Ankylosing Spondylitis (AS) and Sex: How AS Can Affect Sexual Health?

Ankylosing spondylitis (AS) can significantly impact a person's sexuality and sexual activity. Because there is no cure for AS, it is important to address the symptoms, including back pain and stiffness, to improve the quality of life.

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 dysfunction
• Orgasmic function
• Sexual drive
• Intercourse 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:

• Medications
• Physical therapy (posture training, flexibility, and strengthening)
• Daily exercise
• Assistive devices (cane or walker)
• Stress management
• Maintaining a healthy weight
• Avoiding 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.