Can rheumatoid arthritis cause erectile dysfunction (ED)? Some studies link rheumatoid arthritis with erection difficulties but the findings are mixed. Possible contributors include inflammation, pain, fatigue, low mood and in some cases, medicines. If your erections have changed, you are not alone.
ED is often treatable. In this guide, DirectMeds explains what the research shows and what to discuss with your doctor.
How Frequent Is ED in Patients With Rheumatoid Arthritis?
The findings are mixed. Some studies report more sexual difficulties in men with RA, but not all found a higher rate of ED. The Australian Institute of Health and Welfare (AIHW) estimates that about 514,000 Australians (2.0%) were living with rheumatoid arthritis in 2022 based on self reported survey data. RA affects 1.6% of men and 2.5% of women. It commonly starts between the ages of 35 & 64 and prevalence is highest in people aged 75 and over. Healthy Male reports that about one in five Australian men over 40 has ED.
Study | Who was studied | Key finding |
Meta analysis of 7 studies, 44,745 people (6,642 with RA) | RA was associated with a 1.99-fold higher risk of sexual dysfunction in men (low certainty evidence, sexual dysfunction broadly not ED specifically) | |
Taiwanese national claims data | Men with ED had 1.67 times the odds of having had RA, even after adjusting for other health conditions | |
Systematic review of 55 studies across inflammatory arthritis | Men with inflammatory arthritis reported sexual problems, including erection difficulties. In the groups that reported the erectile function index, average scores were 25 or lower, a range associated with ED. This describes group averages, so it does not mean every man had ED | |
260 men with RA vs 260 matched men in Minnesota | No significant increase in ED in RA (hazard ratio 0.80). The authors suggested well-controlled disease as a possible explanation but this was not tested |
The Minnesota study found no significant increase in ED in men with RA. The authors suggested that well-controlled disease might explain this but the study did not show that good control protects against ED. The studies above show associations, not that RA causes ED and the 1.99 figure refers to sexual dysfunction broadly.
Why Might Rheumatoid Arthritis Be Linked to Erectile Dysfunction?
RA can affect more than the joints, and several factors may play a part in sexual function.
Cause | How it can affect erections | Evidence |
Inflammation and blood vessel damage | Researchers suggest the link may run through RA-induced endothelial dysfunction, meaning damage to the lining of blood vessels | |
Pain, stiffness and fatigue | Limit energy, strength and interest. In a 2018 study, more than half of people with RA reported sex-life problems | |
Low mood and body image | Reviews found lowered mood, reduced self-esteem and poor body image affect sexual function in inflammatory arthritis | |
Low testosterone | 24.1% of 170 men with RA had testosterone deficiency in one study. An earlier report found it in 31.7% of men with RA vs 7.1% of healthy controls | |
Heart and vessel risk | Both RA and ED are associated with higher cardiovascular risk and ED can sometimes be an early warning sign of cardiovascular disease |
It's easy to miss the role of pain and exhaustion. As one rheumatologist explained to WebMD, some people with rheumatoid arthritis (RA) just don't feel like doing anything physical and have lower muscle power. In addition, pain in other parts of the body can affect people's interest in sex, according to a psychologist consulted in association with the article.
One small study from Egypt showed a significant difference in erectile function rates between male RA patients and the control group adjusted for other factors, as well as a gap in depression levels and testosterone rates.
Can RA Medicines Affect Erections?
Some medicines may contribute to sexual symptoms in some men but the evidence is limited and the condition itself can also play a role. For other RA treatments, we did not find studies linking them to ED.
Medicine | Examples | What the evidence says | Evidence strength |
Corticosteroids | Prednisone, prednisolone | Limited: studies were small, measured testosterone and were not in men with RA | |
Methotrexate | Methotrexate | In a 2024 study of 109 patients with arthritis, the overall unadjusted comparison showed no significant difference. Men who had taken methotrexate for five years or more had lower erection scores (17 vs 20). Two case reports describe ED that resolved after stopping. None of this shows that methotrexate causes ED | Limited, with mixed results |
TNF inhibitors (biologics) | Adalimumab, etanercept | No clear link to ED found. Whether controlling inflammation affects erections has not been established | Very limited |
Other RA medicines | NSAID painkillers, sulfasalazine, hydroxychloroquine | We found no studies linking them directly to ED | Limited |
Corticosteroids can lower testosterone in some men and low testosterone can reduce libido and may contribute to erection difficulties. A 2024 systematic review of case reports of sexual dysfunction with methotrexate included mostly people with rheumatoid arthritis and the patients reported no previous ED before starting the drug. A small number of reports cannot show that methotrexate caused the problem.
Do not stop or change RA medicines yourself. If you notice erection problems, discuss them with the doctor who prescribes your RA treatment. Whether better RA control improves erections has not been established.
When to See a Doctor About ED and Rheumatoid Arthritis
Studies have linked RA with erection difficulties, but the findings are mixed. ED has many possible causes, so it is worth getting it checked.
Risk factor | What the research found | Source |
Low testosterone | Found in 24.1% of 170 men with RA in one study | |
Age | Odds of ED rise 11% with each year of age after 45 | |
Diabetes | 2.66 times the odds of moderate or complete ED in Australian men | |
Anxiety or depression treatment | 2.36 times the odds | |
Smoking over 20 a day | 1.86 times the odds |
ED can be an early warning sign
ED can sometimes be an early warning sign of cardiovascular disease and RA is also associated with higher cardiovascular risk. Tell your GP about new or worsening ED especially if you also have high blood pressure, diabetes or high cholesterol.
When to consult a doctor
Schedule a consultation if:
- See a doctor if erection difficulties recur, worry you or begin after a medication change
- It began or become severe following a new RA medication or a steroid therapy
- You also have reduced libido, insomnia or depression
- Your RA symptoms or flares are becoming more frequent
- Call 000 for current chest pain or severe breathlessness.
Don't always expect rheumatologists to address the issue. According to Healio, patients are not always willing to discuss sexual health issues and in another piece by Healio, it is stated that these problems often remain unaddressed as a result of ineffective communication from both sides.
Treatment and Management: What Can Help
ED in men with RA is often treatable and your doctors can look at your RA and your ED together.
- Keep up with your RA care. Regular reviews with your rheumatologist help manage your RA. Whether better RA control improves erections has not been established.
- Ask your doctor to review your medicines. Do not reduce or stop steroids or other RA medicines yourself.
- Ask whether hormone testing is appropriate. A doctor may check testosterone, and a single result doesn’t necessarily establish deficiency.
- Look after your mental health. Pain, fatigue, anxiety and low mood can affect sexual function. Talking with your doctor or a counsellor may help.
- Look after your general health. Not smoking, regular activity and a healthy weight are linked with better sexual health in general.
Practical tips for pain, fatigue and intimacy
The following information is based on what rheumatologists and a psychologist informed WebMD of.
Challenge | What can help |
Pain and stiffness | Take pain medicine ahead of time, and use a warm bath, shower or heat pad to ease stiff joints |
Fatigue | Pick times when you feel your best rather than stiff mornings, and nap if you need to |
Communication | Be open with your partner. Saying "today is a bad arthritis day" avoids being misread as lost interest |
Positions | Experiment, and use rolled-up pillows to support sore joints |
Confidence and mood | Raise it with your doctor, who can help get pain and fatigue under control |
ED treatment options
When ED persists, it is necessary for a doctor to evaluate not only your RA medication, but also your level of blood pressure, blood sugar level and psychological health and then to present an appropriate treatment plan. Where suitable, a doctor may discuss prescription treatment options. In Australia, it is necessary for a doctor to assess the patient first before issuing prescriptions for ED medication. Your doctor also needs to be aware of all other medicines you use.
Talk to an Australian doctor online
DirectMeds offers online consultations with AHPRA registered doctors, subject to availability. Tell the doctor about your RA, medicines and symptoms. They may recommend you also speak with your rheumatologist. Start your online ED assessment with DirectMeds
Frequently Asked Questions
Can rheumatoid arthritis cause erectile dysfunction?
Some studies link RA with erection difficulties but the findings are mixed. A low certainty meta analysis found that RA was associated with about twice the risk of sexual dysfunction in men which covers sexual problems broadly, not ED specifically. A Minnesota study of 260 men with RA found no significant increase in ED and the authors suggested good disease control as a possible explanation. These studies show associations, not that RA causes ED.
Can prednisone cause erectile dysfunction?
Prednisone can lower testosterone in some men which may contribute to reduced libido or erection difficulties. We did not find studies showing that it causes ED in men with RA. Do not stop or change prednisone yourself. Discuss any symptoms with your prescriber.
Does methotrexate cause ED?
The evidence is limited. In a 2024 study of 109 patients with arthritis, the overall unadjusted comparison showed no significant difference, but men who had taken methotrexate for five years or more had lower erection scores. Case reports describe ED that resolved after stopping but these do not prove methotrexate was the cause. Do not stop methotrexate yourself. Discuss any symptoms with your prescriber.
Is it safe to take ED medication with rheumatoid arthritis?
It depends, and a doctor needs to assess you first. The doctor will consider any RA medications you are on, your heart and blood pressure, and any nitrate medications that should not be taken with ED medications. It is important to inform the doctor of all the medications you are taking.
Does ED mean my RA is getting worse?
Not necessarily. ED has many causes. Whether RA disease activity affects ED has not been established, and the research is mixed. It is worth telling your rheumatologist, especially if ED appears alongside flares.
Can RA affect sex drive as well as erections?
Yes. WebMD states that RA is associated with a decrease in libido in addition to ED and the 2019 systematic review covering 55 papers showed that decreased libido was a common factor in inflammatory arthritis.
