Sexual Wellness and Chronic Pain: Coping Strategies

Chronic pain can interfere with day-to-day life, which, unsurprisingly means your sex life. Though chronic pain manifests differently across people, pain that lasts more than three months is considered chronic. With a variety of coping strategies, it is possible to have a satisfying sex life with chronic pain. 

How chronic pain can affect your sex life

What’s misunderstood about sex and chronic pain is the misconception that there is one healthy, normal, and best way to have sex, explained Michelle Di Paolo, PhD, LPC, NCC the founder of Stress and Relaxation Services of America. 

“Chronic pain takes an emotional toll as well as a physical toll,” explained Kelsey Bates, LMHC, founder and psychotherapist at Women’s CBT. Between work obligations, family life, and everyday tasks, with chronic pain, the last thing on your mind might be sex. The invisible mental load of handling your pain can change your sex life temporarily, Bates explained. 

It makes sense that chronic pain will shift the way you experience or think about sex. “Folks with chronic pain often think if sex doesn’t look the same as it did prior to the pain-activating event it will never be as good as it used to be,” Di Paolo said. 

Though chronic pain can be exhausting and life-changing, it doesn’t have to be a death sentence for your sex life. Sex can even help chronic pain. Likely due to the release of feel-good chemicals in the brain, arousal and orgasm might even alleviate chronic pain. 

Chronic pain may also facilitate intimacy and deeper experiences. “Some people find that the need to adapt their engagement in sexual activity has opened up an improved quality in their sexual experiences due to exploring the wealth of options they never would have tried had they not been motivated to find alternatives driven by chronic pain needs,” Di Paolo said. 

Coping skills for chronic pain 

Practicing self-soothing techniques

Chronic pain can impact someone’s sex life in a variety of ways—from discomfort in certain positions, lower desire levels, increased performance anxiety, or decreased enjoyment or sensitivity. Incorporating self-soothing techniques as part of your pain management regimen can help you de-stress. This becomes important when it comes to chronic pain and sex, as worrying can cause tension or increase pain, Di Paolo explained. 

Exploring sensate-focused techniques, where you focus on pleasurable sensations, without the goal of orgasm can also help relieve psychological pressure, Di Paolo explained. 

Timing is everything

When it comes to exploring sex with chronic pain, knowing when to explore is just as important, if not more, as knowing what to explore. “Slowly and safely explore when, where, and how your body feels better or most likely to be as comfortable as you can easily muster. It’s important to realize that the first step in having a better sex life with chronic pain is first to understand the variables at play pertaining to pain management outside of your sex life,” Di Paolo said. 

With chronic pain, the timing of when you have sex might look different than before. “Scheduling sex is not a failure of your relationship or intimacy. There may be times of day or days of the week that your pain is significantly better or more manageable,” Bates said. 

Physical comfort is key

“The worst thing you can do is focus first on the sex component,” Di Paolo said. There’s more consideration that needs to be applied to sex beforehand. 

“Start with figuring out the scenarios that provide the highest likelihood of physical comfort having nothing to do with sex. From that point, you can explore how to integrate sexual behaviors, slowly, into those scenarios as opposed to the other way around,” Di Paolo said. 

Sexual wellness products can also help maximize physical comfort. “Get yourself a variety of pillows! Bolster your body in ways that will increase the likelihood that your body will be able to relax,” Di Paolo said. Other toys are designed to make sex or pleasure more accessible. You might also want to cater the kind of sex, such as oral sex, based on your level of pain that day. 

Seeking support

Your medication’s side effects and pain management techniques can always be discussed with your provider, too. When it comes to pain, it’s important that you’re working with someone who hears and validates all your concerns—including sex! “Many pain medications are central nervous system depressants and, of course, reduce your sensations of pain, but because of their mechanisms of action on your nervous system, they also reduce sensations of pleasure during sexual activities,” Di Paolo said.

If you’re having trouble navigating either the physical or emotional pieces of sex, you might also want to seek the support of a professional who is well-versed in helping individuals with chronic pain. Some sex therapists specialize in chronic pain. “A pelvic physical therapist can provide exercises to prepare for intimacy as well as tools to decrease pain during sex. Psychotherapists can help you manage anxieties or fears around sex,” Bates said. 

Talking to your partner about chronic pain

As with any and all good sex, communicating your needs is essential. This might mean knowing when to turn down sex because you need to tend to your pain, or inviting a different form of intimacy, such as cuddling or massages. Getting in touch with your needs and capacity for intimacy can be a helpful launching point. “Your job is to first protect your bodily needs and safety and never to push those needs aside to please your partner or avoid the discomfort that may arise in the short term of sticking to a boundary,” Di Paolo said. 

While watching a partner endure chronic pain can leave you feeling helpless, there may be ways you can provide support, explained Di Paolo. “A partner can be helpful to alleviate the stress in their loved one’s environment, indirectly leading to pain management benefits for their partner,” Di Paolo said. This might look like taking over certain chores for the day or setting up pillows in a way that makes your partner feel comfortable.

It’s a myth that chronic pain thwarts a pleasurable sex life. “The reality is the best sex life is the sex life that is safest and most enjoyable for you in frequency, quantity, and intensity,” Di Paolo said.