Fatigue, Pain, and Sex - ME/CFS and Fibromyalgia
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 an 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 email@example.com
For people with chronic fatigue because of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) or fibromyalgia, any tips on ways to conserve energy, so they can be more engaged during intimate sexual moments?
There are activities that are less strenuous, less laborious, and less energy consuming during sex.
When it comes to foreplay, you can use a vibrator toy to increase the stimulation and decrease the amount of effort required.
You can also think about different sensory input that you might like to use on your partner, such as a feather tickler, or some impact play item such as a flogger. There are many options, not all of which require buying a toy. Would it feel fun to blindfold your partner and run a soft, silky material over their body? Would you like them to do that to you?
Another option is to lay in bed with your partner and as they're masturbating, you can kiss them or read them an erotic story or tell them a fantasy.
These require less strenuous effort for you, so they are ways to be more engaged sexually without being engaged so much physically.
More options include dirty talk, role playing, or sharing fantasies. The thing about fantasies is that you don't have to act them out. A lot of times people are very hesitant to really explore fantasies because they think they will have to act out the fantasy. But many fantasies are best left as just a fantasy and instead you can play around with it and act some of it out with your partner.
Sometimes couples can rely very heavily on the patterns around sex and sexual activity where they follow the same routine and acts. However, the sex that you have doesn't have to be the same every time.
One night it can be just about you and your pleasure, and it's all foreplay and no penetration and then the next night maybe it's more intercourse focused. If there's an energy conservation requirement, then you can split it up and focus on one person's pleasure one night and then another person's pleasure the next night.
Does sex improve fibromyalgia pain?
The answer is both yes and no. It depends on if you’re having enjoyable sex. If the sex you're having is one that feels pleasurable and enjoyable, maybe you orgasm, maybe you don't, but it still feels pleasurable, then yes, that's going to relax the body and help manage chronic pain. If the sex is not enjoyable, it's probably going to exacerbate it.
If you're not relaxed, then you might be tensing up and that's going to exacerbate the pain. So where do you go with this information?
It's really important to make sure that you're talking about the sex that you're having and having the sex that feels really good for you.
There's a nuance to the sequence of what you like and enjoy. For example the pacing and sequence of moving from kissing to breast play to fingering to oral to penetration. That can’t go too fast. Maybe you like having your neck kissed before your breasts are played with, or maybe you don't like having your breasts played with at all. Take time to really understand your body and the nuances of how you receive pleasure. It can be even small details, such as what specific tongue movements you enjoy from your partner during oral sex.
The key is understanding and honoring how nuanced your body is, and then being able to communicate that to your partner.
For some pain management techniques specifically, you can read chronic pain, sex, and intimacy.
What are some ways to create intimacy that don't include sex or foreplay?
Couples often spend a lot of time together, but not necessarily on something that’s fun, for example medical appointments are necessary but typically not a fun way to share time with your partner. By thinking through activities that you enjoy doing, you can do activities together that are novel, where you maybe learn something about the other person or learn something new.
A lot of times when there's a high degree of intimacy, couples can feel like they already know so much about each other. But I love the idea of looking up a question game or asking your partner 11 deep questions.
You're probably going to learn something new about your partner and a lot of times that learning something new sparks a little bit of curiosity that can translate pretty interestingly into the sexual space.
Other ways to be physically intimate other than sex or foreplay can include a massage, cuddling, and showering together. Washing each other's hair or brushing your partner’s hair. That's a very intimate activity. You can also help each other apply lotion after a bath.
Another idea is to create a list of activities, both big and small, that build your desire and be very open minded about what comes up. It might be some things that are sexual and some that are not, such as laughing with my partner or having clean sheets.