Sexuality and Chronic Pain

An Important Topic

Chronic pain often affects sexuality and intimacy, yet this is rarely discussed in medical appointments. Sexual activity can be painful, medications may affect desire or function, and fatigue and mood changes complicate things further. Despite these challenges, satisfying intimacy is possible with adaptation and communication.¹

How Pain Affects Sexuality²

Pain during sexual activity
Reduced desire (libido)
Fatigue and energy limitations
Body image concerns
Depression and anxiety effects
Medication side effects
Fear of causing pain flare

Medication Effects

Opioids can reduce testosterone, libido
Antidepressants may affect arousal/orgasm
Anticonvulsants may cause issues
Discuss concerns with your doctor
Sometimes alternatives exist

Communication Is Key³

Talk openly with partner
Share what feels good and what doesn't
Discuss fears and concerns
Be honest about limitations
Plan together
Couples therapy can help

Practical Strategies

Timing

Choose times when pain is lower
After pain medication has taken effect
When you're most rested
Not during major flares

Preparation

Warm bath or shower beforehand
Gentle stretching
Use heating pad before
Take pain medication if appropriate

Positioning

Experiment with different positions
Use pillows for support
Side-lying often more comfortable
Positioning wedges available

Expanding Intimacy

Intimacy isn't just intercourse
Focus on pleasure, not performance
Massage and touch
Emotional connection matters

Condition-Specific Considerations

Back pain: side positions, avoid arching
Arthritis: warm-up, supportive surfaces
Pelvic pain: pelvic floor PT, lubricants
Headaches: avoid positions increasing head pressure

When to Seek Help

Pain specifically during intercourse (see gynecologist/urologist)
Significant relationship strain
Depression affecting sexuality
Medication concerns

Resources

Sex therapists
Pelvic floor physical therapists
Couples counselors
Pain specialists

References

Ambler N, Williams AC, Hill P, et al. Sexual difficulties of chronic pain patients. Clin J Pain. 2001;17(2):138-145.
Bahouq H, Fadoua A, Hmamouchi I, et al. Sexuality in Moroccan patients with ankylosing spondylitis. Clin Rheumatol. 2013;32(10):1469-1477.
Kwan KS, Roberts LJ, Swalm DM. Sexual dysfunction and chronic pain: the role of psychological variables and impact on quality of life. Eur J Pain. 2005;9(6):643-652.