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
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.
ÒWhere I before went to bed with my husband, I now go to bed
with a hotter bottle.Ó, 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 ÒhealthyÓ 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 ÒpettingÓ 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.
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