Sex And Chronic Pain
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Sex And Chronic Pain

"DOC, COULD IT GET ANY WORSE FOR ME?"

Joseph shuffled into the office with a frown on his face. "Doc, I am in so much pain. Every minute of everyday I have to deal with this pain in my abdomen. My surgeon thought it was my Gallbladder so he took it out...the pain continued."

"My Internist thought I had some type of psychiatric cause for my pain...so he referred me to a Psychiatrist who medicated me so heavily that I was falling asleep driving my car...I still hurt. And Doc...with all the pain...I haven't made love to my wife in 6 years. Could it get any worse for me?"

Since chronic pain touches every aspect of a person's life sexual dysfunction in a person with chronic pain should be no surprise. National statistics on sexual dysfunction in the United States ranges from 30-40 percent...in people without chronic pain.

I have never been a fan of sexual statistics. It's one of those topics that people have a hard time being totally honest about. In my clinical practice nearly every chronic pain patient had some type of problem with intimacy...if I was willing to listen and they were willing to tell me.

"WHY IS THIS HAPPENING TO ME?"

The physiologic response in human sexuality is complicated. Human beings are complicated enough without having chronic pain and chronic pain medications and the emotional response to chronic pain, and...etc., etc., etc.. The human body does not compartmentalize each organ system...the way it is taught in medical school.

There are 3 basic mechanisms to disrupt human sexuality in people with chronic pain:

The most obvious is the very neurochemistry of pain. Intractable pain raises cortisol , reduces dopamine, reduces serotonin, reduces norepinephrine, and reduces oxytocin. Normal levels of these neurotransmitters are essential to a "normal" sexual response.

The nature of the mechanism causing the pain. Some chronic pain syndromes effect the very mechanics for human sexual response (ie. chronic lumbar pain). Other chronic pain syndromes are directly related to intercourse and "torpedo" the intimacy (ie. chronic pelvic pain).

The treatments for chronic pain can profoundly effect the human sexual response. Opiate pain medications lower testosterone levels when taken long term. Certain surgeries can disrupt pelvic nerves literally disconnecting the sexual neural circuits.

Like I said before, "it's complicated." When a person has to endure chronic pain their sexual intimacy will ALWAYS be effected somehow. If depression is the "first cousin" of chronic pain, sexual dysfunction has to be the "brother or sister" to it.

"IS THERE ANYTHING I CAN DO?"

Thankfully, there are several important measures that can be taken to restore sexual intimacy in a person with chronic pain:

First, and foremost, treat the pain. The likelihood that people with chronic pain will achieve a totally pain free state is uncommon. However, predictable pain relief to a tolerable level (most people would report a "5" as tolerable) does wonders for a person's sexual response.

Understand the mechanism for the pain generation and devise a strategy to counteract it's effect on the sexual response. For instance, if the person suffers from chronic hip pain, body positioning during sexual intercouse can reduce pain significantly. Discussions of this type are very private and require time with your pain practitioner.

Identify reversible sexual side effects of the treatments. I used to run all the medications I was treating a person with through a side effect program that I kept on my i-phone (very handy in clinical practice).

"YOU ARE THE BEST, DOC!"

Joseph's pain was treated with a "high tech" mechanism. When he returned to his Doctor's office for his first post-hospitaization visit he was smiling. He said, " I made love to my wife for the first time in 6 years. You are the best, Doc"...and then his Doctor remembered why he had gone into medicine (click here for link).


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