Sexuality and chronic pain

People need physical and emotional intimacy almost as much as they need food and shelter. Sexuality helps fulfill the vital need for human connection. It's a natural and healthy part of living, as well as an important aspect of your identity as a man or woman. But when chronic pain invades your life, the pleasures of sexuality often disappear.

Where's the old passion?

Sometimes pain is the direct cause of sexual problems. You simply hurt too much or feel too tired for sex. If your pain is so severe that sex seems out of the question, talk to your doctor. You may need different or stronger pain-control medication.

On the flip side, pain medication can sometimes cause sexual problems. Some medicines diminish sex drive (libido) or inhibit sexual function by causing changes in your nervous system. Drugs also may affect blood flow and hormones — two important factors in sexual response.

Talk to your partner

The first step in reclaiming your sexuality is to talk with your partner — fully clothed, at the kitchen table or in another neutral setting. Sex can be difficult to talk about. Begin your sentences with "I," not "you." For example, "I feel loved and cared about when you hold me close," is much better than, "You never touch me anymore!"

This is the time for both of you to talk about your fears. You may think that your partner has stopped touching you because he or she has lost interest, or finds you undesirable. Instead, your partner may be frightened of causing you more physical pain.

Rekindling the spark

You both might spend a few weeks just getting to know each other again. Each of you might do little things that will make the other feel loved. Restoring your emotional intimacy will make it easier to move to the next step — physical intimacy.

Start reconnecting physically with "sensate focusing," an exploration of each other's bodies that avoids the genitals entirely. The goal is not orgasm. Instead, you are learning more about what feels good to you and to your partner.

Making love creatively

Sexual intercourse is just one way to satisfy your need for human closeness. Intimacy can be expressed in many different ways.

• Touch. Exploring your partner's body through touch is an exciting way to express your sexual feelings. This can include cuddling, fondling, stroking, massaging and kissing. Touch in any form increases feelings of intimacy.
• Self-stimulation. Masturbation is a normal and healthy way to fulfill your sexual needs. One partner may use masturbation during mutual sexual activity if the other partner is unable to be very active.
• Oral sex. It can be an alternative or supplement to traditional intercourse.
• Different positions. Lie side by side, kneel or sit. Look in your library or bookstore for a guide that describes and illustrates different ways to have intercourse. If you're embarrassed to get this kind of book locally, try an online book retailer.
• Vibrators and lubricants. A vibrator can add pleasure without physical exertion. If lack of natural lubrication is a problem, over-the-counter lubricants can prevent pain associated with vaginal dryness.

Plan ahead

When you feel ready to have sex, plan for it in advance. Make a date with your partner, picking a time of day when you have the most energy and the least pain.

Take your pain medication well in advance, so its effectiveness will peak when you need it. Limit the amount of alcohol you drink and avoid using tobacco in any form. Alcohol and tobacco can impair sexual function.

Give yourself plenty of time to try new things. Try to stay relaxed and keep your sense of humor. Focus on the journey, not the destination.

Worth the effort

Sex can actually make you feel better. The body's natural painkillers, called endorphins, are released during orgasm. And the closeness you feel during lovemaking can help you feel stronger and better able to cope with your chronic pain.

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