If you have arthritis, you may be able to lessen the pain and step up the pleasure.

Annette, a vibrant 32-year-old, has always enjoyed sex. Now that she's been diagnosed with rheumatoid arthritis (RA), she appreciates and enjoys sex even more. But Annette is candid about her fears that someday the pain of RA will prevent her from experiencing sexual pleasure.

According to the Arthritis Foundation, RA affects 1.3 million people in the United States. This autoimmune disease stimulates inflammation in the lining of the joints, and can eventually cause deterioration of the bone and cartilage. RA can cause pain, stiffness, fatigue and restricted movement all of which can be detrimental to romance and passion.

The Sexual Effects of Arthritis

Annette is realistic in her concerns. Although her RA can be controlled with medications, exercise, and rest, there may be days when sexual or physical activity will be more difficult for her. One study that analyzed the sexual responses of women with RA showed that 50% of them experienced less desire for sex after the onset of RA. Some women lost their full range of knee and hip movement, which prevented them from assuming familiar intercourse positions. Other women avoided intercourse because they felt that they would be in pain the next day.

Although the sexual side effects of another kind of arthritis osteoarthritis (OA) have not been as extensively studied as those of RA, many sex therapists have experience counseling people with OA. Osteoarthritis, which breaks down joint cartilage, causes some of the same symptoms, such as pain and movement restriction, which may interfere with the joy of sex.

Reinventing Pleasure

Arthritis may change a person's sex life, but that change doesn't have to signify the end of pleasure.

"Living with arthritis is about acceptance and learning how to develop other parts of yourself," says certified sex therapist Mary Ann Baker-Holmes, LMFT. "If you can't have sex the way that you did before, it might open up some possibilities for becoming intimate with your partner in ways that you never have before. "Although there are many such ways, they involve changing sexual habits and for many of us, this is no easy task.

Changing Your Position

The first habit you may need to change is the very way that you and your partner make love. Some intercourse positions can be painful for people who have arthritis. For instance, people with hip problems say that being on top can be uncomfortable, since this position demands hip movement.

If you and your partner have been assuming the same sexual positions for years, changing positions may feel awkward at first. If you're hesitant about suggesting new positions to your partner, consider the potential consequences of the alternative saying nothing. Says Baker-Holmes, "When people see me because they're not having sex, usually they've gotten to the point that they're so worried about offending the other that nothing's happening."

The Arthritis Foundation recommends some alternative positions for people with common arthritis problems. These particular tips are geared toward heterosexual sex.

  • For women with hip problems: The woman leans her entire upper body over a chair, and kneels on a pillow on the floor. Her partner enters from behind.
  • For women with shortened tendons: The man lies down on his side. The woman lies down perpendicular to the man, and drapes her legs over his thighs and buttocks. Lying on his side, facing her, the man enters her. Together they form a capitol "T" shape (with the man as the top of the T).
  • For men and women with hip problems: Both partners stand. The woman leans on a piece of furniture for support, while the man enters from behind.

Pain Relief

Although it may not sound like an evening in Paris, another way to relieve pain is to synchronize your medication and lovemaking schedules. Sex therapist Dennis P. Sugrue, PhD, suggests making love after you've taken your pain medication, during that window of time when pain is most minimized. However, some pain medications, such as hydrocodone or ]]>oxycodone]]> can reduce both the desire and/or ability to participate in sexual activity.

Of course, this all requires planning. "A lot of people think that the best sex has to be spontaneous," says Baker-Holmes. But if you plan, instead of waiting for the right mood to inspire intimacy, you may find that intimacy inspires the right mood, she says. And, says Baker-Holmes, "anticipation is a highly underrated aphrodisiac!"

Communicating Pain

Even if you try all of the above, sometimes you will still feel pain. It's difficult to communicate this without making your partner feel like he or she is hurting you especially when the intention is to give you pleasure.

Sex researcher Beverly Whipple, PhD, offers some advice on how to communicate pain without embarrassing your partner. "Use positive statements," she says, "[like] 'I feel good when you stroke me here,' or 'that feels really nice.' Try not to focus on what hurts."

Whipple doesn't mean, however, that you should tolerate pain for fear of offending a partner. That's why she suggests using a nonverbal signal when your partner's touch is less than pleasurable perhaps something as silly as pulling on your partner's ear or nose.

Remembering Pleasure

Perhaps the most difficult part of making love when you have arthritis is remembering that your body is a vessel for pleasure, and not just for pain.

"People tend to concentrate on how their body is betraying them," Sugrue says, "and they overlook the fact that their body is also able to give them pleasure."

Whipple offers some ways for reconnecting to this pleasure by reconnecting to what makes you feel sensual. "I like to help people get in tune with their fantasies again with things that turn them on good music, hearing the ocean, certain tastes and foods, candles, incense…whatever you like."

Pleasure may also simply result from making love, particularly if you aim for ]]>orgasm]]> . Orgasm releases feel-good endorphins that may temporarily alleviate arthritis pain.

Sandra, who has arthritis, finds orgasm the perfect balm for pain. "I have been widowed for some time and in the last few months have found my 'soul mate,'" she says. "How handy for me, because...it seems that orgasm releases endorphins adequate enough to relieve the arthritis pain for some time usually the rest of the evening and through to the next morning!"