When Chronic Pain Interferes With Your Sex Life
I’ve discussed how my battle with chronic illness has affected most facets of my life. At first, I had to give up running; then weightlifting became a challenge; eventually, working full time out of the home became a thing of the past. Then, my jaw weakened, and I became unable to chew full meals (I make a mean smoothie). That made kissing (my favorite thing ever) and giving oral sex (I miss the look on Hubby’s face while I’m blowing him) difficult.
Throughout all of that, Hubby and I maintained our daily (sometimes thrice daily) sex habit, and I kept up with my masturbation routine (yes, that’s a thing, and all women should have one).
Until now.
My illness is now affecting my pelvic region so severely that some days I can’t move my left hip. The pain radiates from the joint through my mounds pubis until even touching my vulva around my clit is painful. My vaginal walls ache, and I can’t masturbate, let alone handle a thrusting penis. It doesn’t happen every day, but it happens often enough that I’m seriously concerned.
Even on days when my pelvic region feels somewhat normal (normal is relative, and mine has shifted significantly), I’m often afraid of penetration hurting, which causes me to tense up. Tense muscles aren’t conducive to pleasure or orgasm.
I can’t ignore my sex life
I know I’m not alone in suffering from chronic pelvic pain. Pelvic pain becomes chronic when it lasts for six months or longer. A host of problems from endometriosis, to musculoskeletal diseases, cause pelvic discomfort. The cause can be physical, psychological, or a combination. No matter the reason, chronic pelvic pain is a massive disruption in a woman’s life.
It can be tempting when pain keeps you tense, worried, and exhausted, to skip sex altogether. A 2008 study in Pain Research and Management found that 73% of women with chronic pain report sexual difficulties.
Sexual health is a vital part of your overall health. Sexual activity improves wellbeing thanks to hormones like oxytocin, and it can even improve sleep, suggesting a 2007 report by Planned Parenthood. Furthermore, hormones released during orgasm can help relieve chronic pain symptoms thanks to a rise in pain threshold due to a rush of endorphins and corticosteroids.
To compound the problem, many people who experience sexual dysfunction are reluctant to seek help due to embarrassment, or frustration with the lack of medical response to their condition.
Since maintaining a sex life is essential for mental health and overall wellbeing, people with chronic illnesses need to find ways to maintain an intimate life despite their symptoms. The potential for pain relief is a bonus. There are many ways for people struggling with sexual health to get their groove back.
Talk to Your Doctor.
Medical practitioners can help patients navigate sexual problems caused by their symptoms — an approach that treats both the physical and psychological implications of sexual dysfunction is most effective.
A doctor can help people determine if there are underlying hormonal issues that are making sexual dysfunction worse. They may also be able to provide referrals to a sex therapist. It is important to rule out any underlying hormonal issues or acute ailments. This chart lists common causes of pelvic pain organized by type of pain.
I visited my OBGYN to rule out other pelvic pain causes, such as pelvic inflammatory disease, abnormal uterine or ovarian growth, or STI's. Once I knew nothing new was going on in my woman-parts, I could address the problem as just another part of the chronic pain that I deal with in other areas of my body.
Find a Sex Therapist.
Sex Therapy is a field that is becoming more popular as research indicates the importance of sexual wellness to overall health. Sex therapists aim to reduce the stigma of sexuality, improve patient sexual satisfaction, and learn how to make a sexual activity work.
Women with chronic pelvic pain and fear of pain with intercourse are often what keeps them from enjoying sex. Men with chronic pain may fear their performance is lacking and be afraid to try.
Opioids, often prescribed to treat pain symptoms, can alter hormone levels, causing sexual dysfunction. In circumstances like these, the therapist’s job is to help reduce fears, encourage relaxation techniques, and assist couples with conversations about sexuality.
The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) provides a referral tool for finding someone in your area. Many therapists offer video or phone call services for those who have trouble leaving their homes.
Communicate with Your Partner.
People with a chronic illness whose sexual functioning has suffered must learn to communicate with their partner, though it’s not always an easy topic to tackle. When discussing sex with a partner, it’s important, to begin with, the goal of creating a satisfying sexual life for both people.
Keep in mind that the partner of someone with chronic pain may be mourning the loss of a sexual relationship and also afraid of hurting their loved one. Returning to sexual activity may require a frank discussion about changing the definitions of sex within a relationship, at least temporarily.
People with chronic pain need to learn to self-advocate when something is uncomfortable or painful. Often, people with chronic pain find that as they practice and learn how to listen to their bodies, they can enjoy a greater variety of sexual expression.
Even though I talk about and write about sex a lot (my girlfriends and I compare vibrator preferences regularly), it took me a while to admit to Hubby that pelvic pain was causing me to avoid sex. We were still having sex 3–4 times a week, which I understand is well above the average couple, but it isn’t enough for our libidos. The right amount of sex is the amount that makes you happy, and I needed more.
Because I have the most amazing and supportive partner, he worked with me to find ways to enjoy our sex life again, even if it looks different.
Use Relaxation Techniques
Since chronic pain causes neurological symptoms, including anxiety and depression, it’s vital for people approaching sexual activity to do so in a relaxed state. Conditions such as pelvic floor dysfunction, vaginismus, and interstitial cystitis can be difficult to work around, but that doesn’t mean people need to give up.
Those with chronic pain may benefit from a hot bath to soothe sore muscles and joints, followed by a massage before beginning sexual activity. I purchased a heat pack that wraps around my jaw, which helps a lot. Hubby and I have had luck with a hot bath, a lot of foreplay, vaginal massage, and lots of lube before penetration.
Sure, taking the time to relax before sex requires people to plan time to prepare for intimacy in their lives, but the benefits of satisfying sex are worth it.
Redefine sexual activity
Many people, especially heterosexual couples, define sex as a penetrative activity. For people with chronic pelvic pain, this presents a challenge. Changing the definition of sexual enjoyment can help people with chronic pain wish to maintain a sex life.
University Health describes a sensate model, focused on touch rather than penetration as the key to enjoying sexual activity. Focusing on sensual touch that avoids genitals lessens the pressure, people with chronic pain may feel to engage in penetrative sex.
Engaging in mutual sensual touching with a partner can help people reconnect and be open to communicating about other activities. For people who have been celibate due to their symptoms, this is a terrific starting place. Sensual touching is also a fantastic solo activity that can help patients reconnect with their sexual selves and be open to other experiences. The goal of this touching is not orgasm, but physical pleasure without an agenda.
For Hubby and I, this type of physical affection is a placeholder on the days I can’t handle digital stimulation or oral /vaginal sex. We both have a high need for physical touch, and if we skip it we wind up feeling disconnected. Even if we can’t have sex, we have to spend time together — naked, touching, kissing.
Experiment with Positions.
A sex therapist can assist an individual or a couple with finding positions that don’t exacerbate pain symptoms. In the Pain Research and Management study, participants received significant coaching about positions, and even used pillows and wedges to relieve pain. Often, positions that don’t rely on joints to support weight are best for those with knee, wrist, and hip pain.
Hubby and I use a wedge-shaped pillow for many positions that I can’t hold myself in for too long. When my left hip (the one that hurts most) is particularly painful, and I can’t spread my legs, we use a side-lying position. A willingness to speak up about your needs and experiment without frustration is vital to your sexual rejuvenation. The last thing your partner wants is you laying there in pain while he thrusts into you.
Focus on Lubrication
Many chronic diseases can cause abnormal fluctuations in hormones that interfere with vaginal lubrication. Vaginal dryness can make penetrative sex, or even touching, uncomfortable. The use of a lubricant can increase sexual enjoyment for both partners.
If using condoms, it’s important to use a water-based lubricant, so the condom's integrity isn’t compromised. Otherwise, options containing coconut oil or silicon provide long-lasting results.
Taking an active role in sexual therapy combined with communication, a focus on pleasure, a willingness to experiment with various positions, and appropriate relaxation techniques can help people with chronic illness experience a return of sexual satisfaction despite persistent symptoms.
I’m still figuring out how to navigate my sex life with chronic pain. I have to unlearn what I knew about my body and re-learn how it works right now. Sometimes this can complicate my relationships with partners who aren’t my husband, but only if I let it.
Every time I’ve decided to be honest about my pain level, my need for a slow start, and the possibility that I’ll need to stop in the middle of reverse cowgirl, my partners have responded with kindness, and a willingness to work with me. If your partner (or partners) responds differently, get out of there and don’t look back because they aren’t worth your time.
References:
Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain. 2009;25(2):170–175. doi:10.1097/AJP.0b013e3181850df6
Whipple B, Komisaruk BR. Analgesia produced in women by genital self-stimulation. J Sex Res. 1988;24(1):130–140. doi: 10.1080/00224498809551403
Breton, A. BScPT, Miller, C. M. PhD, & Fisher, K. PhD. Enhancing the sexual function of women living with chronic pain: A cognitive-behavioural treatment group. Pain Res Manag 2008 May-Jun 13(3): 219–224. doi: 10.1155/2008/369382
Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice. Healthcare (Basel). 2018;6(3):104. Published 2018 Aug 25. doi: 10.3390/healthcare6030104
Ajo, Raquel et al. Opioids Increase Sexual Dysfunction in Patients With Non-Cancer Pain. The Journal of Sexual Medicine. Published 2016 May 13, V 13(9): 1377–1386. doi: 10.1016/j.jsxm.2016.07.003
Monga, T.N., Monga, U., Tan, G. et al. Coital Positions and Sexual Functioning in Patients with Chronic Pain. Sexuality and Disability 17, 287–297 (1999). doi: 10.1023/A:1021373428492
