Rheumatoid arthritis(RA) is accompanied by sexual dysfunction in one-third of all RA patients, both men and women. The study found that there are a number of issues that affect RA patients, including low libido, painful intercourse, orgasmic dysfunction, premature ejaculation, and non-satisfactory sexual life.
Dr. Pedro Santos-Moreno, lead author, said, “Sexuality is an important dimension of an individual’s personality, and sexual problems can have a seriously detrimental impact on a couple’s relationship. It is, therefore, rather surprising that, up until now, very little quality research on sexual disturbances in RA patients has been published in the literature, bearing in mind how common the problems are.”
Factors associated with rheumatoid arthritis and sexual dysfunction
There are many factors that affect the prevalence and aggravation of sexual problems, but the relationship between sexual dysfunction and RA disease activity has never been statistically significant. On the other hand, there is a connection between not being sexually active and disease activity.
The study examined three types of factors – precipitating, predisposing, and maintenance – to see how they would influence the prevalence and worsening of sexual disturbances in rheumatoid arthritis.
Precipitating factors for sexual dysfunction in women and men with RA included infidelity, insecurity in a sexual role, and biological or physical causes. The range of predisposing factors in women and men were related to image changes, infidelity, anxiety, and loss of attraction.
Factors believed to be responsible for sexual disturbance in RA included biological causes, infidelity, general alteration of a couple’s relationship, partner’s sexual dysfunction, depression, and anxiety.
The relationship between these factors and disease activity was not found to be statistically significant.
Effects of rheumatoid arthritis on sexual activity
Rheumatoid arthritis may pose some challenges when it comes to sex, but maintaining a healthy sex life while living with RA is very possible. For starters, it’s important to maintain an open conversation with your partner about your needs, feelings, desires, and challenges. Intimacy may have to be changed with different touches, techniques, sexual devices, and new positions to accommodate the condition.
Sexual activity should take place when you are feeling your best throughout the day, which means saving sexual activity for the nighttime may not always be a viable option, as many people feel their worse at this time. Avoid cold temperatures as they can worsen rheumatoid arthritis symptoms. Lastly, keep a good attitude and remember that the goal of intimacy is the emotional closeness.
Aspects that can affect the sexual expression of a rheumatoid arthritis patient include severity of the disease, levels of fatigue, degree of pain, physical limitations, contribution of movement and touch, self-perception, side effects of medications, and effects of surgery.
Tips to manage sexual function with rheumatoid arthritis
Here’s what you can do to manage sexual function with rheumatoid arthritis:
Plan ahead for sex – choose times when you know you are feeling your best and most rested.
Nap before sexual activity.
Take a warm shower or bath, or use a heating pad to relieve stiffness.
Time pain medications so they are at peak effect during sex.
Use massage to help relax muscles and joints.
Pile up pillows or rolled sheets to offer support.
Pace yourself to save energy.
By trying out some of these tips, you can improve your sexual function despite living with rheumatoid arthritis.
Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer, survivors and their partners, it can feel even more awkward. In fact, sex ranks among the top five unmet needs of survivors, and a new digital health startup, Will2Love, has been launched to help fill this void.
Sixty percent of cancer survivors — 9.3 million individuals in the United States alone — end up with long-term sexual problems, but fewer than 20 percent get professional help, according to Leslie R. Schover, PhD, Will2Love’s founder. Among the barriers she cites are overburdened oncology clinics, poor insurance coverage for services related to sexual health and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients and survivors about these issues.
Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for health care practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health.
“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” she adds.
The problem is twofold: how to encourage oncology teams to do a better job of assessing and managing sexual problems and how to help those impacted by cancer to discuss their sexual concerns.
Schover says that simple, open-ended questions such as: “This treatment will affect your sex life. Tell me a little about your sex life now,” can help to get the conversation started.
Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.
Sexual dysfunction after cancer can often lead to depression and poor quality of life for survivors and their partners.
Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, explains Schover. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.
“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stresses. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”
Schover hopes that Will2Love will bring much-needed attention to the topic by providing easily accessible resources for patients, survivors, their partners and health care providers. (Box)
Currently visitors to the website can subscribe to its e-newsletter and receive a free introductory five-part email course covering topics related to what your doctor may not be telling you about sex, fertility and cancer. After the fifth lesson, users will receive a link to the Will2Love “Sex and the Survivor” video series. “Sexual health is a right,” Schover stresses, and oncology professionals, patients and survivors need to be assertive to get the conversation started.
It’s not always clear if a woman is really having an orgasm, as Meg Ryan demonstrated in When Harry Met Sally.
In the nascent field of orgasm research, much of the data relies on subjects self-reporting, and in men, there’s some pretty clear physiological feedback in the form of ejaculation.
But how do women know for sure if they are climaxing? What if the sensation they have associated with climax is actually one of the the early foothills of arousal? And how does a woman know when if she has had an orgasm?
Neuroscientist Dr Nicole Prause set out to answer these questions by studying orgasms in her private laboratory. Through better understanding of what happens in the body and the brain during arousal and orgasm, she hopes to develop devices that can increase sex drive without the need for drugs.
Understanding orgasm begins with a butt plug. Prause uses the pressure-sensitive anal gauge to detect the contractions typically associated with orgasm in both men and women. Combined with EEG, which measures brain activity, this allows for a more accurate picture of a woman’s arousal and orgasm.
Dr Nicole Prause has founded Liberos to study brain stimulation and desire.
When Prause began studying women in this way she noticed something surprising. “Many of the women who reported having an orgasm were not having any of the physical signs – the contractions – of an orgasm.”
It’s not clear why that is, but it is clear that we don’t know an awful lot about orgasms and sexuality. “We don’t think they are faking,” she said. “My sense is that some women don’t know what an orgasm is. There are lots of pleasure peaks that happen during intercourse. If you haven’t had contractions you may not know there’s something different.”
Prause, an ultramarathon runner and keen motorcyclist in her free time, started her career at the Kinsey Institute in Indiana, where she was awarded a doctorate in 2007. Studying the sexual effects of a menopause drug, she first became aware of the prejudice against the scientific study of sexuality in the US.
When her high-profile research examining porn “addiction” found the condition didn’t fit the same neurological patterns as nicotine, cocaine or gambling, it was an unpopular conclusion among people who believe they do have a porn addiction.
The evolution of design of the anal pressure gauge used in Nicole Prause’s lab to detect orgasmic contractions.
“People started posting stories online that I had falsified my data and I received all kinds of sexist attacks,” she said. Soon anonymous emails of complaint were turning up at the office of the president of UCLA, where she worked from 2012 to 2014, demanding that Prause be fired.
Does orgasm benefit mental health?
Prause pushed on with her research, but repeatedly came up against challenges when seeking approval for studies involving orgasms. “I tried to do a study of orgasms while at UCLA to pilot a depression intervention. UCLA rejected it after a seven-month review,” she said. The ethics board told her that to proceed, she would need to remove the orgasm component – rendering the study pointless.
Undeterred, Prause left to set up her sexual biotech company Liberos, in Hollywood, Los Angeles, in 2015. The company has been working on a number of studies, including one exploring the benefits and effectiveness of “orgasmic meditation”, working with specialist company OneTaste.
Part of the “slow sex” movement, the practice involves a woman having her clitoris stimulated by a partner – often a stranger – for 15 minutes. “This orgasm state is different,” claims OneTaste’s website. “It is goalless, intuitive, and dynamic. It flows all over the place with no set direction. It may include climax, or it may not. In Orgasm 2.0, we learn to listen to what our body wants instead of what we think we ‘should’ want.”
Prause wants to determine whether arousal has any wider benefits for mental health. “The folks that practice this claim it helps with stress and improves your ability to deal with emotional situations even though as a scientist it seems pretty explicitly sexual to me,” she said.
Prause is examining orgasmic meditators in the laboratory, measuring finger movements of the partner, as well as brainwave activity, galvanic skin response and vaginal contractions of the recipient. Before and after measuring bodily changes, researchers run through questions to determine physical and mental states. Prause wants to determine whether achieving a level of arousal requires effort or a release in control. She then wants to observe how Orgasmic Meditation affects performance in cognitive tasks, how it changes reactivity to emotional images and how it compares with regular meditation.
Brain stimulation is ‘theoretically possible’
Another research project is focused on brain stimulation, which Prause believes could provide an alternative to drugs such as Addyi, the “female Viagra”. The drug had to be taken every day, couldn’t be mixed with alcohol and its side-effects can include sudden drops in blood pressure, fainting and sleepiness. “Many women would rather have a glass of wine than take a drug that’s not very effective every day,” said Prause.
Prause is studying whether these technologies can treat sexual desire problems. In one study, men and women receive two types of magnetic stimulation to the reward center of their brains. After each session, participants are asked to complete tasks to see how their responsiveness to monetary and sexual rewards (porn) has changed.
With DCS, Prause wants to stimulate people’s brains using direct currents and then fire up tiny cellphone vibrators that have been glued to the participants’ genitals. This provides sexual stimulation in a way that eliminates the subjectivity of preferences people have for pornography.
“We already have a basic functioning model,” said Prause. “The barrier is getting a device that a human can reliably apply themselves without harming their own skin.”
There is plenty of skepticism around the science of brain stimulation, a technology which has already spawned several devices including the headset Thync, which promises users an energy boost, and Foc.us, which claims to help with endurance.
Neurologist Steven Novella from the Yale School of Medicine uses brain stimulation devices in clinical trials to treat migraines, but he says there’s not enough clinical evidence to support these emerging consumer devices. “There’s potential for physical harm if you don’t know what you’re doing,” he said. “From a theoretical point of view these things are possible, but in terms of clinical claims they are way ahead of the curve here. It’s simultaneously really exciting science but also premature pseudoscience.”
Biomedical engineer Marom Bikson, who uses tDCS to treat depression at the City College of New York, agrees. “There’s a lot of snake oil.”
Sexual problems can be emotional and societal
Prause, also a licensed psychologist, is keen to avoid overselling brain stimulation. “The risk is that it will seem like an easy, quick fix,” she said. For some, it will be, but for others it will be a way to test whether brain stimulation can work – which Prause sees as a more balanced approach than using medication. “To me, it is much better to help provide it for people likely to benefit from it than to try to create fake problems to sell it to everyone.”
Sexual problems can be triggered by societal pressures that no device can fix. “There’s discomfort and anxiety and awkwardness and shame and lack of knowledge,” said psychologist Leonore Tiefer, who specializes in sexuality. Brain stimulation is just one of many physical interventions companies are trying to develop to make money, she says. “There’s a million drugs under development. Not just oral drugs but patches and creams and nasal sprays, but it’s not a medical problem,” she said.
Thinking about low sex drive as a medical condition requires defining what’s normal and what’s unhealthy. “Sex does not lend itself to that kind of line drawing. There is just too much variability both culturally and in terms of age, personality and individual differences. What’s normal for me is not normal for you, your mother or your grandmother.”
And Prause says that no device is going to solve a “Bob problem” – when a woman in a heterosexual couple isn’t getting aroused because her partner’s technique isn’t any good. “No pills or brain stimulation are going to fix that,” she said.
Female sexual function is an important component of a woman’s sexual health and overall well-being. New research examines the relation between female sexual functioning and changes in relationship status over time.
Female sexual functioning is influenced by many factors, from a woman’s mental well-being to age, time, and relationship quality.
Studies show that sexual dysfunction is common among women, with approximately 40 million American women reporting sexual disorders.
A large study of American adults between the ages 18-59 suggests that women are more likely to experience sexual dysfunction than men, with a 43 percent and 31 percent likelihood, respectively.
Treatment options for sexual dysfunction in women have been shown to vary in effectiveness, and the causes of female sexual dysfunction still seem to be poorly understood.
New research sheds light on the temporal stability of female sexual functioning by looking at the relationship between various female sexual functions and relationship status over a long period of time.
Studying the link between relationship status and female sexual desire
Previous studies that examined sexual functions in women did not look at temporal stability and possible interactions between different female sexual functions.
But researchers from the University of Turku and Åbo Akademi University – both in Finland – looked at the evolution of female sexual desire over a period of 7 years.
The new study was led by Ph.D. candidate in psychology Annika Gunst, from the University of Turku, and the results were published in the Psychological Medicine science journal.
Researchers examined 2,173 premenopausal Finnish women from two large-scale data collections, one in 2006 and the other 7 years later, in 2013.
Scientists used the Female Sexual Function Index – a short questionnaire that measures specific areas of sexual functioning in women, such as sexual arousal, orgasm, sexual satisfaction, and the presence of pain during intercourse.
Researchers took into consideration the possible effects of age and relationship duration.
The average age of the participants at the first data collection was 25.5 years. Given that the mean age was quite low and the average age of menopause is much later, at 51 years, the researchers did not think it necessary to account for the possible effects of hormonal changes.
Relationship status influences sexual desire over time
Of the functions examined, women’s ability to orgasm was the most stable over the 7-year period, while sexual satisfaction was the most variable.
The ability to have an orgasm improved across all groups during the study, with single women experiencing the greatest improvement.
Women with a new partner had a slightly lower improvement in orgasmic ability than single women, but a higher improvement than women who had been in the same relationship over the 7-year period.
The study found that women who had stayed in the same monogamous relationship over the entire 7-year observation period experienced the greatest decrease in sexual desire.
By contrast, women who had found a new partner over the study duration experienced lower decreases in sexual desire.
Women who were single at the end of the observation period reported stable sexual desire.
According to the researchers, relationship-specific factors or partner-specific factors that have no connection with the duration of the relationship do have an impact on women’s sexual functions. Consequently, healthcare professionals should account for partner-specific factors when they treat sexual dysfunction in women.
However, researchers also point out that sexual function needs to be further examined in a short-term study to have a better understanding of the diversity in sexual function variation.
Strengths and limitations of the study
Researchers point out the methodological strengths of the study, as well as its limitations.
Firstly, because the study was longitudinal, it reduced the so-called recall bias, meaning that participants reported their own experience with higher accuracy.
The study also benefited from a large study sample, validated measures, and structural equation modeling, which reduces errors in measurement.
However, the authors note that the long 7-year timeframe may not account for short-term fluctuations, and varying sexual functions may interact differently when studied over a long period of time.
The study did not examine sexual dysfunctions.
Finally, the authors mention that they did not have access to data about cohabitation, or about the duration of singlehood.
Hello and welcome to almost 2017, a time when millions of people have pledged their hearts (and vaginas) to a fictional character named Christian Grey who likes to engage in BDSM. Although the 50 Shades of Grey fervor is alive and well, especially as the second movie’s premiere approaches, tons of myths about BDSM persist.
“‘BDSM’ is a catch-all term involving three different groupings,” Michael Aaron, Ph.D., a sex therapist in New York City and author of Modern Sexuality, tells SELF. First up, BD, aka bondage and discipline. Bondage and discipline include activities like tying people up and restraining them, along with setting rules and meting out punishments, Aaron explains. Then there’s DS, or dominance and submission. “Dominance and submission are more about power dynamics,” Aaron explains. Basically, one person will give the other power over them, whether it’s physical, emotional, or both. Bringing up the rear, SM is a nod to sadism, or liking to inflict pain, and masochism, liking to receive it. It’s often shortened to “sadomasochism” to make things easier.
Got it? Good. Now, a deep dive into 9 things everyone gets wrong about BDSM.
1. Myth: BDSM is a freaky fringe thing most people aren’t into.
“There’s a lot of misunderstanding about how common this is,” Aaron says. “A lot of people may think just a small minority has these desires.” But sex experts see an interest in BDSM all the time, and a 2014 study in the Journal of Sexual Medicine also suggests it isn’t unusual. Over 65 percent of women polled fantasized about being dominated, 47 percent fantasized about dominating someone else, and 52 percent fantasized about being tied up.
“It’s 100 percent natural and normal [to fantasize about BDSM], but some people come and see me with shame,” certified sex coach Stephanie Hunter Jones, Ph.D., tells SELF. There’s no need for that. “It’s a healthy fantasy to have and one that should be explored,” Jones says.
2. Myth: BDSM is always about sex.
Sex isn’t a necessary part of the action. “BDSM doesn’t have to be sexual in nature—some people like it for the power only,” Jones says. It’s possible to play around with BDSM without involving sex, but for some people, incorporating it into sex ratchets things way up.
3. Myth: You can spot a BDSM fan from a distance.
All sorts of people like BDSM, including those who seem straitlaced. For them, it can actually be especially appealing because it offers a chance to exercise different parts of their personalities. “Some of the most conservative-seeming individuals are into BDSM,” Jones says.
4. Myth: If you’re into BDSM, your past must be one big emotional dumpster fire.
“One of the biggest misconceptions is that people do BDSM because of some sort of trauma in their background,” Aaron says. People who engage in BDSM aren’t automatically disturbed—a 2013 study in the Journal of Sexual Medicine actually found that BDSM proponents were as mentally sound, if not more so, than people who weren’t into it. “We conclude that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes,” the study authors wrote.
5. Myth: BDSM is emotionally damaging.
When done properly, BDSM can be the exact opposite. “I often use BDSM as a healing tool for my ‘vanilla’ couples,” or couples that don’t typically engage in kink, Jones says. She finds it especially helpful for people who struggle with control and power dynamics.
To help couples dig themselves out of that hole, Jones will assign sexual exercises for them to complete at home. Whoever feels like they have less power in the relationship gets the power during the role play. “This has saved relationships,” Jones says, by helping people explore what it feels like to assume and relinquish control first in the bedroom, then in other parts of the relationship.
6. Myth: The dominant person is always in charge.
When it comes to dominance and submission, there are plenty of terms people may use to describe themselves and their partners. Top/bottom, dom (or domme, for women)/sub, and master (or mistress)/slave are a few popular ones. These identities are fluid; some people are “switches,” so they alternate between being submissive and dominant depending on the situation, Jones explains.
Contrary to popular opinion, the dominant person doesn’t really run the show. “In a healthy scene [period of BDSM sexual play], the submissive person is always the one in control because they have the safeword,” Jones says. A safeword is an agreed upon term either person can say if they need to put on the brakes. Because a submissive is under someone else’s control, they’re more likely to need or want to use it. “Whenever the safeword is given, the scene stops—no questions asked,” Jones says.
7. Myth: You need a Christian Grey-esque Red Room to participate in BDSM.
Christian should have saved his money. Sure, you can buy BDSM supplies, like furry blindfolds, handcuffs, whips, paddles, floggers, and rope. But there’s a lot you can do with just your own body, Jones explains: “You can use fingers to tickle, you can use hands to spank.” You can also use things around the house, like scarves, neckties, and stockings for tying each other up, wooden spoons for spanking, and so on. Plus, since your mind is the ultimate playground, you may not need any other toys at all.
8. Myth: If your partner is into BDSM, that’s the only kind of sex you can have.
When you’re new to BDSM but your partner isn’t, you might feel like you need to just dive in. But you don’t have to rush—people who are into BDSM can also like non-kinky sex, and it can take some time to work up to trying BDSM together. And much like your weekly meals, BDSM is better when planned. “BDSM should never be done spontaneously,” Jones says. Unless you’ve been with your partner for a long time and you two are absolutely sure you’re on the same page, it’s always best to discuss exactly what you each want and don’t want to happen, both before the scene happens and as it actually plays out.
9. Myth: BDSM is dangerous.
The BDSM community actually prides itself on physical and emotional safety. “A number of discussions around consent are integral to individuals in the community—people have negotiations around what they’re going to do,” Aaron says. People in the community use a couple of acronyms to emphasize what good BDSM is: SSC, or Safe, Sane, and Consensual, and RACK, or Risk-Aware Consensual Kink.
Of course, sometimes it’s still a gamble. “A number of things people do have some danger—boxing, skydiving, and bungee jumping are all legal—but it’s about trying to be as safe as possible while understanding that there’s some inherent risk,” Aaron says. It’s up to each person to set parameters that allow everyone involved to enjoy what’s going on without overstepping boundaries.
If you’re interested in trying BDSM, don’t feel overwhelmed—you can take baby steps.
“There are a number of entry points for people,” Aaron says. One is FetLife, a social media website for people with various kinks. You can also look into Kink Academy, which offers educational videos for different payment plans starting at $20 a month. Another option is Googling for “munches,” or non-sexual meet-and-greets for kinky people in your area, along with searching for kink-related organizations in your city—most big cities have at least one major resource. They usually go by different names, like TES in New York City and Black Rose in D.C., Aaron explains, but when you find yours, you may be on the road to opening up your sex life in a pretty exciting way.