Chronic Pain, Sex, and Intimacy
We had people submit their personal questions to our Resident Sexual Health Clinician, Dr. Kathryn Ellis, OTR/L, OTD, AASECT-SC, an occupational therapist and American Association of Sexuality Educators, Counselors, and Therapists Certified Sexuality Counselor. We hope that this information helps improve your wellbeing and always feel free to submit your own questions to firstname.lastname@example.org
How do I help my partner understand that I have physical limitations sexually because of my illness?
People can experience changes in their body that make it difficult to have sex the way they used to and this can sometimes be difficult to navigate with a partner.
In order to effectively communicate with your partner about your limitations, it’s first important that you understand what the limitations are and how that impacts sex.
Then, consider taking a problem solving approach collaboratively with your partner. Often time people will just share the limitation and stop there, for example, “I have pain during sex” or “I can't get on top anymore.” Then there's not really a discussion about how to accommodate for the limitation or how to change what you're doing.
So take time to think about how exactly this impacts sex. Write it down and then spend some time by yourself thinking, “How could I problem solve this?” or “How could it be better?” Stay solution focused. Then bring your partner into the problem solving process and do it together.
Another example is a couple where one person has knee pain and finds it difficult to be on top during sex. How do we problem solve this? Maybe it's thinking about a different position that can work during sex, finding different pain management techniques, or identifying different mobility techniques.
Everything starts with problem solving by yourself, and then inviting your partner into that process.
Another suggestion is to consider if there is a specific ask for your partner. When you’re problem solving a limitation, also think about if there should be a direct “ask” of your partner. Consider this example, a person with limb loss has pain in her residual limb.
In this case, she tells her partner “don't touch my residual limb during sex.”
What are some pain management techniques for sex?
Chronic pain can make it difficult to have desire for sex. Engaging in pain management techniques before and during the sexual experience can be helpful.
Schedule medication. You can plan to have sex at a time when the pain meds are the most effective in your body.
Plan relaxation. Apply heat, stretch, meditate, or do anything that is relaxing prior to sex.
Manage anxiety. There's usually anxiety with chronic pain and sex. Talking with your partner about what specifically you're going to do is helpful. This might feel a little foreign if you and your partner don't normally talk about sex, or maybe you do very similar things every time so you don't necessarily need to talk about it. However, knowing what to expect is always going to reduce anxiety. Get together, talk about what you're going to do, talk about how you feel, and if there's anything that you don't want to do.
Get pleasured. If penetrative sex is a part of the sex you have, it’s important to be sufficiently aroused prior to penetration. This means doing pleasurable activities beforehand – foreplay, oral, fingering – that feel good to you right before the penetrative activity to make sure that you're sufficiently lubricated. If you don’t naturally lubricate, you can use lubricants, but that doesn't mean that you should rush through arousing non-penetrative activities.
Dedicate time. Arousal takes time, particularly for females. If the pelvic region is not sufficiently aroused, then sex can be more painful. So, give yourself plenty of time to enjoy the things that you like to do other than penetration.
Have an orgasm. The feeling of release from an orgasm can help relax the pelvic region, so try having an orgasm prior to penetration.
Sequence activities. It’s important to think about the unique sequence of sexual activities that feel the best for you. There's your sex, and then there's your partner's sex. This means that the sex that's a 10 out of 10 for your partner might not be a 10 out of 10 for you, and that's completely normal. Actually, it would be very unlikely for two people to come together, have sex, and both feel the same exact amount of pleasure from a given activity. So think through, what is the 8, 9, or 10 out of 10 activity that you enjoy doing? What feels really pleasurable to you? And make sure that you're doing that every time that you're having sex.
Pain with Penetration: If there's specifically pain with penetration, it's important to share that with your doctor and to see a pelvic floor therapist.
When you experience pain during sex, how do you talk to your partner about it without hurting them and find alternatives to pleasure?
We often think that sex is supposed to look one way. That’s likely the way you've always done it. Perhaps you think that if you can’t do it that way, then it may upset your partner, make them feel uncomfortable, or hurt their feelings.
Think about yourself first. Especially when there's chronic pain or limited mobility, it’s important to think about yourself. Think about when you’re uncomfortable or feeling pain with sex. It’s likely that if your partner knew you were in pain, they wouldn't want you to be suffering through it.
Ask yourself, “Why do I think that that would hurt them or make them uncomfortable?”
If you can stay solution-oriented, then you can tell your partner something like, “Hey, I really enjoy the sex that we have and I'd like to continue to be sexual with you. It's just that we have these things that we need to work through.”
A major reason that people with limited mobility – or illness, injury, aging, disease – stop having sex is because there's one aspect of the sexual experience that they can't do anymore. And typically, it's penetration. Whether it’s because their partner had prostate cancer and has erectile dysfunction, because penetrative sex is too painful, or some other reason.
People aren’t able to do this one aspect of the sexual experience anymore, and they stop everything. They stop kissing, hugging, flirting, having oral sex, foreplay, etc... They don't do any of it because they're afraid that it’s always going to lead to this one thing that they can't do.
Get on the same page with your partner about what is off the menu now, then think through all the things that you can do. And it might be some sexual things that you've never done before. And that's okay. That can feel scary and it can feel like a risk, but it can also feel really exciting to add new things that you're still able to do.