Chronic Pain and Sex

There’s an estimated 12 million people (couples) who deal with chronic pain and intimacy issues. It can be difficult, both physically and emotionally, to get yourself prepared for sex and sometimes the pain wins and you choose not to have sex even though you may want to. There’s absolutely no shame in avoiding intimacy when you are in pain, but communication is essential between you and your partner. The last thing you want is added strain in your life because your partner thinks you are rejecting them. Remember, even those closest to us do not understand the pain we live with daily. So, it is imperative to talk to your partner and explain to them as best you can how you feel.

Now, listen up. We’re going to tackle this together and hopefully learn how to cope, learn things we can do to achieve intimacy without sex and how we can have sex more without being in so much pain. Don’t think for one minute that chronic pain is a death sentence for your sex life. Patience, communication, understanding and creativity is the key!

Pain and Sex Fears
If you are hurting, it’s only natural to want to protect yourself. No one wants to hurt more but you don’t have to avoid sex entirely either. Talk to your partner about your worries and concerns so they can be aware and take more care in how they handle you. Remember that you are in a loving relationship and it’s more than likely that your partner has similar worries and concerns about causing you pain. Communication is so very important; you are going to hear me say this a number of times. It allows you to connect, offers a chance to listen and exchange ideas and best of all you’ll feel better afterwards. And for those of you dating out there with chronic pain- the same thing goes when you step into a relationship that will involve sex. You have to talk to potential partners about your worries and concerns so they know. It’s much better to be upfront about it rather than have an awkward time in the bedroom.

Failure to Launch
Chronic pain is insidious. It can bring on depression. The meds prescribed to help chronic pain can affect sexual performance or the ability to get aroused or achieve orgasm. Opioids happen to be a huge culprit in this area. Simple stress and anxiety can have the same effect. You may want to speak to your doctor if you think your medicine is affecting you sexually. But many times, patience and understanding between you and your partner can help overcome these issues.

Just Saying No?
Again, it’s okay and don’t let anyone guilt you into it. Not only is that wrong, it’s selfish. No one wants chronic pain. There are plenty of other excuses to hand out when not really feeling in the mood than using the chronic pain card. Anyone accusing you of just using it as an excuse clearly doesn’t understand your pain. and while not engaging in sex is your option, there are ways to stay intimate without intercourse. Here are a few examples:

Touching: Cuddling, fondling, massaging (if you can tolerate that kind of touch) and kissing are all worthy explorations, that increase feelings of intimacy. Even bringing one another to orgasm from touching can be satisfying.

Oral Sex: This might also be a possible alternative to traditional intercourse or as something supplemental when you are not feeling up to it. And remember, any combination of these can bring you and your partner closer and satisfy those needs and desires.

Forethought and Planning: Understand that the nature of pain means less spontaneity. And what I mean by that is no quickies! Think of sex as planning a big date, and evening to set the mood and do all those things I’ve just spoken to you about, as not only a way to set the mood but a way to gauge your comfort. After all, it’s not like that attention is a waste of time – any time with our partner showing affection is welcome and much needed. Another part of planning – make sure the patient takes pain medication, perhaps takes a hot bath or shower before hand or sits with a heating pad against their vulnerable areas or stretches a little bit to help limber muscles. Choose a time of day that you may be in less pain. For me, afternoon and evening are better. Mornings, I am not very agreeable.

Pillows: Lots and lots of pillows, I mean it. No joke. Lots of pillows even if you have a truly comfortable mattress. The pillows are for both comfort and stabilization.

Low Impact Positions [In control of movement]: Believe it or not, studies and research have been done in an effort to help those with chronic pain enjoy sex more. Some studies have shown “that for patients trying to have spine-sparing sex, the general recommendation is to try to use more hips and knees versus thrusting the spine, to get that movement.” [Natalie Sidorkewicz, PhD candidate at the University of Waterloo, Ontario]

[Not in Control of movements]: The goal for those not in control is a more neutral spine. For example, for men or women lying on their back during sex, an easy way to get a more neutral spine is by putting a rolled-up towel behind their neck. Another example is for women to be in a tabletop position while keeping a bit of an arch in their back for a neutral spine position.

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Tips for Minimizing Pain During Sex
Pillows: Lots of pillows! Pillows under hips, bum or chest, for both comfort and to help stabilize you so you aren’t rolling around too much. Experiment with different sizes and placement and have fun.
Hip Check: If you have lower back avoid a lot of thrusting from your hips as well as too many fast and jerky movements.
Alignment: Neck or back pain? Try to find a position where both your neck and back are aligned as much as possible.
Safe Word: Don’t worry! I’m not about to get all 50 Shades of Grey on you, but this is important so listen up! Sex is between you and your partner and it’s not something that is done one way or other. Experiment, change it up. Even if a sexy session only lasts 20-30 minutes, change positions. Agree before hand on a safe word to call out if at any point you hurt or feel fatigued. It might be a bit of an inconvenience hitting the brakes at first, but it will open up communication and possibilities of different play.

Positions for Fatigue
Because it’s not just chronic pain, but also chronic fatigue that can make intimacy difficult. Chronic fatigue can sometimes accompany chronic pain; however, it is also a stand along medical problem that can be very debilitating. The position you have sex in can make a big difference. Here are some positions that I suggest which may help you and your partner and can also be experimented with by those who have chronic pain.

Edge of the Bed
The partner who experiences fatigue lies either on their back or on their stomach with their bottom at the edge of the bed. This allows the bed to provide support for the partner experiencing fatigue, while the partner who has more energy can either kneel or stand by the edge of the bed and use their hands and arms to create movement between their body and yours. Why is this position great? It allows the partner who is fatigued to completely relax and enjoy without exertion. But, if you have some strength you can hold on to your partner and move with them.

Sitting Sex Position
This works best in a large chair with arms and a back and can be great if you tire easily. These don’t allow for as much movement for either partner, but they do offer more physical contact and closeness.
Position A: Is for the partner who has more energy and is also the one doing the penetrating. They can sit on the chair first and as it sounds, the partner who is fatigued can lower on top of them. They can either face toward their partner or away.
Position B: If the person with fatigue is the one penetrating they can sit on the chair and their partner can support themselves on the arms of the chair to move up and down in their partners lap.
Side-by-side while Face-to-face: Just the way it sounds. Both partners lie on their side and face-to-face. You can use pillows tucked behind you and around you for extra support. This position is not always the most convenient or practical, given height differences, but is does allow for a lot of physical skin-to-skin contact.
Spooning: This position offers the same benefits as side-to-side, but here you are facing away. This position works best if the partner with more energy is the one doing the penetrating, as they can grab your hips or waist and create movement without the partner needing to do much work.
Right angle Position: Sometimes referred to as scissor. The partner being penetrated lies on their back with a leg in the air, braced against their partner’s chest/shoulder. The partner with stamina does all the work and can also move your body by moving your leg. Not everyone will benefit from this position but it’s worth a try. You can experiment with variation and pillows.

The Recap: What I want you to walk away with, after reading this, is hope. Remember that planning is important. Communication is essential. Experimentation can open up new possibilities and intimacy is not solely about intercourse. If you feel it might be medication related, speak to your doctor. Last of all, remember you are not alone. Lean on your partner, talk to your partner and spend time giving one another the attention you need.