Negative sexual effects are widely reported in studies of people with such chronic diseases as lupus (systemic lupus erythematosus), rheumatoid arthritis, multiple sclerosis and diabetes. However, most researchers have asked only about negative sexual sequelae, using checklists of dysfunctions that may not fully reflect some patients' experience. Not surprisingly, the results are lists of problems. However, in this qualitative study, women with lupus were asked to describe the sexual effects of their illness in their own language and with their own emphases. One unexpected finding was that for some women, despite physical and emotional problems, coping with lupus brought improved sexual function and relationships. Similar effects have been described in some studies of other illnesses; these women with positive sexual outcomes may represent a significant and generally unrecognized minority of patients. This paper presents case studies of several such women with lupus, and discusses the implications for research, health care, patient education and the training of health professionals.