with Ascension Crittenton Health in Rochester, Michigan. 

 Sketch out your situation to direct the conversation: Do you want to resume a robust and adventuresome sex life or is your goal a gradual restoration of closeness with a lifelong partner? 

Frame sex as you would any other physical activity, outlining your definition of success in terms of intensity, frequency and emotional and social context. 

 Gillian Hawker, MD, chair of the department of medicine at the University of Toronto, recommends taking a cue from workout routines for managing pain during sex. What works for your workout – warming up, respecting your range of motion, expecting to have some post-activity TLC – is likely an equally successful strategy for sex. 

 Ask your physical or occupational therapist to include strength and balance exercises to help you stay in preferred sexual positions longer and with more confidence. Barr even coaches (fully clothed) patients and their partners through the biomechanics of recommended sex positions. 

 Experimenting with a variety of positions will likely be necessary, especially after surgery – that means positions that respect the range of motion prescribed by doctors. 

 Author: Joanne Cleaver 

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