Chronic Pain and Sexuality                         

Søren Frølich, Health Psychologist

Chronic pain, understood as constant or regularly recurrent pain, is a problem suffered by at least 10% of the population.
In the course of the last 25 years there has been a renewed interest in research in the problem of pain, viewed medically and psychologically. A great number of scientific reports have been published on various aspects of pain and pain treatment. However very few of these many papers mention sexual aspects of pain. Most of the reports that do relate to sexual aspects of chronic pain are concerned with specific, genitally related pain states (e.g. dyspareunia) while even fewer address the general problem, that any form of chronic pain can have, and often has, a profound impact on the patients sexual life.
Chronic pain sufferers seeking medical assistance are more often women than men, more often elderly than they are young. This fact might be part of the explanation for the apparent professional disregard for the problems that chronic pain poses in relation to sexual experience and behavior.

Pleasure and displeasure

Pain is defined as an unpleasant experience. Sexual desire and behavior is usually associated with achieving satisfaction and pleasure as a final result.
Thus pain (at least chronic pain) and sex seem to be incompatible concepts. The few scientific reports available do indeed affirm the assumption that chronic pain in general inhibits sexual desire and activity. And, on the other hand there are experimental confirmations that sexual arousal under certain circumstances can alleviate pain temporarily.

Pain as an inhibitor of desire

Even in regard to the general population pain seems to be a fairly common cause of reduced sexual activity. In a recent Danish population survey about quality of life in general  3.7% of women (as compared with only 0.5% of men) indicated pain as responsible for a reduction in sexual activities.In clinical practice, working with chronic pain patients, it will become apparent if one cares to ask, that a large proportion of the patients have acquired problems in their sexual lives. These problems can be very straightforward ones as when sexual activity causes a worsening of the pain, or they can take a more indirect form associated with a general lack of energy and decreased sexual desire.
"Where I before went to bed with my husband, I now go to bed with a hotter bottle.", says a woman with chronic back pain.
When one part of a couple, for one reason or another develops a chronic pain handicap, it will inadvertedly influence the relationship as such, including the sexual relationship. Worsening of pain in connection with sexual activities or even the expectation of such a worsening is a sexual put off and functions as a deconditioner of the sexual responses. Lust becomes tainted with displeasure, and sexual activities tend to become less frequent. Life together with a chronic pain sufferer also tends to have a negative influence on the "healthy" partner's general physical and psychological well-being.
In cases where the location of pain is not in close vicinity of sexual organs, increased pain can many times be avoided by changes in technique, e.g.. using "petting" or oral sex instead of coitus. Change of habits requires a good communication between the parties, and in this sensitive subject area both involved far too often refrain from mentioning additional problems out of (misunderstood) concern for the other's feelings.

Sex as a pain-killer ?

Experiments on animals have shown that a suitable stimulation of sexual organs raises the pain threshold for stimuli, that otherwise provoke pain reactions. Similar experiments have been conducted with humans and show, likewise that sexual arousal eases pain.
This evidence supports the assumption that natural pain reducing mechanisms are stimulated by sexual arousal. Beside this there is the psychological factor, that any type of distraction, especially pleasant distractions, tend to make pain more bearable.
Some patients with chronic pain have discovered a relieving effect of sexual activity or phantasy on their pain, and a few are able to employ this effect deliberately.

Concluding remarks

People with chronic pain have a handicap that fundamentally reduces their quality of life and most often also has negative consequences for their work, their economy, their family life and their sexuality. When afflicted with a pain state, that turns out to be chronic, pain patients at first tend to put their life on "stand by" and often show depressive behaviors in the form of decreased activity and withdrawal from social contacts, including sexual contacts.
Medical treatment can only partly alleviate chronic pain, so the patient will have to try to "learn to live with" the remaining pain as best possible. Professional help can be very usefull in this difficult process in limiting the damage caused by the pain on many other aspects of the patients life. Professionals trying to help pain patients should perhaps be less shy about addressing the sexual aspects of pain. Frankness is essential both in the communications between patient and the professional as well as between the patient and the patient's partner. In an effort to conserve a measure of life quality for a pain patient the prospective potential for sexual functioning, should definitely play a role.
Carlsson P, Frølich S. Smerte og seksualitet. In: Graugaard C, Hertoft P, Møhl B (eds.) Hjerne og seksualitet. København: Munksgaard 1997