Sunday, July 24, 2011

Chronic Pain and Sexuality

Almost  80% of people living with chronic pain and/or disability and their partners report a significant reduction or loss of their sexual functioning.

Chronic pain can lead to fatigue, insomnia, and symptoms of depression. Pain medicines may reduce libido. And for some people, intercourse itself can cause pain, says Meeru Sathi-Welsch, MD, an anesthesiologist and pain specialist with Long Island Neuroscience Specialists.

“Chronic pain infuses every aspect of a person’s life,” agrees Daniel Kantor, MD, president-elect of the Florida Society of Neurology (FSN) and Medical Director of Neurologique, an organization dedicated to patient care, research and education. “You don’t see yourself as a romantic, sexual being, because you’re so defined by the pain.”

What can you do to light the fires again? “It takes a lot of creativity and patience!” says Sherrie Sisk, 43, a single mom who chronicles her 10-year struggle with fibromyalgia pain in a blog called “The Tramadol Diaries.”

First, talk to your doctor about what aspects of your treatment might be changed to help improve things sexually.  Be aware that this is a common problem; you are not alone.  Don't be afraid of discussing the issue with your physician.  If your physician minimizes the problem, find another physician or a psychologist you can talk to.   David Rosenfeld, MD, a pain specialist with the Atlanta Pain Center, says your doctor can help in several ways:
  • Change medications. “We can decrease opiates and use more other medications that we know are effective for treating chronic pain with less effect on sexuality, like Cymbalta and Lyrica,” says Rosenfeld.
  • Add new medications. For men with low testosterone levels, a prescription for testosterone may help with sexual desire. Drug treatments such as Cialis, Levitra, and Viagra may also be used for men with erectile dysfunction.
  • Refer you for biofeedback treatments. “We’ve found that biofeedback can be very helpful for women, in particular, who complain of significant pelvic pain and dyspareunia,” says Rosenfeld. Dyspareunia is pain with sexual intercourse.
  • Connect you with a support group. It can help to know that you’re not alone -- and other people in the same boat might have new ideas you haven’t tried.
Don’t think of sex in the same way you always did. The positions that worked for you before you began your struggle with chronic pain may not work for you now. You may need to think of new ways to initiate intimacy and different ways to be intimate.
  • Change positions. Especially if you have severe back pain or neck pain, being on the bottom -- or the top -- could be painful. Try a side-to-side position to alleviate back or neck pressure; use pillows for support.
  • Take your time. Instead of just initiating sex, sit quietly by the fireplace with your partner and read a romantic or sexy book to each other. “This is time for you as a couple, not focused on pain,” Kantor says. “Hold each other’s feet and give your partner a foot massage. Don’t be in a rush. After awhile, it becomes not about the pain and not about forcing yourself.
  • Try alternatives to intercourse. “People can try using vibrators, manual stimulation, and other intimate acts besides just intercourse itself,” says Sisk. “Go beyond ‘You do me and I do you.’”
When you’re coping with chronic pain it can be tempting to just write off the sexual part of your life. But that puts your relationship at risk. “If you’re not at least willing to explore intimacy with your partner, you’re going to be in trouble,” Sisk says. “Your partner has to learn what your illness means to you, how it affects your sexuality, and try new things to make it better. And you have to understand that sex is important to your partner. You can’t say, ‘That part of our life is over now.’”

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