I recently had the pleasure of interviewing Gail Saltz, M.D., psychiatrist and active national health, sex, and relationship contributor. She is famed for writing a weekly relationship column for MSNBC.com, is a bestselling author, and is a regular contributor to O, The Oprah Magazine. This question and answer format will go over Saltz's background, why she has focused her attention on the importance of intimacy,as well as tips and advice for those living with chronic diseases like rheumatoid arthritis (RA).
Q: How did Saltz get involved in intimacy and RA?
A: Saltz is specially trained in sex therapy. Many of her patients were women 30-40 years of age, commonly diagnosed with rheumatoid arthritis. While helping these patients through the trails of fatigue, pain, and sometimes disfigurement associated with the disease, she became increasingly interested in specific therapies to help target the issues of body image and how these women relate sexually.
Q: Why is intimacy especially important for those living with RA? Are there any physiological benefits?
A: “Relationships are the number one source of happiness,” Saltz said. She then touched on both the emotional and physical aspects of relationships and how being able to express ourselves sexually is critical to a lasting relationship. She continued to explain how this is especially important for those living with a chronic disease due to the potential sadness, and the need and benefits of sharing one’s life and feelings. When discussing the physiological benefits, Saltz emphasized the mind-body connection, and how those with depression or high stress levels tend to deteriorate more and feel pain more significantly. “Having a source of pleasure in your life and feeling supported, and feeling that you are supporting someone else makes a big difference in terms of not only your mental health, but also your physical health.”
Q: Do you have any tips for maintaining intimacy during RA flare-ups?
A: Saltz stressed the importance of communication. Communicating with your partner not only during flare-ups, but also on a regular basis is key. If you know that you generally feel fatigued and stiff toward the end of the day, why wait for the turn of events to unfold? “Instead of a candlelight dinner, why not try a romantic brunch?” she said. Communicate with your partner to plan times of intimacy when you have the most energy and feel the strongest. Saltz gave more great tips like, “Let's plan a bubble bath on Valentine's Day because it will be fun, it will be romantic, and the warm water is soothing for my joints and helps with flexibility.”
Q: Are there specific roles for partners of individuals with RA to help maintain intimacy?
A: This topic is pretty huge, Saltz said. She mentioned that she most often saw burnout with partners due to the constant feeling of being a caregiver. Only this “caregiver burden” is not due to the disease, it is associated with the partner feeling as if they are not supposed to ask for anything or say they need anything because, “look at my poor partner.” Often times it is the partner who puts himself in the caregiver role, but it is essential for partners to feel comfortable to communicate their own needs, and wants, and pleasures. This benefits the affected individual as well, because someone with a chronic disease does not want to always feel like they need care, or feel like a burden. They need to feel like they are also giving in the relationship.
Q: What are the benefits of communicating and educating partners about rheumatoid arthritis? Does this translate into the bedroom?
A: “Communicating and educating are numbers one and two of my tips,” Saltz said. “It’s just talking about things.” She emphasized talking and listening to each other so there are not any unrealistic expectations. Keep your partner informed with how you are feeling physically and emotionally. Educating yourself and your partner builds confidence, because she said “it creates a different vantage point of the disease.” Having close communication translates into the bedroom and according to Saltz, “the fact is, to some degree, you have to broaden your definition of sex.” Saltz mentioned how you might not always be able to get in the same missionary position for intercourse, and this is a good thing! Start expanding what is physically pleasurable for the two of you is important, because someday some things might not be possible.
Q: So, do you have any specific positions for less impact/stress on the body?
A: “Yes, typically missionary is not so great," Saltz said. She added that she concentrates on not necessarily exact positions, but finding out what takes pressure off of affected joints. Possibilities include the use of gravity to remove pressure, or using pillows to prop your hips, the areas under the knees, or whatever it is that needs less pressure today. She also mentioned, “intimacy is about mutual pleasure, this does not always have to mean intercourse. Stimulating each other in a caring and loving way, that’s what it’s all about.”
Q: How does the vulnerability of intimacy affect those with low self-esteem due to the physical changes and limitations occurring with RA?
A: Saltz said how this happens quite often, but can be lessened by emphasizing the areas that are not affected. “Sometimes dressing in lingerie allows women to feel more comfortable and sexy.” Often times, it is the affected individual that amplifies the vulnerability herself. If she just talked with her partner about the issue, she would probably find that the partner really thinks she is sexy and she would get a chance to hear her partner say, “but I love your…x, y, and z.”
Q: Do you have any last take home message for our readers?
A: One last time, Saltz emphasized that communication is very important in any relationship. Specifically for those living with a chronic disease, flexibility is very important. “Unfortunately this is a chronic problem, so you can’t always know what will be a good day or not. If you build everything on, ‘it has to happen now’ then, you know, there will be disappointment.” She touched on the fact that February 14 is a Hallmark holiday, and how there are 364 other days that are very important to maintain your relationship. So if that is not a good day, just make it February 15! Just try and be flexible with your plans, “and with flexibility comes spontaneity, and that’s always a good thing.” Lastly, Saltz reemphasized the importance of educating yourself and your partner, because “people feel more in control of their illness when they know more about it.”
Saltz is contributing to an episode on www.newwayRA.com, an online talk show with RA experts and patients involved with the disease. Her episode is on dating, relationships, and sex and will be airing February 8, 2011.
Thank you Dr. Saltz for your time and valued information.
Claire is a twenty-four year old new graduate Registered Nurse interested in women’s health and wellness. She currently lives in Tempe, AZ with her dog Bella.