What Does the Research Say?
In research on chronic lower back pain, many patients report limitations to their sex lives due to pain, as well as decreased sexual arousal and decreased frequency of sexual activity (Berg et al., 2009; Kanayama et al., 2010). Fears of sex causing increased pain can also have an impact on engagement in sexual activities.
In another study, researchers found that sexual disability was closely linked not only to pain, but also to depression, avoidance of activities, and rumination (Ferrari et al., 2019). Our mood, self-confidence, thoughts, and pain can all have an impact on our sex lives and relationships. Intimate relationships are a part of life – they bring us connection, comfort, enjoyment, and have health benefits overall. Let’s find some ways to make living with pain sexy.
What is Getting in the Way of My Sex Life?
If sex is healthy and enjoyable, why do we avoid it? We are creatures of habit. If we fall into a pattern of inactivity or avoidance, this may trickle over into our sex lives. We may experience fear that if we engage in sexual activities, our pain will increase.
Pain is a subjective experience and it is possible that sexual activity can lead to increased pain. We may fear further injury. It is possible that we may not feel attractive due to pain or disability. Perhaps our sexual partner is concerned about causing re-injury. Maybe we are “out of practice” and feel self-conscious. Maybe medications we take are impacting sexual performance or desire (such as some anti-depressant medications). Maybe sex is the elephant in the room that no one wants to talk about because it has been forgotten or pushed aside for so long, with pain being the focus of our lives.
Talk About It
What can be done about this sex delimma? Start by talking to your partner. These conversations should be open, supportive, and understanding. Be realistic and vulnerable about what you want from your sex life. Share things in a positive manner rather than placing blame on your partner for not having sex as frequently as you would like. Using “I” statements and assertive, rather than passive or passive-aggressive communication, is more effective for relationships. Remember, our partners can’t read our minds — be explicit about your needs and how they can be satisfied.
This may take some reflection. Think about what attracted you to your partner initially and how this can be re-ignited. Be open to feedback and validate how your partner may be feeling (disconnected, less attractive, frustrated, etc.). Recognize that chronic pain is hard on you, but that it also has an impact on your partner.
Visit the doctor or your pain specialist. “Sex” is considered an occupation, in my profession of Occupational Therapy (OT), and reaching out to qualified healthcare providers to support you with your sexuality goals is a part of well-rounded care. Sexual therapists and counsellors can be helpful for patients with persistent sexual issues/dysfunction. OTs and other healthcare providers can support patients with learning helpful positions which are least likely to provoke pain when having sex. Talk to your doctor or pharmacist about the medications you are taking and how they may be impacting sexual desire, dysfunction, or arousal.
It can be awkward to talk to your healthcare provider about sex. When living with chronic pain, however, sex is something that can be impacted significantly, and sexual disability can have consequences for relationships, quality of life, and overall well-being. It is important to seek support from your healthcare provider on holistic approaches for improving intimate relationships. Healthcare providers should also engage in proactive patient-centered care by applying a psychosocial model and actually asking patients about their sexual functioning.
Healthcare providers can open up the conversation with patients by asking questions such as, “how is your sex life?” or, “are you experiencing any difficulties in your relationship or with sexuality.” Without asking these important questions, healthcare providers are missing an important piece of health and wellness. Healthcare providers should be aware of appropriate referrals that can be supportive for folks with chronic pain.
Try Something New
Different types of sex positions may be more comfortable for patients with different types of pain. For example, maintaining a neutral spine position may be more supportive for patients with lower back pain. Choose positions that put less pressure on the painful area. Props such as pillows or towels under the legs or lower back can also be helpful for some patients.
There are also other types of enjoyable sexual activities that do not necessarily involve intercourse such as masturbation, foreplay, using props or sex toys, oral sex, and so forth. Get creative with your sexuality and try to find different ways of exploring healthy sexuality.
Pacing techniques can also be helpful for those with chronic pain. We can easily apply these techniques to sexuality/our sex lives. Don’t do everything in one day, even if you are experiencing less pain. Sometimes, we feel the urge to do it all when our pain is well-managed, however this can create a boom-bust cycle of pain, in which we become burnt out for several days after engaging in a multitude of strenuous activities in one day or several hours.
Pace yourself throughout the day and maintain some energy for sexual activities if it is a priority for you and your relationship. Take frequent breaks and rest times if needed. Talk to your partner if you are experiencing excessive pain or fatigue.
It is easy to fall into a pattern of avoidance, rumination, and catastrophizing, especially where it concerns sexuality. We may need to challenge thoughts that come up around sexuality such as, “I will never be able to have sex again without pain” or “my partner doesn’t find me attractive anymore because of my pain or disability.”
Trying to find ways to challenge these thoughts and restore self-esteem and self-confidence can be beneficial for improving one’s sex life. Sex does not always lead to an increase in pain. Use the above approaches and seek support from professionals. Reach out to your partner and discuss your relationship goals, which is no different than in any other healthy relationship. Live your best sex life, even with chronic pain.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.
Berg, S., Fritzell, P., & Tropp, H. (2009). Sex life and sexual function in men and women before and after total disc replacement compared with posterior lumbar fusion. The spine journal, 9(12), 987-994. http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A285772&dswid=8559
Kanayama, M., Horio, M., Umi, Y., Yamaguchi, A., Omata, J., Togawa, D., & Hashimoto, T. (2010). How does surgery affect sexual desire and activities in patients with lumbar disc herniation?. Spine, 35(6),647-651.https://journals.lww.com/spinejournal/Abstract/2010/03150/How_Does_Surgery_Affect_Sexual_Desire_and.9.aspx
- Ferrari, S., Vanti, C., Frigau, L., Guccione, A. A., Mola, F., Ruggeri, M., … & Monticone, M. (2019). Sexual disability in patients with chronic non-specific low back pain—a multicenter retrospective analysis. Journal of physical therapy science, 31(4), 360-365.https://www.jstage.jst.go.jp/article/jpts/31/4/31_jpts-2018-389/_pdf