Advice from A Sexual Counselor For Chronic Patients

In November, I attended a session entitled Sexual Issues in Rheumatology: Assessment and Intervention at the American College of Rheumatology’s annual meeting. The session presenters were Doctor Mijal Luria, of The Center for Sexual Health in Israel, and Sharon Peleg-Nehsre, a sexual counselor for chronic patients at the Tel – Aviv Medical Center. I must admit that the thought of having a sexual counselor specifically trained to help chronic patients made me want to get on a plane to Tel – Aviv!

After the session, I sent Ms. Peleg-Nehsre an email. I introduced myself as a patient living with RA and thanked her for tackling a subject that plays such an important role in our quality of life. Hopefully, as healthcare professionals are encouraged to consider issues of sexual health, more rheumatologists will start to routinely include the types of suggestions Ms. Peleg-Nehsre and Dr. Luria made during their presentation.

However, the presentation also included results from a study that found that 71% of rheumatology healthcare professionals seldom or never raise the topic of sexual health with their patients. That’s a lot of patients who may be struggling to figure out how to deal with sexual issues on their own! So I asked Ms. Peleg-Nehsre if she had any particular advice for patients in situations where doctors are not broaching the subject of sexual health, and she was kind enough to provide some advice for us.

Ms. Peleg-Nehsre agreed that patients with rheumatoid arthritis face some challenging sexual issues. They may find that their partner tends to avoid sexual activity for fear of causing pain or patients may avoid initiation themselves because they are afraid of being rejected. Many patients living with chronic illnesses suffer from depression, low self-esteem, poor body image, pain, and other side effects of medications. This can very commonly cause sexual dysfunction. Some of these issues – such as depression – can be treated with additional medications, though it is important to work as a team with your doctor to make sure you find the right combination of medications to treat multiple conditions. Many of these issues can also be treated through therapy if they are not improving sufficiently with the help of your rheumatologist.

Physical pain can affect lubrication and even cause erectile dysfunction. Luckily, there are many over-the-counter lubricant options, including water-based and oil-based lubricants so that each person can find their preference. Lubricants are safe to use and very helpful, particularly if each partner uses some. For erectile dysfunction, there are a few medications that are available with a prescription from your physician. It is particularly important to make sure you follow the instructions when using these medications. Ms. Peleg-Nehsre also emphasized that it is important to inform your partner and let him or her be involved in the process.

For dealing with the pain of rheumatoid arthritis, it is very helpful if pain medication is taken 30 to 60 minutes prior to sexual activity. It is important for you and your partner to work together as a team to try to find the most comfortable positions. Pillows can be very useful for supporting your body. While certain positions may be unpleasant for certain types of pain, Ms. Peleg-Nehsre advises patients not to become upset that a particular position didn’t work out. Instead, she encourages patients to treat it as an opportunity to try something different and diverse. She also emphasized the importance of exploring other options, including oral sex, masturbation, and using toys or other accessories.

Ms. Peleg-Nehsre also counsels individuals with chronic illnesses to make sure they work with their partner on open communication. This includes discussing with your partner the best time for having sex. For example, many patients with rheumatoid arthritis find the morning to be a less suitable time for sex due to morning stiffness and pain. Whatever time of day works best for you, it may be helpful to have a date with your partner so that you will be able to be prepared for a good experience.

Sexual health is a very important aspect of a person’s quality of life. According to a 1999 study, 84 to 91% of married individuals ranked a satisfying sex life as important, and 94% said sexual enjoyment added to quality of life at any age. Although life with a chronic illness does present some challenges when it comes to having satisfying sex, there are things that patients can do pro-actively to work to improve their situations.

I’d like to thank Ms. Peleg-Nehsre for her time and efforts on this important subject!