Does arthritis cause erectile dysfunction? This question concerns many men living with joint conditions who notice changes in their sexual health. Whilst arthritis primarily affects the joints, causing pain and inflammation, research shows that men with certain types of arthritis—particularly rheumatoid arthritis and ankylosing spondylitis—report higher rates of erectile dysfunction. The relationship is complex, involving shared mechanisms such as chronic inflammation, vascular changes, medication side effects, and psychological factors. Understanding these connections can help you and your healthcare team address both conditions effectively, improving your overall quality of life.

Understanding the Link Between Arthritis and Erectile Dysfunction

Arthritis and erectile dysfunction (ED) are both common conditions that can significantly impact quality of life, particularly in men over 50. Whilst arthritis primarily affects the joints, causing pain, stiffness, and inflammation, erectile dysfunction involves difficulty achieving or maintaining an erection sufficient for sexual activity. Research suggests there may be connections between these conditions, though the relationship is complex and multifactorial.

Men with certain types of arthritis, particularly rheumatoid arthritis and ankylosing spondylitis, report higher rates of erectile dysfunction compared to the general population. However, arthritis is associated with higher ED prevalence, but a direct causal relationship is not established. Instead, multiple shared mechanisms appear to be implicated, including chronic systemic inflammation, reduced physical activity, psychological factors such as depression and anxiety, and the side effects of certain medications used to manage arthritis.

Vascular health plays a crucial role in this association. Both rheumatoid arthritis and ankylosing spondylitis are associated with increased cardiovascular risk, endothelial dysfunction (damage to the inner lining of blood vessels), and atherosclerosis. Since erectile function depends on healthy blood flow, the vascular changes seen in inflammatory arthritis may contribute to erectile difficulties. Erectile dysfunction can itself be an early warning sign of cardiovascular disease, as the smaller blood vessels in the penis may show signs of damage before larger coronary arteries.

Understanding these connections can help healthcare professionals provide comprehensive care that addresses both musculoskeletal and sexual health concerns, improving overall wellbeing for patients living with arthritis. If you are experiencing erectile dysfunction alongside arthritis, it is important to discuss this with your GP, who can assess your cardiovascular risk and explore treatment options tailored to your individual circumstances.

How Arthritis Can Affect Sexual Function

Arthritis can impact sexual function through several mechanisms, both physical and psychological. Chronic pain and joint stiffness are perhaps the most obvious barriers, making certain positions uncomfortable or physically difficult to maintain. Hip, knee, and lower back arthritis can particularly affect mobility during sexual activity, whilst hand and wrist involvement may limit the ability to support body weight or engage in foreplay.

Fatigue is another significant factor, as it is a common symptom of inflammatory arthritis conditions such as rheumatoid arthritis and psoriatic arthritis. This persistent tiredness can reduce libido and sexual desire, making intimacy feel like an additional burden rather than a pleasurable activity. The unpredictable nature of arthritis flares can also create anxiety about planning intimate moments, further diminishing sexual confidence.

From a physiological perspective, chronic systemic inflammation associated with inflammatory arthritis may contribute to erectile dysfunction through vascular mechanisms. Inflammatory cytokines (signalling molecules released during inflammation) can damage the endothelium, impairing the normal vasodilation (widening of blood vessels) required for achieving an erection. Men with active rheumatoid arthritis and ankylosing spondylitis have higher levels of inflammatory markers and increased cardiovascular risk, which may contribute to erectile difficulties.

Psychological factors cannot be overlooked. Living with a chronic, painful condition often leads to depression, anxiety, and reduced self-esteem, all of which are recognised risk factors for erectile dysfunction. Body image concerns, particularly if arthritis has caused visible joint deformities or weight changes due to reduced activity, may further impact sexual confidence. Additionally, relationship strain from the challenges of managing a chronic illness can affect intimacy and communication between partners, indirectly contributing to sexual difficulties.

Practical strategies can help manage these challenges. Consider scheduling intimacy for times when pain and fatigue are lowest, often after rest or medication. Taking pain relief in advance, gentle warm-up exercises or stretching, using pillows or supports to protect joints, and exploring different positions that minimise joint stress can all make a significant difference. Your GP, physiotherapist, or occupational therapist can provide tailored advice on joint protection during sexual activity. Versus Arthritis, a UK charity, also offers practical guidance on sex and relationships for people living with arthritis.

Medications for Arthritis That May Impact Erections

Several medications commonly prescribed for arthritis management have the potential to affect erectile function, though the evidence varies in strength across different drug classes. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and diclofenac, are frequently used for pain relief in arthritis. Some observational research has suggested a possible association between long-term, high-dose NSAID use and erectile dysfunction, possibly through effects on vascular function, but the evidence is inconsistent and may be confounded by other factors. The clinical significance of this association remains uncertain.

Corticosteroids, such as prednisolone, are often prescribed to manage inflammation in rheumatoid arthritis and other inflammatory conditions. These medications can affect sexual function through multiple pathways, including suppression of testosterone production, weight gain, mood changes, and increased cardiovascular risk factors such as hypertension and diabetes. However, it is worth noting that controlling inflammation with corticosteroids may actually improve overall wellbeing and indirectly benefit sexual function in some patients.

Disease-modifying antirheumatic drugs (DMARDs), including methotrexate, sulfasalazine, and hydroxychloroquine, form the cornerstone of rheumatoid arthritis treatment. There is limited evidence directly linking these medications to erectile dysfunction, though methotrexate can occasionally cause fatigue and gastrointestinal side effects that may indirectly affect sexual desire. Biologic therapies, such as TNF-alpha inhibitors (etanercept, adalimumab, infliximab), generally have not been associated with erectile dysfunction; in fact, by effectively controlling inflammation, they may improve overall quality of life and potentially sexual function.

Opioid analgesics, sometimes prescribed for severe arthritis pain, can cause opioid-induced hypogonadism (low testosterone), which may lead to reduced libido and erectile dysfunction. Gabapentinoids (gabapentin, pregabalin) and tricyclic antidepressants (amitriptyline), occasionally used for chronic pain, can also affect sexual function through various mechanisms.

Some patients with arthritis may take antidepressants for associated depression or, in the case of duloxetine, for chronic pain. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are well-recognised causes of sexual dysfunction, including erectile difficulties and reduced libido. It is important to note that duloxetine is not routinely recommended by NICE for osteoarthritis; any use for osteoarthritis pain would be off-label in the UK.

If you suspect your arthritis medication is affecting your sexual function, it is essential to discuss this with your GP or rheumatologist rather than stopping treatment, as there may be alternative options available. You can also report suspected side effects via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Managing Both Conditions: Treatment Options

Effective management of both arthritis and erectile dysfunction requires a holistic approach that addresses physical, psychological, and lifestyle factors. Optimising arthritis control is fundamental, as reducing pain, inflammation, and fatigue can significantly improve overall quality of life and sexual function. Working with your rheumatology team to find the most effective disease-modifying treatment with minimal side effects is an important first step. NICE guidelines recommend early referral to rheumatology and a treat-to-target approach with DMARD therapy, aiming for remission or low disease activity in rheumatoid arthritis, to prevent joint damage and maintain function.

Lifestyle modifications can benefit both conditions simultaneously. Regular physical activity, tailored to your arthritis limitations, improves cardiovascular health, reduces inflammation, maintains joint mobility, and enhances mood—all factors that support erectile function. The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity activity weekly, which might include swimming, cycling, or walking. Weight management is particularly important, as obesity is a risk factor for both arthritis progression and erectile dysfunction. A balanced diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids may help reduce inflammation whilst supporting vascular health. Smoking cessation and moderating alcohol intake are also important, as both smoking and excessive alcohol can worsen erectile function and cardiovascular health.

For erectile dysfunction specifically, phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are first-line treatments. These medications work by enhancing the natural erectile response to sexual stimulation by increasing blood flow to the penis. They are generally safe and effective when used appropriately.

Important safety information for PDE5 inhibitors:

• Do not use with nitrates (e.g., glyceryl trinitrate for angina) or nicorandil, as this can cause a dangerous drop in blood pressure

• Use with caution if you take alpha-blockers for prostate problems or high blood pressure, as the combination may lower blood pressure

• Your GP will assess whether you are cardiovascularly stable enough for sexual activity before prescribing

• Common side effects include headache, flushing, indigestion, and nasal congestion

• Rare but serious side effects include sudden vision or hearing loss—seek immediate medical attention if these occur

Your GP can assess suitability and prescribe these medications if appropriate. If PDE5 inhibitors are unsuitable, ineffective, or contraindicated, alternative treatments are available, including vacuum erection devices (mechanical pumps that draw blood into the penis) and alprostadil (a medication that can be applied inside the urethra or injected into the penis to promote erections). If blood tests confirm persistent low morning testosterone levels (measured on two separate occasions), your GP may refer you to an endocrinologist to consider testosterone replacement therapy, though this is only appropriate where true hypogonadism is confirmed.

Psychological support should not be overlooked. Cognitive behavioural therapy (CBT) or psychosexual counselling can help address anxiety, depression, and relationship issues that may be contributing to erectile difficulties. Some NHS services offer specialist psychosexual therapy, and organisations such as Relate provide relationship counselling. Communication with your partner about physical limitations, pain management, and sexual preferences can help maintain intimacy and reduce performance anxiety. Exploring different positions that minimise joint stress, using pillows for support, and timing intimate activity for when pain and fatigue are lowest can all make a significant difference.

When to Seek Medical Advice

It is important to seek medical advice if you are experiencing erectile dysfunction, particularly if it is persistent, worsening, or affecting your quality of life and relationships. Erectile dysfunction can be an early warning sign of cardiovascular disease, as the smaller blood vessels in the penis may show signs of atherosclerosis before larger coronary arteries. NICE guidance recommends that men presenting with ED should have their cardiovascular risk factors assessed.

Contact your GP if:

• You have persistent difficulty achieving or maintaining erections sufficient for sexual activity

• Erectile dysfunction develops suddenly, particularly if accompanied by other symptoms

• You suspect your arthritis medication may be contributing to sexual difficulties

• You are experiencing significant psychological distress, depression, or anxiety related to either condition

• Your arthritis symptoms are poorly controlled, affecting your daily activities and quality of life

Your GP can conduct a thorough assessment, including medical history, medication review, and physical examination. They will assess your cardiovascular risk using tools such as QRISK3, and arrange appropriate investigations including blood pressure measurement, HbA1c or fasting glucose, lipid profile, and morning total testosterone levels (measured on two separate occasions if hypogonadism is suspected). Additional tests such as prolactin or thyroid function may be requested if clinically indicated.

Seek urgent medical attention if:

• You experience chest pain, breathlessness, or exertional calf pain (claudication, which may suggest peripheral arterial disease) during or after sexual activity, as this may indicate underlying cardiac or vascular disease requiring immediate assessment

• You develop a painful erection lasting more than four hours (priapism)—this is a medical emergency requiring immediate treatment to prevent permanent damage

• You experience sudden vision or hearing loss after taking erectile dysfunction medication

• You notice penile deformity, trauma, or other concerning physical changes

Your GP may refer you to specialist services if needed, including:

• Urology or andrology if PDE5 inhibitors fail, are contraindicated, or if there is suspected Peyronie's disease, post-pelvic surgery or trauma, or complex causes

• Endocrinology if confirmed hypogonadism or other hormonal issues are identified

• Cardiology if there are concerns about cardiovascular stability or fitness for sexual activity

Remember that both arthritis and erectile dysfunction are common, treatable conditions, and healthcare professionals are accustomed to discussing these issues. Open, honest communication with your medical team enables comprehensive assessment and personalised treatment planning that addresses all aspects of your health and wellbeing. Many men find that addressing erectile dysfunction improves not only their sexual health but also their overall confidence and quality of life whilst living with arthritis.

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