title: Rheumatic diseases and sexuality: Disease impact and self-management strategies.
abstract: OBJECTIVE
  To explore how intimate relationships and sexuality are influenced by rheumatic diseases and to describe self-management strategies used to manage disease consequences.
  
  
  METHODS
  To ensure that data were grounded in patients' language and experiences, individual and focus group interviews were conducted. Purposeful sampling was used to ensure variation in age, sex, disease duration, diagnosis, and marital status among the informants. Participants were men and women ages 18 years or older, were diagnosed with inflammatory rheumatic disease by a rheumatologist, and had a disease duration of ≥2 years.
  
  
  RESULTS
  The mean age of the 23 participants was 44 years, the mean disease duration was 13.6 years, and the mean ± SD modified Health Assessment Questionnaire score was 1.58 ± 0.46. Four key themes summarized the main issues described by the informants: between disease and normality, relational aspects, disease-related sexual challenges, and self-management strategies. The results reveal that the disease constituted a disruption in life, requiring a new orientation of sexual identity and relationship. Participants' experiences of sexuality went beyond specific sexual activity, including aspects such as body image and relational issues, illustrating a multidimensional perception of sexuality. A large inter- and intrapersonal variety of impact and a wide range of management strategies were reported.
  
  
  CONCLUSIONS
  This study shows that sexuality is a vital area of life for people living with arthritis. It is a source of physical pleasure and intimacy with their partner, but may cause anxiety and distress when affected by rheumatic disease. However, various self-management strategies are applied to enhance intimate relationships and sexual activity. Knowledge and openness concerning sexual issues need to be emphasized as part of the competence of health professionals and researchers.
authors.affiliation: Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Helland
authors.forename: Ingvild
authors.initials: I
authors.lastname: Kjeken
authors.forename: Eldri
authors.initials: E
authors.lastname: Steen
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.forename: Mona-Iren
authors.initials: MI
authors.lastname: Hauge
authors.forename: Hanne
authors.initials: H
authors.lastname: Dagfinrud
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001828:Body Image; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009664:Norway; D012216:Rheumatic Diseases / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D012648:Self Care; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology* / Q000503:physiopathology; D019529:Sexuality; D012803:Sick Role; D011795:Surveys and Questionnaires