Rheumatoid Arthritis and Erectile Dysfunction

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Understanding Rheumatoid Arthritis and Erectile Dysfunction

Published: 14 October 2026

Rheumatoid arthritis and erectile dysfunction (ED) are linked more often than many men realise. Research shows that men with rheumatoid arthritis (RA) are significantly more likely to experience erectile problems than those without the condition [1][2]. This connection exists because RA causes chronic inflammation that can damage blood vessels, reduce testosterone levels, and affect the nerves and circulation needed for healthy erections. Pain, fatigue, reduced mobility, and some arthritis medications can also contribute to erectile difficulties.

How rheumatoid arthritis and erectile dysfunction are connected

Rheumatoid arthritis is an autoimmune condition that causes persistent inflammation throughout the body, not just in the joints. This systemic inflammation can damage the endothelium—the delicate lining of blood vessels—making it harder for arteries to relax and allow sufficient blood flow into the penis during arousal [1][2]. Because erections depend on healthy blood flow, any condition that affects vascular health can contribute to ED.

RA also increases the risk of cardiovascular disease, which shares many risk factors with erectile dysfunction [2]. Men with RA may have higher rates of atherosclerosis (narrowing of the arteries), high blood pressure, and metabolic changes that further impair erectile function. Additionally, chronic inflammation can lower testosterone levels, reducing libido and making erections more difficult to achieve or maintain.

Pain, stiffness, and fatigue from RA can reduce interest in sex and make physical intimacy challenging. Joint pain in the hips, knees, or hands may limit comfortable positions, while the emotional burden of living with a chronic condition can affect mood, self-esteem, and relationships—all of which play a role in sexual function [1].

Medications for rheumatoid arthritis that may affect erections

Some medicines used to manage rheumatoid arthritis can influence erectile function, though the evidence varies. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and diclofenac are commonly prescribed for pain and inflammation. While occasional use is unlikely to cause problems, long-term or high-dose NSAID use has been associated with a slightly increased risk of ED in some studies, possibly due to effects on blood flow and vascular health [2].

Corticosteroids like prednisolone are often used to control RA flares. Prolonged steroid use can affect hormone levels, including testosterone, and may contribute to weight gain, mood changes, and metabolic issues that indirectly impact sexual function. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and biologics are essential for controlling RA progression, and most do not directly cause ED. However, if RA is poorly controlled, the resulting inflammation and fatigue can worsen erectile problems.

If you suspect a medication is affecting your erections, do not stop or change your dose without speaking to your rheumatologist or GP. Uncontrolled RA poses serious health risks, and there are often ways to manage both your arthritis and erectile function effectively [2].

Blood pressure medicines and ED treatments

Men with RA may also take medicines for high blood pressure or other cardiovascular conditions. Some blood-pressure-lowering drugs can add to the blood-pressure-lowering effect of ED treatments, which may cause dizziness or light-headedness [3][4]. This combination is usually manageable, but it must be reviewed by a prescriber during your consultation. Always declare every medicine you take, including over-the-counter painkillers and supplements, so that safety checks can be carried out properly.

Assessment and diagnosis of erectile dysfunction in men with RA

If you are experiencing erectile difficulties and have rheumatoid arthritis, it is important to see your GP for a full assessment. ED can be an early warning sign of cardiovascular disease or diabetes, conditions that are more common in men with RA [1][2]. Your doctor will ask about your symptoms, medical history, current medications, and lifestyle factors such as smoking, alcohol intake, physical activity, and stress levels.

A physical examination and blood tests are usually recommended. Blood tests typically check for diabetes (HbA1c or fasting glucose), cholesterol levels, kidney and liver function, and hormone levels including testosterone [2]. Low testosterone is more common in men with chronic inflammatory conditions and can contribute to reduced libido and erectile problems. If testosterone is low, your GP may refer you to an endocrinologist for further evaluation and possible hormone replacement therapy.

Your GP may also assess your cardiovascular health, particularly if you have other risk factors such as high blood pressure, high cholesterol, or a family history of heart disease. Managing these conditions effectively can improve both your overall health and your erectile function. Once any underlying causes have been identified and addressed, oral ED treatments can be considered if appropriate [2].

Lifestyle measures to support erectile function with rheumatoid arthritis

Lifestyle changes can make a meaningful difference to erectile function, even when you have a chronic condition like rheumatoid arthritis [1][2]. Regular physical activity helps control inflammation, improve cardiovascular health, maintain a healthy weight, and boost mood—all of which support better erections. Low-impact exercises such as swimming, cycling, walking, or yoga are often suitable for people with RA and can be adapted to your current mobility and pain levels.

A balanced, anti-inflammatory diet rich in fruits, vegetables, whole grains, oily fish, nuts, and seeds may help reduce RA inflammation and support vascular health. Limiting processed foods, red meat, sugar, and saturated fats can also benefit both your arthritis and your erectile function. Maintaining a healthy weight reduces strain on joints and lowers the risk of diabetes and cardiovascular disease, both of which are linked to ED [1].

Smoking is particularly harmful for men with RA because it worsens inflammation, increases cardiovascular risk, and directly impairs blood flow to the penis [1]. Stopping smoking is one of the most effective steps you can take to improve erectile function. Reducing alcohol intake is also important, as heavy drinking can worsen ED and interfere with the effectiveness of ED treatments. Managing stress through relaxation techniques, mindfulness, or talking therapies can improve both RA symptoms and sexual confidence [2].

Communication and intimacy

Living with rheumatoid arthritis can affect intimacy, but open communication with your partner can help you find comfortable positions, plan for times when you have less pain or fatigue, and maintain emotional closeness. Some couples find it helpful to schedule intimacy for times of day when pain relief is most effective. A physiotherapist or occupational therapist can suggest joint-friendly positions and aids that make physical intimacy more comfortable.

Oral ED treatments for men with rheumatoid arthritis and erectile dysfunction

Oral ED medicines called PDE5 inhibitors are the first-line treatment for erectile dysfunction in men with rheumatoid arthritis, provided there are no medical reasons why they cannot be used [2][8]. These medicines—sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra)—work by improving blood flow to the penis during sexual arousal. They do not cause an automatic erection; sexual stimulation is still needed [3][4][5][6].

Sildenafil is taken about one hour before sex and works for around four to six hours. Tadalafil can be taken on-demand (at least 30 minutes before sex, with effects lasting up to 36 hours) or as a lower daily dose for men who prefer spontaneity. Vardenafil works within 25 to 60 minutes, and avanafil is the fastest-acting option, often effective within 15 to 30 minutes [3][4][5][6]. All are taken as needed, with a maximum of one dose per day for on-demand use.

PDE5 inhibitors are generally well tolerated, but they are not suitable for everyone. They must never be taken with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called poppers, because the combination can cause a dangerous drop in blood pressure [3][4]. If you take an alpha-blocker for prostate symptoms (such as tamsulosin or doxazosin), you must be stable on that medicine and start ED treatment on the lowest dose, as there is a risk of dizziness or low blood pressure [3]. Some other medicines can interact with PDE5 inhibitors, so a full medication review is essential during your consultation.

Choosing the right ED treatment

The choice of ED medicine depends on your preferences, how spontaneous you want to be, how long you want the effect to last, and any other medicines you take. Sildenafil and tadalafil are available as lower-cost generics, while branded Viagra and Cialis, and newer options like Spedra, are also available. Your prescriber will discuss which option is most suitable for you based on your medical history, current medications, and lifestyle. All prescription ED treatments from Cured Pharmacy are supplied following an online consultation reviewed by a UK-registered prescriber.

Treatment cautions and safety for men with rheumatoid arthritis

Men with rheumatoid arthritis may have a higher risk of cardiovascular disease, so it is particularly important that your heart health is assessed before starting ED treatment [2]. PDE5 inhibitors are not suitable if you have had a recent heart attack or stroke, have unstable angina, severe heart failure, very low blood pressure, or have been advised that sexual activity is not safe for you [3][4]. Your prescriber will review your cardiovascular risk during the consultation.

If you take medicines that affect liver enzymes—such as some antibiotics (clarithromycin), antifungals (ketoconazole, itraconazole), or HIV medicines (ritonavir, cobicistat)—the dose of your ED treatment may need to be adjusted, or certain PDE5 inhibitors may not be suitable [3][4][5][6]. Always declare every medicine you take, including those prescribed by your rheumatologist, GP, or any other specialist, as well as over-the-counter medicines, herbal remedies, and supplements.

Common side effects of PDE5 inhibitors include headache, facial flushing, indigestion, and nasal congestion. These are usually mild and short-lived [3][4]. Rare but serious side effects include an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sex. If any of these occur, seek urgent medical help [3]. Grapefruit juice can increase the levels of some ED medicines in your blood and should be avoided. Heavy alcohol can worsen ED and add to the blood-pressure-lowering effect of these treatments [3][4].

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 14 October 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 14 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 14 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 14 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 14 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 14 October 2026]
7. European Association of Urology. (n.d.). EAU Guidelines on Sexual and Reproductive Health. https://uroweb.org/guidelines/sexual-and-reproductive-health [accessed 14 October 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.