In association with the National Chronic Pain Outreach Association

Pain need not be the end of a fulfilling and satisfying sexual life. You still can find pleasure, says Robert Rothrock.

Sexual expression is one of the most basic human needs. Along with food, shelter, and clothing, sexual activity is normally a necessity of human life. However, for chronic pain sufferers, sexual expression often becomes disrupted and inhibited. Fearful of aggravating or exacerbating the pain, individuals with chronic pain are usually reluctant to engage in sexual activity and may resort to abstinence.

Surprisingly, little has been written regarding sex and chronic pain, yet it is estimated that 75% of chronic pain sufferers experience some form of sexual dysfunction.

Many physicians and health care practitioners are often reluctant to talk with patients about their sexual concerns. In turn, this leads to further anxiety, depression, and diminished sexual function.

RETURNING TO SEXUAL ACTIVITY

Sexual activity should be resumed as soon as possible. From early childhood, humans are exposed to many myths and misconceptions regarding sexual roles. Unfortunately, many people believe that sex must always be spontaneous, involve intercourse and lead to orgasm.

There are many ways to give and receive pleasure no matter what degree of discomfort or bodily dysfunction exists.

The achievement-oriented and competitive views of our society regarding sex need to be de-emphasised. With new insight and willingness to explore other avenues of pleasure, you can uncover many ways to attain physical satisfaction.

PLANNING FOR BETTER SEX

For people who suffer from chronic pain, sufficient preparation for sexual activity may be necessary.

To many chronic pain sufferers, surprise planning is often the key to a satisfying sexual relationship. Sure, spontaneous sex is great, but so can be planned sex.

Knowing your body’s best time will enhance your comfort and pleasure. Ask yourself:
a) when are my muscles the least painful and my joints not so stiff?
b) when am I least tired?

If you’re like most people, just before going to sleep at night is the common time to be intimate. However, as for most individuals with chronic pain, this may be one of your worst times. Don’t be afraid to be different!

Planning a romantic rendezvous in the afternoon is often invigorating and can boost your mood for the remainder of the day. Keep in mind, when planning a sexual encounter, to eliminate as best as possible the


demands of your daily life. A friend or family member is usually willing to baby-sit. Let the house go, take the phone off the hook, spend the night at a hotel. Put the world on hold!

Whether you get away for the night or just spend a quiet evening together at home, the most important thing is to plan time to be together with your partner.

COMMUNICATE YOUR THOUGHTS

Communication is the link through which we share our thoughts and desires. It is by communicating openly with your partner that you will establish intimacy and a healthy sexual relationship.

It is important that you are willing to be pro-active. Seek out the kind of help you need to overcome your particular problem. If necessary, seek outside help or become better informed by reading publications related to your specific problems. Your ability to express yourself emotionally, physically and sexually need not be curtailed because of pain!

TIPS FOR MORE COMFORTABLE SEX

Sexual intercourse usually causes some degree of discomfort in those who suffer from chronic pain. Most, if not all, individuals can utilise a number of specific techniques or vary others to engage successfully in and enjoy sexual stimulation.

Remember to plan your sexual activity for a time of day when you generally feel your best. If you are taking medication for pain, try and time your sexual encounter when your medicine is at its optimal peak.

Pacing daily activities will often lessen pain and fatigue. Take a warm shower or bath with your partner and have him or her gently massage your sore muscles and joints. Often, a brief application of transcutaneous electrical nerve stimulation (TENS) is helpful.

If need be, warm the bed in advance with an electric blanket to add comfort to muscles and joints.

When sexual intercourse is too painful or mechanically impossible, alternative means of sexual gratification such as masturbation, oral sex, and artificial stimulation, for example, a vibrator, can be quite pleasurable and satisfying for you and your partner.

Sometimes, the best thing a couple can do is stop worrying about having intercourse and reaching orgasm and just enjoy the moment at hand. Do what makes you feel good!

GIVING YOUR PARTNER INFORMATION

Dealing with chronic pain is a difficult task in itself. Pain has a significant impact on a person’s lifestyle. How you relate to your problem can make a world of difference.

Try to focus on your strengths rather than on your limitations. Disinterest and fear of pain are the two most common causes for decreased sexual activity in chronic pain sufferers.

Have you noticed a loss of interest in sex? If so, why? Maybe you feel less attractive or undesirable – this is not unusual. Are you afraid that sex will make your pain worse? This can happen if you choose a position that is uncomfortable for you.

On the other hand, you may be surprised to learn that research shows that sexual activity when comfortable is often followed by several hours of pain relief!

If you experience pain, tell your partner. He or she is unable to read your mind. Sex is more than just intercourse; rather, a way to show pleasure through both the mind and body.

OTHER CONSIDERATIONS

Medications used for pain relief can decrease libido and even induce impotency. Narcotic pain medications, tranquillisers, sedatives and anti-depressants can all decrease sexual desire. Corticosteroids can decrease sensation in the genital area in both men and women.


Alcohol and marijuana (cannabis), which is commonly used by many people to try and control their pain, can result in decreased libido and impotency.

Other commonly prescribed medicines such as antihistamines, some blood pressure and heart medications, can result in decreased libido and difficulty obtaining and maintaining an erection. If you are concerned about the medication you are taking, do not be afraid to discuss this with your physician.

Some women, because of medication or medical causes, can have a problem with decreased lubrication, that makes intercourse painful and unpleasant. Application of a lubricant, for example, K-Y jelly ® is an excellent substitute and is available without a prescription. Petroleum jelly should not be used since it may harbour bacteria that can result in infection.

HOW TO FIND HELP

If self-help techniques are not enough, professional sexual counselling can be of primary importance in restoring the sense of independence and capacity in those with chronic pain.

The following organisations can assist:-

Relate: see your local phone book; in Scotland, look under Couple Counselling Scotland: http://www.relate.org.uk : http://www.couplecounselling.org

Sex and Chronic Pain © Robert Rothrock. All rights reserved. First published by the National Chronic Pain Outreach Association, Inc, PO Box 272, Millboro, Virginia 24460, USA. UK edition published by Pain Concern.

ABOUT THE AUTHOR

Robert Rothrock is a physician assistant and pain management specialist. He is a member of the American Academy of Pain Management, American Pain Society and American Academy of Physician Assistants.

FURTHER READING

Robert Rothrock and Gabriella D’Amore, The Illustrated Guide to Better Sex for People with Chronic Pain. Available from Pain Concern, 1 Civic Square, Tranent, EH33 1LH, £12.90 inc. p&p.