Chronic pain and intimacy

This document is aimed at people living with chronic pain who are experiencing difficulties with physical aspects of intimacy because of their pain. It presents practical ideas and suggestions to address their difficulties.

Chronic pain affects many aspects of daily life, including relationships. For most people, physical intimacy and sex is a natural part of a healthy relationship. When pain becomes chronic, some people may find that they are not able to enjoy this part of their relationship anymore.

Physical intimacy and sex are complex human experiences. They are influenced by many different factors, not just pain.

Factors affecting intimacy

Common factors

Factors that can affect our sex-life include:

• pain, joint restriction, muscular tightness
• self-esteem
• change in roles
• fatigue
• mood
• menopause
• medication
• health of the relationship
• environment
• kinds
• worries or stress (finances, health)

Those living with pain are not the only people who may have difficulties with sex. Other stresses in life, such as financial worries or family problems, often influence relationships. Getting help with those difficulties may be the way forward.

Factors within the relationship

Painful sex can set off a vicious spiral: painful sex causes avoidance of intimacy, which in turn causes worry about more pain, which causes muscle bracing, which causes further avoidance.

When we have been in a relationship for a long time, we know what brings us pleasure. However, chronic pain can affect how attractive we feel, our self-esteem and our roles within our relationship which can then affect how we feel about intimacy and pleasure. When pain starts affecting our ability to engage in our usual intimacy, we may need to explore new ways in which we can experience pleasure. Knowing what works for your body will help you to explain it to your partner.

Your partner may be worried about causing you pain during intimacy or causing a flare-up of your pain. You may have to talk to them and help them understand what you need to enjoy the moment and avoid pain. Communication is key. Being playful, sensitive and curious will help to find new ways to enjoy your togetherness.

If difficulty with intimacy extends beyond the pain, for example if you are struggling with other relationship problems, you may benefit from having couples counselling. Charities such as Relate can also address relationship problems with just you, particularly if your partner is not ready or comfortable to have counselling.

Practical ideas

Once you feel ready to try sex again, you could try some of the following ideas:

• schedule a time of day that works for you
• try different positions (search the web for ‘chronic pain and sex positions’)
• using cushions and pillows to support parts of your body
• taking a warm bath before may be helpful to reduce pain and relax muscles, or try having a shower together
• consider taking some appropriate pain medication half an hour before
• try doing some relaxation together
• stop and take a break if you need it, chat, cuddle and hold hands

Remember that physical intimacy does not necessarily need to involve penetrative sex. There are different ways to explore pleasure such as you may find benefit from using sex toys or a vibrator – there are options for men and women.

People going through the or post menopause might benefit from using a good quality lubricant like ‘Yes’ or ‘Sutil’.

People with endometriosis who struggle having penetrative sex, might want to use something like the ‘Ohnut’ wearable to help manage the depth of penetration.

If you experience chronic pelvic pain and you feel you need more support, you could self-refer or ask for a referral to a pelvic health physiotherapist. They specialise in pelvic pain conditions and supporting people to manage these, including addressing difficulties with intimacy/sex.

External factors

Medication can be helpful; it can reduce your pain in order to make physical intimacy more comfortable. However, many medications can make us feel worse, by causing weight-gain, drowsiness and/or constipation. Some medications can also interfere with sexual function, by reducing your libido (sex drive) and the ability to achieve/maintain an erection. If you find that your medication is affecting your physical intimacy, and you are concerned about it, speak to your GP.

Take home messages

✔ Intimacy and sex are complex human experiences, influenced by many factors. Pain can affect many aspects of this experience.

✔ Explore new ways of being intimate.

✔ Communication is key!

Other resources

• Pain Concern: ‘Sex and Chronic Pain’ (Airing Pain 97).
• Versus Arthritis: ‘Sex and arthritis – how to make it work’.
• Arthur’s place:
  • ‘Is arthritis killing your sex life? Here’s how to enjoy lovemaking again’.
  • ‘Chronic Pain and Sex’.
• SportSheet.com: ‘Painful Sex Positions? The Best Tips and Alternatives to Reduce Discomfort’.
• The Pain Relief Foundation: 'Chronic pain and sex' leaflet.
• Relate website: Ideas around relationships and self-help for relationship issues.