*Sex education material here; adults only*
Feel free to reproduce for other patients; please give credit to FridaWrites as the author.
Despite the wealth of information available about sex and sexual problems, unfortunately almost nothing is written about chronic illness/disability and sex. Often severe arthritis makes every single physical action challenging; on difficult days, every movement is carefully considered or at least keenly felt. And when it comes to sex and sexuality, relationships can suffer and personal/spiritual fulfillment be compromised.
If pain or fatigue are uncontrolled, sex can be difficult or impossible, especially if the individual has a lot of demands on his/her limited energies. And sex can create severe inflammation or a flare afterwards. Libido can be severely affected by pain or medications. Controlling your pain as much as possible may allow you room to get in the mood. But remember that sex and becoming aroused also release endorphins—at a certain point, the pain will diminish. You need enough pain control to begin, but not 100% pain control.
One key is to allow lots of time. You may have to schedule sex, so you can take a little more pain med in advance. Try for mid-morning to early evening rather than late night or early morning. Plan before a big and exhausting event, not after. And allow hours, not quickies; it's worth it to go very slow to avoid the pain flare. Using heat on joints (microwave heat packs!), soaking in a hot tub, or taking a hot shower can help ease pain on joints. Gentle massage of tight muscles can help reduce pain and increase relaxation. There are Youtube videos by LMTs demonstrating techniques--go very gently at first so as not to flare later!
Keep movements slow and easy and pay attention to positioning. Use pillows underneath joints that hurt (without a pillow under my left knee, my hip says no and I shut down), and large bed wedges from the back stores or Liberator pillows to make alternate positions more comfortable. The wedges mean you can position closer to the other person and be more supported without straining your spine.
For those with spinal arthritis or pelvic pain, reducing pelvic motion will help a lot--think of both of you with micro-movements focused on keeping the spine straight, so that you're rocking more on a horizontal axis rather than pushing your spine into the plane of the bed. For women, using a vibrator can reduce the physical effort required. A side-lying position or doggy-style may take most pressure from joints. Look up different positions and see if something else might help.
One RA blogger, Lene Andersen, reminds people that our necks are vulnerable to injury during sex (actually, go read her whole post), so you may have to be careful not to arch it. Neck movement is as dangerous with spondylitis--you are vulnerable to spinal cord injury and vertebral fracture as your spine becomes brittle and fused. I second her voice--when the rush of endorphins and your body tension is at its strongest, you will not be able to feel the pain you may be producing in any of your joints or soft tissue, not until later. So be careful! What feels great now may produce an injury or setback. Go easier next time if you need.
Sometimes it's just not going to work, even when you're both in the mood. It’s okay. Come back and try later in the day or the next day—a few hours often makes all the difference physically.
Carlin Ross, who writes with Betty Dodson, writes fairly regularly about disability and sex: http://dodsonandross.com. Ross has 67 posts with the disability tag already, and a lot of what Ross writes would apply to arthritis.
There are a couple of books that may help (there's also a more recent theoretical text):
-Enabling Romance: A Guide to Love, Sex, and Relationships for People with Disabilities (and the People Who Care), Ken Kroll and Erica Levy Klein
-The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness, by Miriam Kaufman, Cory Silverberg, and Fran Odell