Q: May 10 was World Lupus day. What are the sexual impacts of this illness on women?
A. Systemic lupus erythematosus (SLE), commonly referred to as lupus, is an autoimmune illness that can affect any organs or system in the body. The severity and course of disease can be unpredictable, making the acute flares of this chronic illness most difficult to manage.
Research has been conducted that shows a link between distress of women regarding desire, arousal, lubrication, orgasm and pain. Sexual health and pleasure can be impacted by joint pain, mouth sores, vaginal ulcers and a decrease in lubrication from the glands can slow sexual responsiveness and make both foreplay and intercourse painful.
Lupus can have a physical and an emotional impact; physical pain during oral sex due to lesions in the mouth such as sores, vaginal ulcers causing pain with foreplay and penetration, vaginal dryness and tightness of the skin can cause friction and pain as well as fatigue, headaches, extreme temperature changes and joint pain.
Some physical adjustments, such as using pillows for support, trying out more comfortable sexual positions, warming the lubricant before applying can often promote comfort during sex. Taking a warm shower or bath as part of foreplay can relax sore muscles and joints.  
Taking anti-inflammatory medication may also provide relief before and after sex.
Good communication and understanding, other forms of physical contact such as gentle massage, tender touching and a loving embrace can provide intimacy without penetrative sex. Sex toys can be incorporated as well as self-play, which is encouraged as it is fulfilling and does not depend on having a partner.
• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za. Mofokeng has recently been named SA's Commissioner of Gender Equality by President Cyril Ramaphosa.
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