“Sex and Intimacy in Chronic Disease” at the 2016 American College of Rheumatology Annual Meeting

Living with a chronic illness like rheumatoid arthritis can often make it a challenge to maintain a healthy sex life. Patients face challenges like physical pain, side effects from treatments, issues with body image and self-esteem, and more. But while patients may want to ask their healthcare providers for advice on these issues, the subject of sex can often be difficult or uncomfortable for patients to bring up. As a result, many sexual health challenges and concerns may remain unaddressed – which can have a negative impact on a patient’s quality of life.

I firmly believe sexual health is an issue that ought to be addressed by our healthcare providers, so I’ve been excited to see sessions addressing the issue at the American College of Rheumatology Annual Meetings for the past two years. Last year, the session on sexual issues featured some excellent information and advice for the healthcare providers in attendance – but unfortunately it was scheduled for 7:00am and attendance was very poor. For this reason, I was extremely excited to see the 2016 session on sexual health scheduled for 11:00am – resulting in a packed auditorium.

Iris Zink, who has been a rheumatology nurse practitioner for 16 years, was this year’s speaker. She is currently the president of the Rheumatology Nurses Society, and her passion for this subject was immediately apparent. Zink shared the story of one of her patients who lives with ankylosing spondylitis (a type of arthritis that affects the spine), who confided that she couldn’t physically open her legs wide enough to have sex with her husband. Stumped at how to help her patient with this issue, Zink did her own research and came up with a plan to help her patient overcome the sexual issues she was facing. This story emphasized Zink’s main message: that healthcare providers have a duty to treat the whole patient, which includes addressing issues of sexual health.

Zink reminded the healthcare providers in the audience that patients aren’t just patients – they are also sexual beings – and that there are a whole range of non-reproductive benefits to sex, including bonding, tension reduction, entertainment, and solidifying a bond between two people. She cited a study that showed 62% of patients with RA have reported difficulties with sexual performance. Since the data clearly shows that this is an issue of concern for patients, Zink appealed to healthcare providers to do a better job educating and helping their patients concerning issues of sexual health, so that patients can regain their sexual selves.

The presentation was helped along by a healthy dose of humor to make an awkward subject easier to talk about. In addition to including myriad comics and jokes in her slides, Zink used a vibrator instead of a pointer to point out things on the screen. Halfway through the presentation, she actually changed into a Wonder Woman costume to emphasize the point that doctors shouldn’t be surprised if their patients say or do shocking things. It is my hope that her humorous approach helped the healthcare providers in the audience realize the importance of this issue to patients’ lives.

In addition to having fun with her talk, Zink also offered healthcare providers practical advice for how to bring up the issue of sex with their patients – such as asking about sexual concerns on intake forms or enquiring about vaginal dryness as a starting point. After the talk, I asked Ms. Zink whether she had any advice for patients whose doctors never bring up the topic of sexual health. Zink recommended that patients who are uncomfortable start with their nurse practitioner or registered nurse, as these healthcare professionals tend to be more open to communication, take more time, and generally empathize better. A good way for patients to start might be to say something like, “I have some concerns that are sexual in nature related to my chronic illness – are you comfortable addressing these?”

Overall, Zink worked to debunk many of the myths surrounding sex and chronic illnesses. She demonstrated how general health can affect sexual health and showed that disabled people are still sexual. She encouraged the use of sexual aids and emphasized the importance of body image and communication between partners. She listed the concerns that patients with chronic illnesses may have when it comes to sexual health – lack of desire, ability to satisfy partner, change in partner perception, pain during sex, fatigue, and more – and encouraged healthcare providers to work as a team with their patients to address these concerns.

This activity is not sanctioned by, nor a part of, the American College of Rheumatology.

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