Psychosocial
Abstract 661: Sex, Relationships and RA : An in-Depth Exploration of Patient and Partner Perspectives
Authors: Gillian Grundy1, Lynne Goodacre, Dr2,2, Alan Riley, Prof2,2, Robert J. Moots, Prof1,1, John Goodacre, Prof2,2. 1University Hospital Aintree, Liverpool, United Kingdom; 2University of Central Lancashire, Preston, United Kingdom
Purpose: To gain an in-depth understanding of the impact of rheumatoid arthritis on the sexual relationships and sexual function of patients with Rheumatoid Arthritis and partners.
Methods: In-depth interviews and questionnaires were used to query patient and partner perspectives. The sample included a wide range of ages, disease activity levels, disease duration, types of relationships and treatments. Tape recorded interviews were carried out to make an in depth exploration of their relationship experience. Transcripts were analysed thematically using ATLAS-Ti. Data reported relate primarily to the qualitative data.
Results: 15 men and 15 women with RA and 10 male and 10 female partners of people with RA were recruited. Among couples, patients and partners reported satisfying aspects of their sexual relationships but also provided insight into the extra challenges they faced. Joint pain, fatigue, fear and reduced physical function had a profound effect on sexual function, frequency of intercourse, sexual positioning, foreplay, spontaneity, enjoyment and sexual satisfaction. Weight changes, low mood, low self-esteem, lack of confidence and feeling useless were reported by patients. Embarrassment about joint deformities, feeling old and guilty were more commonly reported by women patients. All these issues impacted on the sexual experience of partners. Some partners expressed feelings of sexual frustration and rejection. One partner seriously considered ending her relationship, while 2 others reported the desire to leave. Conflict between the care-giver role and lover role caused difficulty for some female partners. Lack of communication or understanding of RA was a problem for some couples. Among single people with RA, social isolation created concerns about meeting potential partners.
Anxieties about future disability and the impact of this on their relationships were expressed by all groups. Lack of communication with Healthcare Professionals (HCP) around relationships was evident. Two men with RA had developed erectile dysfunction since the onset of RA while several others reported a reduction in sexual desire.
Conclusion: Persons with RA and their partners often face complex physical and psychosocial challenges within their relationships. These difficulties can have an important impact on their sex lives. Despite facing significant problems very few participants had communicated their needs to HCP.
Editorial Note: The quality of an RA patient’s relationship with their partner can serve as a significant buffer to stress, depression and enhance overall well-being. Sexual intimacy is an important component of healthy relationships and central to marital satisfaction. Relationship satisfaction in turn is a primary foundation of social support. Despite the potentially key role that sexual intimacy in relationship can play in the sexual functioning of RA patients and their partners, this topic has received little empirical attention.
While patients indicated that sexual intimacy was still desired and could be pleasurable, disease symptoms such as pain and fatigue were strong determinants of interest and frequency. Women often reported feeling less sexually attractive due to physical changes resulting from RA. Erectile dysfunction was not uncommon in men with RA, although women did not report significant changes in sexual functioning. In women, guilt, depressive symptoms and feelings of uselessness often diminished interest in sexual activity. Partners often felt sexually rejected in response to diminished interest.
Both patients and partners reported that it was often difficult to talk with each other about changing sexual roles. Similarly, very few patients had talked with their health care providers about the effect of RA on their ability to be sexually intimate, often fearing that such discussions were not a legitimate use of their provider’s time.
Studies have consistently found that both patients and providers are reluctant to discuss sexual issues. Thus, without prompting, it is unlikely that clinicians will be aware of their patients’ sexual difficulties. Reasons for sexual dysfunction include disease-related issues, as psychosocial concerns (i.e., depression) and medications. Since most problems related to sexual functioning can respond to a combination of treatment, adaptability and increased communication, this important aspect should be addressed as part of routine rheumatic care.