Chronic pain affects sexuality on several levels. At the most basic level, pain itself can inhibit sexual activity. Kerrie Smyres, a 31-year-old writer in Seattle who blogs about her daily headaches, says that the pain in her head often hurts too much for sex. Despite the cliche, it's true that headaches can be a major obstacle to intimacy. In a small 2007 survey by the National Headache Foundation, 69% of respondents said they had avoided sex because of a headache.
The alchemy of pain, sex, and relationships is complex. "Typically what I see is a combination of factors," says Geralyn Datz, PhD, a pain psychologist and behavioral medicine specialist in Hattiesburg, Miss. "The person has chronic pain, and intercourse may be physically uncomfortable." But she says often a person can feel emotionally unwilling or just feel bad about themselves.
Communication is the key to rekindling
People with chronic painand those who love themdon't need to resign themselves to a lifetime of celibacy. The subject can be broached from several angles, but the main lesson from doctors and couples is this: Communicate.
Once your doctor has a clear picture, he or she can help. "The main thing is to validate that this is an anticipated side effect that can be treated, and that sexual activity is a normal part of intimacy that chronic pain patients shouldn't be denied," says Dr. Sitzman. Then, patient and doctor can work together to devise a pain management protocol for alleviating pain during sexual activity.
Couples can also seek out a sex therapist or couples counselor to relearn the building blocks of intimacy. "A lot of times couples are avoiding even basic levels of contact, not holding hands, not kissing, not even talking," says Datz. Part of her therapy with couples includes helping them reestablish physical contact and teaching them relaxation techniques: "Because there is often a lot of anxiety about sexual activity when you have pain," she explains, "it's helpful to learn to relax mentally and physically."
Reigniting intimacy can actually help pain, at least temporarily: "As doctors, we prescribe external opiates, but the best opiates around are the natural ones that the brain produces," says Dr. Gevirtz. "If you can give someone an orgasm, they will have a flood of endorphins and their overall pain numbers will go down."
Helping yourself at home
Express your limitations and desires to your partner, says Sueann Mark, PhD, a clinical sexologist with a private practice in San Francisco. "The person in pain needs to take an inventory about what touch is pleasurable and what's not," she says.
Through trial and error, couples have found creative ways to maintain intimacy. Jennifer, who lives with chronic migraines, says that she takes advantage of her pain-free days: "We make the best of the times that I feel better than usual," she says. "Even if we have plans, we decide that the most important thing is going to bed together."
- How familiar are you with treating sexual dysfunction?
- Would you feel comfortable referring me to a specialist?
- What are my options for treatment? (These should include a wide range of things including medication, cognitive-behavioral therapy, sex therapy, and marital therapy.)