One of the most difficult things about chronic pain is the profound impact that it can have on your sex life. But if you think you are the only chronic pain sufferer with intimacy issues, think again. "It's a silent epidemic," says Clifford Gevirtz, MD, medical director of Somnia Pain Management in New Rochelle, N.Y. "People are embarrassed to talk about it, but they are suffering."
But experts say that many are suffering needlessly: "There is a lot of help available," he says. "They just have to have the courage to ask."
Finding the root cause of sexual dysfunction
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 last thing a chronic pain sufferer needs is more discomfort. But when sex increases pain and patients avoid sex, a vicious cycle can start. "If avoidance continues, a major fear becomes associated with a sexual activity," says Todd Sitzman, MD, a past president of the American Academy of Pain Medicine. "That lack of intimacy can have detrimental effects on relationships."
How emotions play a role
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.
Self-esteem can also plummet, says Datz: "You can imagine how someone who used to be the head of the household and is now relegated to the couch isn't feeling interested in intercourse or intimacy�their self esteem is dramatically affected."
Anticipation or fear of pain is another common problem: For Smyres, orgasms can sometimes trigger migraines, which "doesn't give me a whole lot of incentive," she says.
Communication is the key to rekindling
People with chronic pain�and those who love them�don'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.
First, don't be embarrassed to talk to your doctor. "If the physician doesn't bring it up, the patient should," says Dr. Sitzman. "They should get validation that this is a common consequence of chronic pain and its therapy�and they should expect treatment."
Dr. Gevirtz recommends emailing questions beforehand so they can be discussed during the session. He also suggests keeping a pain diary at home so you can remember the details: For example, at what point during intimacy pain occurred or what the circumstances were surrounding an instance where your pain subsided.
Help is a doctor's visit away
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.
Addressing the emotional component
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."
When a loss of self-esteem is keeping a patient from being comfortable with their partner, "we have specific ways of treating that in therapy," says Datz, including "normalizing" a person's symptoms so they don't feel quite so alone and alienated.
The payoff in pain reduction and relaxation
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.
While communication is important, it has to be done at the right time: "Talking about these issues is best done when not in bed," she says. Instead, set aside a separate time of day. And remember to think beyond intercourse: "You can find ways to maintain some sexual relationship," she says, including massage, bubble bath, cuddling, and masturbation.
Couples find what works
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."
Smyres says that she tries to initiate sex once a week and at times other than the evening, when her head often hurts. She's found that talking about sex more with her husband also helps.
Smyres is proof that by communicating and staying in touch with your partner, you can have a rich and loving relationship in spite of chronic pain: "In general, I'm very happy," says Smyres. "My husband is great and my life is wonderful, I'm in the healthiest emotional place that I've ever been."
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