This article explores ankylosing spondylitis and how it affects sex.
What Is the Connection Between Sexual Problems and AS?
Ankylosing spondylitis can significantly affect an individual’s sexual function and desire. This condition causes spinal inflammation, leading to pain and stiffness in the back, shoulders, ribs, hips, knees, ankles, and feet. When symptoms are not under control with treatment, sex can feel painful and overwhelming.
Research shows that sexuality is an essential part of our overall health, and sexual expression is crucial to our identity. Sexual problems with AS can lead to decreased function, decreased quality of life, and depression. When people with AS experience disease progression and poor function, their sexual relationships are negatively impacted.
Do AS Medications Cause Sexual Problems?
There are several types of medications that are used to treat AS. These may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) Biologics like Enbrel (etanercept) and Humira (adalimumab) Janus kinase (JAK) inhibitors like Xelijanz (tofacitinib) and Rinvoq (upadacitinib) Corticosteroids like prednisone Disease-modifying antirheumatic drugs (DMARDs) like Rheumatrex (methotrexate)
Some side effects of these medications may affect sexual function. Corticosteroids may cause mood changes, headaches, fatigue, and decreased sexual desire. Methotrexate has been associated with reduced libido, erectile dysfunction, and impotence. Biologics are used to treat inflammatory pain and some may result in headaches, which may affect sexual desire.
How Are Sexual Problems With AS Medications Treated?
Talk with your healthcare provider if you suspect your medication is affecting your sexual function. They may be able to recommend changes to your treatment plan.
Possible strategies include:
Lowering the medication dosage Switching to a different medication Adding a new medication to the treatment plan, such as Viagra (sildenafil) or Cialis (tadalafil) Taking a break from your medications Scheduling sexual activity for times of day when the side effects are lower Meeting with a mental health provider to learn how to cope with the side effects
Symptoms and Gender Differences
AS affects males and females differently. It also affects their sexual health differently. Males experience a more significant reduction in sexual function than females.
Men
Research shows that men experience more severe sexual function declines than females because men tend to experience more damage to the hips and spine in those with AS. Males with ankylosing spondylitis have reported changes in the following:
Erectile dysfunctionOrgasmic functionSexual driveIntercourse satisfaction
Women
While males tend to have more damage from AS, females experience and report more pain from this condition. A study found that sexual impairment is related to the degree of disease severity. This means that the more severe your disease is, the higher the likelihood you will experience changes in sexual function.
Females with AS have reported lower levels of sexual desire and sexual arousal.
How Are Sexual Problems With AS Treated?
Because the severity of the disease affects sexual function, it’s important to treat AS effectively. Managing the pain and stiffness associated with this condition can improve sexual function. Treatments for AS include:
MedicationsPhysical therapy (posture training, flexibility, and strengthening)Daily exerciseAssistive devices (cane or walker)Stress managementMaintaining a healthy weightAvoiding smoking and tobacco products
In addition to these treatments, talk with your healthcare provider or physical therapist about sexual function. Your provider may have recommendations to improve both your symptoms and sexual function. Some ideas to try include:
Ask your physical therapist about sexual positions that minimize pain or discomfort. Talk with your partner about your symptoms and concerns. Plan the best time of day for sexual activity based on your pain level and medication side effects. Use assistive props such as cushions to make yourself more comfortable.
Summary
Ankylosing spondylitis (AS) is a form of arthritis that causes inflammation in the joints and ligaments in the spine. This inflammation leads to back pain and stiffness. People with AS may experience decreased sexual function due to chronic pain and medication side effects. The best way to improve sexual health is to manage AS symptoms effectively. Work with your healthcare provider to improve your treatment and address sexual concerns.
A Word From Verywell
Sexual health is not a topic that many people are comfortable discussing with a healthcare provider. It’s common to avoid the conversation and figure out a solution on your own. However, a decline in sexual function is typical for people with AS, and your healthcare provider may be able to help. Consider making an appointment to share your concerns and ask for help.
