7 Ways to Put Sex Back into Your Life When You Have Chronic Pain

Being sexually active is important for overall quality of life. Plus, research shows that sex can reduce chronic pain levels.  But if you are among the 120 million Americans living with pain, you know it can disrupt your relationship—not to mention what goes on behind closed doors. The good news is the problem can be treated when properly addressed.


frustrated couple Living with pain doesn't have to mean living without sex. It's important to discuss your pain-related fears of sex with your partner as well as your doctor. Pain isn’t sexy. There’s no doubt about it. But since there are many benefits of having a healthy sex life including less pain, increased intimacy and a better self-image, it’s worth doing the work necessary to put sex back into your life. If the mere idea of sex triggers fear of even more pain—or worry about aggravating it—read on for some expert insight. Education is the very best way to get around this Catch 22. Here, tips to improve your sex life and get some pain relief, too.

The Scope of the Issue

A nationwide survey of patients with low back pain found half of the respondents reported that pain interfered with their sexual enjoyment. Seventy-two percent said they avoided sex after the onset of their pain, and 70% said sex itself was less satisfying after the onset of their back pain. Most noteworthy in terms of overall quality of life, 61% said their back pain interfered with normal sexual activity and made their relationships more difficult.1

The Silent Problem

Despite these statistics, fully two-thirds of patients responding said they had never discussed this topic with their spine specialists.1 It may be that your doctor neglected to ask (many doctors find the topic difficult to discuss) or perhaps you feel too embarrassed to bring up. The truth is, it can be awkward to talk about sexual difficulties but your feelings are too important to keep to yourself.

Finding a way to talk with your spouse or partner is also important. Your partner should know the severity of your pain, where it hurts and what movements relieve or increase the pain. If your pain is affecting your sex drive, this information should also be shared. (Avoiding sex without an explanation can be extremely hurtful.) For additional resources, click here

Getting Over Your Pain-Related Fears

In the meantime, here are some suggestions:

#1. Be honest with your physician.  If your doctor has not asked you about your sex life and you are in a romantic relationship, and not having regular sexual relations, this is relevant.

#2. Fill out the doctor’s questionnaire. Some doctors use questionnaires to determine everything from frequency of sexual activity and accompanying pain to hormone levels (eg, How is your sex life? How often do you have sex? Are you having any sexual difficulties?). You may also be asked about having a history of sexual abuse. Studies suggest anywhere from 40 to more than 50% of sexual abuse victims have chronic musculoskeletal pain, are more likely to have severe pain, longer duration of pain and take higher levels of medication. Since all these factors can impact sexual health, this information is relevant.2

#3. Know your medication doses. Beyond fear of pain, some pain medications, especially opioids, can lower sexual hormones, thus inhibiting desire and performance. Depression, anxiety and impotence can also be side effects of medication. (In a recent study of more than 11,300 men with back pain, long-term use of opioids was associated with more likelihood of taking medication for erectile dysfunction compared with no opioid use.) If you suspect medication could be the culprit, speak to your physician about switching to a different opioid that is less likely to impact hormone levels.2

#4. Ask for a referral. Gloria Shurman, PhD, a clinical psychologist on staff with Scripps Memorial Hospital in La Jolla, California recommends asking your doctor to give you specific options to improve sexual functioning, including referral to specialists with advice on attachment or intimacy issues.2

#5. Experiment with different positions. Since chronic pain often hinders free movement, you and your partner may need to experiment to find postures that work well for you. Props like pillows can help. See “Patient Guide to Sexual Health” for examples of alternate positions.3

#6. Prepare in advance. As unromantic as it sounds, it’s important to understand that successful sex may take some planning. “Unfortunately, spontaneous sex might not be possible right now,” said Hilda Hutcherson, MD, Professor of Obstetrics and  Gynecology at Columbia University College of Physicians and Surgeons, in New York City. “You may need to plan your pain medication, apply heat or stretch before having sex.” Dr. Hutcherson suggests using the time to increase your arousal by reading erotica, watching a sexy video or asking your partner to massage a painful area.

#7. Enjoy yourself! Dr. Hutcherson made two very encouraging observations about sex and pain: First, orgasm affects the pain threshold such that “people who had pain found they lowered their amount of pain with orgasm.” Second, when using pillows and finding comfortable new positions for sex “sometimes patients discover new areas of the body that are stimulated.” 1

Recognizing that sex is a normal, natural, and fun part of life may be the way back into the bedroom again. Basic communication can help you have a satisfying—and possibly therapeutic—sex life in spite of your chronic pain.

Updated on: 09/09/16
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