Pain—the Great Inhibitor

Pain—relentless and unpredictable—is an obvious obstacle to sexual enjoyment. Not only does it make certain positions difficult and/or impossible, pain also limits desire, sexual response and function. Equally inhibiting, though, is poor self-image. Few of us with RA remain physically unscathed. Many of us have visible deformities; some of us have surgical scars. In a country that bases an almost impossible standard of beauty on youth, health and strength, it is no wonder that many of us feel “sexless”.

So Why Bother?

Because sex is the life force! It is our greatest intimacy, that which links us to humanity; it is how we show our love and vulnerability to each other. Orgasm releases endorphins, reducing pain and stress, relieving fatigue and depression, making us feel alive and desirable. And making love with our partners is a way of reassuring each other, of letting him or her know that we still find them attractive. It’s joyful, rewarding and free. Sure, you could conceivably live without sex. You could live without laughter, too, but why would you want to?

“Lowered Expectations” v. Redefined Expectations

Recently, I came across an article on RA and sexuality in which the author suggested that if you have RA, you should “reduce your expectations”, sexually speaking. Although I’m sure the author meant well, I felt like screaming. Reduce our expectations? Why? Haven’t we reduced enough of our expectations? Granted, if your expectations are based on gratuitous media images in which trapeze acts, hurling each other into walls and being double-jointed in general seem to be the norm, then perhaps you might want to reduce your expectations. The rest of us, though, should be able to use a little creativity and redefine—rather than “reduce”—our expectations.

Redefining Our Sexuality

Physical Obstacles

Obviously, if you are in the midst of a five-alarm flare you should postpone lovemaking until your symptoms subside. On the other hand, it probably isn’t necessary to wait until you are pain-free before making love (for some of us, that would be a very long wait). In fact, sex—like exercise—may be just what you need to relieve moderate stiffness and pain. Here are a few ideas you can use to prepare your body for lovemaking:

* Try to limit extra activity
Postpone extra chores or errands for another day or delegate a few of them to your partner.

* Plan sex for the time of day you feel best…and time your medications accordingly.
Some of us feel stiffness in the mornings; others feel fatigue at night. You know better than anyone when your peak time is…and how to time your medication for maximum comfort.

* Trade spontaneity for anticipation
True, spontaneous sex might be harder to pull off. But don’t discount the fun of anticipation! (e.g. catching each other in the hallways and whispering, “Just two more hours until you-know-what!”)

* Take a warm bath or shower beforehand
Better yet, take one together!

* Warm up with range of motion exercises
Yoga, tai chi, qui gong, Pilates or any range of motion exercise recommended by your doctor or physical therapist will reduce stiffness and enhance enjoyment.

* Create a relaxed atmosphere
Put the kids to bed, turn on the answering machine, light some scented candles, and—if your medication allows you—have a glass of wine.

* Incorporate massage into your foreplay
Scented, flavored massage oil can be warmed and worked into stiff muscles. Therapeutic and erotic!

* Develop subtle signals for your partner
Use a light tap or tug to let your partner know if he or she is hurting you…by the same token, let them know when something feels good, as well.

Positions

It is possible that some positions will cause too much discomfort, but instead of seeing this as yet another limitation, treat this as an opportunity to add some spice to your love life! Buy a copy of the Kama Sutra or Alex Comfort’s Joy of Sex . Experiment with oral sex and marital aids. Arrange pillows to support sore joints.

In the 1800’s, pneumonia was called “the old man’s friend” because so many elderly people afflicted with other horribly debilitating and chronic diseases died mercifully of pneumonia instead of wasting away from cancer or suffering for years with the effects of a stroke or crippled with arthritis.

Antibiotics can now cure many infections from pneumonia to ulcers. Different classes of antibiotics kill infectious bacteria in different ways, but the results are that the bacteria die and you feel better. There are bacteria in and around us at all times (one bacterium, two bacteria). Species of bacteria are much more numerous than there are people on this planet. Not all of these species of bacteria are harmful or infectious. Over millions of years, people have learned to live with most bacteria and in fact, some bacteria are the “good guys” and help us digest food or fight off the “bad guys”. Our bodies have evolved wonderfully complex and effective ways of killing bacteria and most of the time our immune systems are quite happily killing off invasions of bacteria every day.

Antibiotics are needed to kill bacteria under only a few conditions: first, when a really bad kind of bacteria like the “flesh-eating” staphylococcus gets past our defenses and gets started growing in a wound, for example. This bacterium is hanging around all the time but we fight it off routinely. If it starts growing under your skin, you need antibiotics and you need them very quickly and in large doses. Secondly, when someone’s immune system is compromised or not working very well for some reason or another like disease or surgery, then a normally friendly bacterium can start growing like crazy and completely overwhelm the body’s ability to fight it off. In that case you also need the right kind of antibiotics and lots of them.

The most common reason for a prescription for antibiotics is an invasion of a garden variety everyday bacteria like streptococcus, the kind that causes strep throat in your ten year old. Strep is everywhere. We could never hope to rid the planet of these bacteria. Most of the time when it gets into the throat of your ten-year-old, her saliva kills it. But sometimes it gets going and doesn’t stop. When this happens, she needs a prescription for antibiotics; most commonly some sort of penicillin.

…see part 2 to continue