The other day I had one of my clients come into session and say…. “Dr. Phillips, my rheumatologist really pisses me off….she assumes I have all of these problems due to my diagnosis with Fibromyalgia, including my want and desire for sex….I still have sex! My desire and arousal may fluctuate and my husband gets it!” This is the lovely myth that people with chronic illness don’t want sex. Relationship and sexual satisfaction are important factors for couples and they are a crucial concern for people who live with chronic pain and illness. What people don’t know is that in a life restricted by pain and illness, sex can be a powerful source for comfort, pleasure, and intimacy. For people with chronic pain and illness and their partners, a satisfying sex life is one way of feeling healthy when so much of their life has been changed.
Chronic pain and illness can have profound negative effects on a relationship and sexual satisfaction for both the person with pain and illness and their partner. I have found in my research that the effects of chronic pain and illness are complex and can impact on all phases of sexual response. These effects can be classified into biological and psychological. Your sexual desire, capacity and activity may be changed by illness through the side effects of medication. Some of these medications used to treat chronic pain and illness can cause sexual dysfunction in men and women. Therefore, it is critical to speak with your medical provider about the sexual dysfunction. You have to be an advocate for yourself because you know your body better than anyone else and you are the one taking the medication! I remember I had a client who was diagnosed with arthritis. He was prescribed Methotrexate over a twelve month period to treat the arthritis and this caused erectile dysfunction. After discussing this in therapy, he advocated for himself, and his rheumatologist replaced the medication with an anti-inflammatory agent. This greatly improved his sexual functioning.
Anxiety, depression and loss of self-esteem associated with chronic pain and illness can diminish sexual fulfillment. Alteration of sexual function or unsatisfactory sexual relation can spark a significant emotional crisis. However, some couples easily accept limitations or cessation of sexual activity caused by chronic pain and illness, and this is the goal! As a woman, you may experience severe vulvar pain during sex in the area around the opening of the vagina. Sex is important to you and you learn that you can no longer have penetrative sex with your husband. You begin to feel unfeminine and inadequate. You react with depression that causes anger, causing you to emotionally withdraw. With couples sex therapy and support, you can adapt to non-penetrative sex techniques. This is revalidating sexual intimacy in the relationship….remember it is learning what is possible as opposed to what was once achievable!
