Everybody loves a bit of loving now and again, but when you suffer from chronic pain, expressing that love can be a bit tricky. In fact, it can be downright painful, leading many chronic pain sufferers to avoid sex and intimacy altogether. But it doesn’t have to be all doom and gloom. The Spoonie Society spoke to sex therapist and medical doctor Mia Harris, to find out how to overcome the barriers and still feel close to their partners.
TSS: How does chronic pain impact sex and intimacy?
MH: Chronic pain is pain that persists for greater than three to six months, and it is felt on most days of the week, affecting 1in 5 Australians.
Chronic pain affects the whole person. It changes how we see ourselves, how we relate to others, how we view life, what jobs we are able to do, and what activities we are able to participate in. Naturally, this can cause negative effects on our sexual identity and lead to sexual problems.
TSS: What are the challenges?
MH: Chronic pain can cause sexual issues in numerous ways. It can be by way of physical limitations, depression and anxiety that may occur because of the chronic pain, fatigue and sleep problems, or as a result of the side effects of some of the medications used to treat chronic pain or the mental health problems that it causes.
TSS: How can this impact relationships/mental health etc?
MH: Sexuality is a core part of what it is to be human, and anything that damages our sexual identity and sexual function can impact our sexual or intimate relationships and our mental health.
For the person with chronic pain who is experiencing sexual problems, they may lose confidence in their ability to have sex or be sexual, they may have shame around their body or sexual identity, and they may start to avoid sexual encounters, with anxiety being triggered by the very thought of sex.
TSS: Can these challenges be overcome?
MH: Yes, although there isn’t a lot of research evidence to back this up! It may take time and work by the person and/or couple and involve a whole team of professionals to help them, but they can come to experience pleasure and sexual self-worth again.
TSS: Are sex and intimacy the same thing? If no, what are the differences?
MH: Sex and intimacy are not the same thing.
Intimacy can also be called closeness or connectedness. It develops over time, and it takes trust, honesty and respect. Intimacy can be expressed in many ways, and can include emotional, sexual or spiritual intimacy.
People may have sex to create intimacy but there are other reasons that may motivate people to have sex.
TSS: How can people with chronic pain achieve intimacy?
MH: Try to see the problem as external to yourself. You are not faulty, and you or your partner are not to blame. It is the chronic pain causing the issues, and if you are
in a sexual or intimate relationship, it is a problem in the space between you and your partner. Be kind to yourself and each other. Communicate openly and without blame.
Remember that sex and intimacy are not the same thing. Sex can be an expression of intimacy, but there are other ways to maintain intimacy.
It is normal for sexual desire to settle, and wax and wane in long term relationships. This has a two-fold effect: it paves the way for more intimacy or connectedness, and it changes the nature of sexual desire. Sexual desire is often more spontaneous at the start of a relationship and it then leads to arousal.
As time goes on, desire often becomes more responsive and this means that you may need to become aroused first and this will lead to wanting to have sex. Take the time to text loving or sexy messages to each other during the day, put aside time together, cuddle on the couch at night, give each other massages, clean the house for one another, do whatever you each find sexy!
TSS: What about sexual intimacy?
MH: Again, try to see the problem as external to yourself. You are not faulty, and you or your partner are not to blame. It is the chronic pain causing the issues, and if you are in a sexual relationship, it is a problem in the space between you and your partner.
Be patient. It may take time and experimentation to find what works sexually for you and your partner. You will have wins and losses, just go into each sexual encounter with as open a mind as you can manage.
Talk about your issues. Open communication between you and your partner is integral to each of you experiencing sexual pleasure and intimacy. Speak up during sex and say what is working for you, and what is not. Reflect at other times on what you liked and didn’t like and build the things that work into your sexual repertoire.
Reframe what sex is to you and remember that sex is a smorgasbord of activities to be enjoyed! Focus on what gives you and your partner pleasure, and it isn’t only penis-in-vagina intercourse and orgasm. Sex can be kissing, mutual masturbation using hands or toys, oral sex, penetrative intercourse using sex toys… the list goes on!
Solo sex (masturbation), and your own private pleasure and the enjoyment of your own body is equally as important!
Speak to trusted health professionals about your sexual issues. See if there are different medications or treatments you can try if the side effects of your current ones are having too much of a negative effect on sex.