Pain & Sexuality

• Introduction to pain and sexuality
• How is pain related to increased sexual dysfunction?
• How to address the issues regarding pain and sexual dysfunction

Introduction to pain and sexuality

Sexuality is an important and sensitive issue that must be addressed in chronic pain sufferers. In people who suffer from pain, it is common for them to experience problems in their sexual functioning. This can result in much psychological distress and contribute to problems such as low self-esteem and depression. Pain can result in partners having decreased sexual desires and also difficulties performing during sex.

How is pain related to sexual dysfunction?

Decreased sexual interest
Pain can cause decreased sexual interest, which results in a loss of sexual desire and a reduction in sexual activity. Ongoing pain can result in significant changes to one’s own physical image of themselves. Individuals may feel that their pain, or associated conditions causing the pain makes them appear less ‘sexy’ and less attractive to their partners. In some cases, changes have to be made, which further interfere with sexuality. For example, ongoing pain may mean that you and your partner have to sleep in separate beds. Another common problem is for the involved partner to avoid sex, in fear of hurting or disturbing their loved one, who is in pain.
Interference with sexual performance
A common problem in men is difficulty in obtaining or sustaining a penile erection. Prolonged use of opioid analgesics to relieve pain, such as codeine and morphine can interfere with sexual performance. Other types of medications used to treat pain or ongoing medical problems, such as anti-hypertensives (for lowering high blood pressure), sedatives and anti-depressants can also affect sexuality. Substances, such as alcohol, cigarettes, and over the counter (non-prescription) drugs, also can impair sexual function.
Too painful to enjoy sex
Ongoing pain may result in avoidance or fear of engaging in intimate physical activity. This is because physical movements during sexual intercourse may exacerbate or trigger pain. This can interfere with erectile functioning in men or decrease sexual arousal in women. To overcome this problem, couples may have to try different positions to find those which are least painful.
Associated medical problems
In particular, those medical disorders affecting the hormones in the body (endocrine system), nervous system or heart (cardiovascular system) can result in pain and decreased sexual desire and performance. A complication of poorly controlled Diabetes is end organ nerve and artery damage, which may result in problems such as erectile dysfunction in men. Endocrine disorders like hypothyroidism (where there are low levels of thyroid hormone, which helps our body control it’s metabolism) may also result in decreased sex drive.
Physical inactivity
Individuals experiencing pain may not feel like moving about as often, or exercising, as this exacerbates their pain. Prolonged physical inactivity can result in a decrease in levels of sexual hormones. This highlights the importance of lifestyle changes in managing pain and sexual dysfunction. Visit our information on Pain & Physical Activity.
Emotional factors
Emotional factors affecting sex include depression, anxiety, and fear. These can all be linked to ongoing pain. Furthermore, ongoing difficulties with managing pain and the constant stress due to pain can deter one from being interested in sex. In patients experiencing pain, there are often many reasons for sexual dysfunction. This may be a reflection of underlying physical or emotional problems. It is important to address all of these contributing factors, to overcome the challenges posed by ongoing pain. If you are one of these people suffering from pain, don’t be afraid to discuss any sexual issues with your doctor.

How to address the issues regarding pain and sexual dysfunction

Discuss the problem with your doctor / other health professional
Communication with your doctor is important, to gain a better understanding of the possible causes of sexual problems. Any concerns about medical conditions or medications that may be contributing to sexual dysfunction should be discussed. In some cases, counselling may help sort out any emotional or relationship issues that are present. Address any worries or negative thoughts about your sexual image and functioning. Low self esteem and negative thoughts about one’s body image is common in people with pain. It is important to face these issues, which if solved, will help overcome difficulties with sexual dysfunction.
Good communication
The importance of open and honest communication can not be underestimated. Raise the problem with your partner. Tell them how you really feel and what you are really thinking. Find out what they think, want or expect in the relationship. This opens up the doors for any ways to overcome problems with sexuality and adaptations can be made.
Other alternatives to sex with ongoing pain
It is important to understand that sex does not always have to involve the physical act of intercourse itself, but can be expressed in other ways, to meet emotional and physical intimacy needs. You can explore other ways to express love, affection and care for your partner.
Visit our information on Male Sexual Dysfunction and Female Sexual Dysfunction.

References

1. Ambler N, Williams AC, Hill P. ‘Sexual difficulties of chronic pain patients’ Clin J Pain 2001;17(2):138-45. [Abstract]
2. Hanson RW. Chronic Pain & Sexual Functioning [online]. 2003 [cited 3rd April 2006]. Available from: URL link
3. Smith K. Chronic Pain & Sexuality [online]. 2002 [cited 3rd April 2006]. Available from: URL link