Chronic Pain and Sex

Chronic Pain and Sex

By Liza Zoellick.

Let’s talk about sex baby. Let’s talk about you and me. No, for real, let’s talk about sex.

There’s an estimated 12 million people (couples) who deal with chronic pain and intimacy issues. It can be difficult, both physically and emotionally, to get yourself prepared for sex and sometimes the pain wins and you choose not to have sex even though you may want to. There’s absolutely no shame in avoiding intimacy when you are in pain, but communication is essential between you and your partner. The last thing you want is added strain in your life because your partner thinks you are rejecting them. Remember, even those closest to us do not understand the pain we live with daily. So, it is imperative to talk to your partner and explain to them as best you can how you feel.

Liza Zoellick

Now, listen up. We’re going to tackle this together and hopefully learn how to cope, learn things we can do to achieve intimacy without sex and how we can have sex more without being in so much pain. Don’t think for one minute that chronic pain is a death sentence for your sex life. Patience, communication, understanding and creativity is the key!

Pain and Sex Fears

If you are hurting, it’s only natural to want to protect yourself. No one wants to hurt more but you don’t have to avoid sex entirely either. Talk to your partner about your worries and concerns so they can be aware and take more care in how they handle you. Remember that you are in a loving relationship and more than likely your partner has similar worries and concerns about causing you pain. Communication is so very important, you are going to hear me say this a number of times. It allows you to connect, offers a chance to listen and exchange ideas and best of all you’ll feel better afterwards. And those of you dating out there with chronic pain- the same thing goes when you step into a relationship that will involve sex. You have to talk to potential partners about your worries and concerns so they know. It’s much better to be upfront about it rather than have an awkward time in the bedroom.

Failure to Launch

Chronic pain is insidious. It can bring on depression. The meds prescribed to help chronic pain can affect sexual performance or the ability to get aroused or achieve orgasm. Opioids happen to be a huge culprit in this area. Simple stress and anxiety can have the same effect. You may want to speak to your doctor if you think your medicine is affecting you sexually. But many times, patience and understanding between you and your partner can help overcome these issues.

Just Saying No?

Again, it’s okay and don’t let anyone guilt you into it. Not only is that wrong, it’s selfish. No one wants chronic pain. There are plenty of other excuses to hand out when not really feeling in the mood than using the chronic pain card. Anyone accusing you of just using it as an excuse clearly doesn’t understand your pain. and while not engaging in sex is your option, there are ways to stay intimate without intercourse. Here are a few examples:

Self -Pleasure: Masturbation is a normal and healthy way to fulfill your sexual needs.

Touching: Cuddling, fondling, massaging (if you can tolerate that kind of touch) and kissing are all worthy explorations, that increase feelings of intimacy. Even bringing one another to orgasm from touching can be satisfying.

Oral Sex: This might also be a possible alternative to traditional intercourse or as something supplemental when you are not feeling up to it. And remember, any combination of these can bring you and your partner closer and satisfy those needs and desires.

Forethought and Planning: Understand that the nature of pain means less spontaneity. And what I mean by that is no quickies! Think of sex as planning a big date, and evening to set the mood and do all those things I’ve just spoken to you about, as not only a way to set the mood but a way to gauge your comfort. After all, it’s not like that attention is a waste of time-any time with our partner showing affection is welcome and much needed.  Another part of planning- make sure the patient takes pain medication, perhaps takes a hot bath or shower before hand or sits with a heating pad against their vulnerable areas or stretches a little bit to help limber muscles. Choose a time of day that you may be in less pain. For me, afternoon and evening are better. Mornings, I am not very agreeable.

Pillows: Lots and lots of pillows, I mean it. No joke. Lots of pillows even if you have a truly comfortable mattress. The pillows are for both comfort and stabilization.

Low Impact Positions [In control of movement]: Believe it or not, studies and research have been done in an effort to help those with chronic pain enjoy sex more. Some studies have shown “that for patients trying to have spine-sparing sex, the general recommendation is to try to use more hips and knees versus thrusting the spine, to get that movement.” [Natalie Sidorkewicz, PhD candidate at the University of Waterloo, Ontario] [Not in Control of movements]: The goal for those not in control is a more neutral spine. For example, men or women lying on their back during sex, an easy way to get a more neutral spine is by putting a rolled-up towel behind their neck. Another example is for women to be in a tabletop position while keeping a bit of an arch in their back for a neutral spine position.

Tips for Minimizing Pain During Sex

Pillows: Lots of pillows! Pillows under hips, bum or chest, for both comfort and to help stabilize you so you aren’t rolling around too much. Experiment with different sizes and placement and have fun.

Hip Check: If you have lower back avoid a lot of thrusting from your hips as well as too many fast and jerky movements.

Alignment: Neck or back pain? Try to find a position where both your neck and back are aligned as much as possible.

Safe Word: Don’t worry! I’m not about to get all 50 Shades of Grey on you, but this is important so listen up! Sex is between you and your partner and it’s not something that is done one way or other. Experiment, change it up. Even if a sexy session only lasts 20-30 minutes, change positions. Agree before hand on a safe word to call out if at any point you hurt or feel fatigued. It might be a bit of an inconvenience hitting the breaks at first, but it will open up communication and possibilities of different play.

Positions for Fatigue

Because it’s not just chronic pain, but also chronic fatigue that can make intimacy difficult. Chronic fatigue can sometimes accompany chronic pain; however, it is also a stand along medical problem that can be very debilitating. Here are some positions that may help you and your partner and can also be experimented with by those who have chronic pain.

Edge of the Bed

The partner who experiences fatigue lies either on their back or on their stomach with their bottom at the edge of the bed. This allows the bed to provide support for the partner experiencing fatigue, while the partner who has more energy can either kneel or stand by the edge of the bed and use their hands and arms to create movement between their body and yours. Why is this position great? It allows the partner who is fatigued to completely relax and enjoy without exertion. But, if you have some strength you can hold on to your partner and move with them.

Sitting Sex Position

This works best in a large chair with arms and a back and can be great if you tire easily. These don’t allow for as much movement for either partner, but they do offer more physical contact and closeness.

Position A: Is for the partner who has more energy and is also the one doing the penetrating. They can sit on the chair first and as it sounds, the partner who is fatigued can lower on top of them. They can either face toward their partner or away.

Position B: If the person with fatigue is the one penetrating they can sit on the chair and their partner can support themselves on the arms of the chair to move up and down in their partners lap.

Side-by-side While Face-to-face: Just the way it sounds. Both partners lie on their side and face-t-face. You can use pillows tucked behind you and around you for extra support. This position is not always the most convenient or practical, given height differences, but is does allow for a lot of physical skin-to-skin contact.

Spooning: This position offers the same benefits as side-to-side, but here you are facing away. This position works best if the partner with more energy is the one doing the penetrating, as they can grab your hips or waist and create movement without the partner needing to do much work.

Right angle Position: Sometimes referred to as scissor. The partner being penetrated lies on their back with a leg in the air, braced against their partner’s chest/shoulder. The partner with stamina does all the work and can also move your body by moving your leg. Not everyone will benefit from this position but it’s worth a try. You can experiment with variation and pillows.

The Recap: What I want you to walk away with, after reading this, is hope. Remember that planning is important. Communication is essential. Experimentation can open up new possibilities and intimacy is not solely about intercourse. If you feel it might be medication related, speak to your doctor. Last of all, remember you are not alone. Lean on your partner, talk to your partner and spend time giving one another the attention you need.

Liza is a chronic pain warrior from Houston who has been chronicling her journey through chronic pain and illness on her blog: She is a frequent and valued contributor to the National Pain Report.

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Authored by: Liza Zoellick

Liza is a chronic pain warrior from Houston who has been chronicling her journey through chronic pain and illness on her blog: She is a frequent and valued contributor to the National Pain Report.

newest oldest
Notify of
Lynda Hillebrenner

I have lectured on Sex for those in pain and/or have breathing problems. Talking about how important intimacy & a loving relationship is to a marriage or any sexual relationship. There are the great suggestions made in this article by Lisa, and she has covered a lot of the points in my talks. I have a Master’s Degree in Ed. Psychology. I have spoken to chronic pain patients with their partners, & separately. I found it very helpful to talk to the partners first, allowing them to talk plainly about how sex or lack thereof, affects their relationship. I explain obstacles for the chronic pain patients & really encourage discussion about sex. Then I talk to both partners. NOW, when I talk about sex, I am talking about all aspects of it, from light hugs, holding hands, talking & using that to open discussion about cuddling, spooning & if & when the sexual act itself is possible. I never encountered a partner who wanted to have intercourse with a partner who was in increased pain or who just wasn’t up to it. However, allowing the ccp to determine when, how & to what degree they wanted to please & feel the intimacy of maybe just taking a shower or bath together, or giving each a massage. For those who just don’t want to touched, I provided separate one on one discussions to find a way for them to demonstrate intimacy. Everyone needs to feel connected to their partner & there are ways to achieve that, but first you have to be open to it, willing to broach the conversation & talk about how each of you feel about sex. I am a chronic pain patient, I am on antidepressants, which totally decrease my libido, BUT my husband explained very clearly to me (tho not quite in these words), that intimacy & sex was his main way to show me how much he loved me and that he needed to be pleasured (new word) by my touch. We don’t always get it right & we don’t always have intercourse, but we are better at being intimate.

Your article is so well written! Thank you! I posted it on my facebook group that addresses pelvic pain and sex


what about BOTH partners in Chronic pain????????? We gave up about 8 yrs ago, not for lack of wanting to

Mavis Johnson

They are kidding right. I just read somewhere that people who took anti depressants lose all ability to enjoy sex. I was just thinking that many pain patients were forced to take anti depressants, instead of get their pain treated. This sounds over optimistic or else it was written as a joke.

Liza Zoellick

Thank you for all the comments. Generally, I do try and answer individually, but it’s not such a great day. However, there are so many interesting comments, I am thinking about writing another piece relating to the subject in coming weeks. Thank you for engaging. It really does help what I write and subject matter I tackle.


This is where I see just how amazing my husband is… He’s a very sexually oriented person so when I became a chronic pain sufferer, the sex was put on the back burner. Lots of fights, arguments and discussions later we finally found something that works for us. Our routine allows him to get the sexual release he needs and keeps us intimate without severely hurting me. Only downside is I never orgasm, but that causes an excruciating headache anyway which kinda ruins the experience. It’s important to find ways to maintain a good level of intimacy with each other and to work past the awkwardness of trying new things.

Julia Heath

Way to tackle a tough subject! As someone who’s been married for 28 yrs, intimacy is still very important, but we make it that way on purpose. Communication truly is key, and even then things can still become strained. You just got to be willing to love & forgive. I’m the one with chronic pain, and I’m grateful for an exceptional hubby!

Denise Bault

Thanks for writing an article that most people don’t or can’t talk about! You’ve got some great advice in here…


This column shocked me, as it is so opposite of what happened to me. While my pain makes me frequently too ill for sex, my longterm BF stopped wanting it, even at my request. He came to view me as an invalid instead of as a sexual partner.

I really don’t understand how people with chronic pain can still work, or do much, and when this column suggesting dating, I almost fainted. I can’t imagine any man who is remotely healthy wanting to be with me, since being with me means staying home almost all the time.

If I can take a shower and eat something besides a frozen dinner, it’s a good day. My quality of life has steadily declined over the years. A lot of my problems are exhaustion-related, as I have adrenal issues and other medical issue plus the pain and the opioids to make me tired. Put them all together, and I am largely housebound, and really, sofabound. My 90 year old father goes to the theatre and on bus trips, and long walks, but I can’t b/c I can’t sit up for any length of time and any activity makes my pain spike and wipes me out for days. I’m 61.

My chronic pain began 10 years ago tomorrow — the date of my hysterectomy that left me with pelvic pain syndrome that has not responded to PT or to other non-Rx treatments or to non-opioid Rx’s. This pain, on top of my other medical issues, was the end of my working life and life as I knew it — which was a struggle due to fibromyalgia and untreated adrenal problems and more, but I still managed to have a life, which I dont’ any more.

To the Publisher - I know that I typed in the correct Captcha code but got a message that I didn’t. And had to try again. There is something wrong with this system.


I have had CRPS since the early 90’s, of course they didn’t call it CRPS back then but call it what you like being in horrendous pain 24/7 doe not make relationships easy. I know so many people with chronic pain who have had their relationships fall apart for just that reason. Granted it is not easy to live with someone who lives with pain. It takes more than just love, I think. It takes real deep down commitment - you took that person for better or worse, and this is about as worse as it can get. My sex life died on the vine for many years because of chronic pain. My partner was terrified that whatever we did would hurt me more than I already was and if you go into intimacy with fears for yourself, or fears for your partner the sex is going to be bad.
Talking about what might work for you with your partner is key. If done in a way that actually creates some excitement the experience can in many ways rival those first times. After all, aren’t you figuring out all over again what your partner likes, wants, needs, from and intimite relationship. When it’s the guy who is in pain I think it is harder (no pun intended) because if left unspoken the woman will feel as though it’s all up to her and many women don’t like being put in that position (oops- there I go again)
Anyway, this post is SO RIGHT! Talk to your partner, don’t be afraid to go into detail about what feels good and what doesn’t. This isn’t rocket science - it’s nature - and for any couple it is a good idea.


Are u kidding. I dknt even want to be touched