You and your partner can have a satisfying sexual relationship in spite of your chronic pain. By Mayo Clinic Staff

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 person.

However, when chronic pain invades your life, the pleasures of sexuality often disappear. Here's help on how to reconnect with your sexuality in spite of the chronic pain.

Sometimes pain is the direct cause of sexual problems. You may simply hurt too much to consider having sex. Adjusting your pain medication may be the solution.

If your pain is so severe that sex seems out of the question, talk to your doctor. You may need to adjust the timing of your medication or create a different or stronger pain control plan.

Alternatively, certain medications, particularly pain medications, may cause sexual problems. Some medicines diminish sex drive (libido) or inhibit sexual function by causing changes in your nervous system. Drugs may also affect blood flow and hormones, which are two important factors in sexual response.

Tell your doctor about any medication side effects that seem to be affecting your sexuality. Your doctor may be able to recommend an alternative medication or adjust the dose of your current medication.

To have satisfying sex, you need to feel good about yourself. So start by examining your own emotions.

If pain has left you physically scarred, unemployed or unable to contribute to management of your home, your self-esteem could be so battered that you feel you are unattractive and undesirable to your partner.

Awareness that your physical and emotional distance is hurting your partner may add to your anxiety, fear, guilt and resentment.

Stress can also worsen underlying difficulties in your relationship. Even strong relationships can be challenged by medical problems or chronic pain. Being aware of emotional conflict and what's causing it is an important first step in strengthening your relationship with your partner. Counseling may help.

The next step in reclaiming your sexuality is to talk with your partner about your feelings. At first, this may be best accomplished by talking to each other fully clothed, at the kitchen table or in another neutral setting.

Sex can be difficult to talk about. Begin your sentences with, "I," rather than "you." For example, "I feel loved and cared about when you hold me close," is more likely to invite dialogue than, "You never touch me anymore."

This is the time for both of you to talk about your fears and desires. 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 fearful of causing you more physical pain or discomfort.

Spend time 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 of physical intimacy.

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

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 holding hands, 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 from vaginal dryness.

Intimacy can be more satisfying if you 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 that 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. If you encounter setbacks, try not to become discouraged or focus on the negative. Keep trying.

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

Feb. 01, 2014