Fibromyalgia and its chronic pain can affect sex and intimacy in a relationship.
Decreased libido, altered genital sensation, fatigue/weakness, bladder/bowel dysfunction and painful intercourse may be some causes of sexual dissatisfaction. Physiological, psychological and pharmacologic factors may affect any or all of the four phases of sexual response—desire (libido), excitement, orgasm and afterglow.
Decreased Libido
Decreased libido is one of the most common concerns. This may be related to your illness, fatigue, medication side effects, depression, hormonal imbalances, or body-image concerns. Other reasons why individuals may lack sexual desire, include lack of attraction to a partner, and anger in the relationship, interpersonal conflicts, fear of closeness due to illness, vulnerability with intimacy, and even a passive-aggressive solution to power imbalance. Health professionals can provide insights into the nature of the desire problem. Treatment depends on the underlying cause.
Altered Genital Sensation
Uncomfortable genital sensations including burning, pain or tingling that can sometimes be relieved with prescription medications. Decreased vaginal lubrication can be relieved with water-based lubricants, such as KY jelly, Astroglide or Replens, applied during sexual activity.
Altered genital sensation may challenge a woman to explore her body for alternative, sensual areas. If she has a partner, the couple can explore this together. The focus should be on stimulation of the chosen area without any plans of moving to other areas or having sexual intercourse. These exercises place the emphasis on intimacy and pleasure over the goal of performance and orgasm.
Fatigue/Weakness
The partner may be able to identify certain times during the day when she has the most energy, often dependent on sleep patterns and administration of medication. Energy conservation techniques include taking naps. Expectation for spontaneous sexual encounters should be re-directed to allowing more planning for sexual activity. It is important for both partners to recognize that a woman with fibromyalgia may need more time and attention to get aroused.
Bladder/Bowel Dysfunction
Emptying the bladder before sexual activity can sometimes prevent voiding during sex. Avoiding intense genital or anal stimulation when having a full bowel will help avoid an unscheduled bowel movement during sexual activity. Protective sheets or towels may lessen concern about bowel or bladder release. Pelvic floor physiotherapy sometimes may improve bladder and bowel control. Some medications help manage incontinence by reducing spasms of the bladder and urethra.
Painful Intercourse
Pain during sex can be managed by scheduling sexual activities when symptoms are least problematic. Pain-controlling or antispasmodic medications can be taken prior to sexual activity. Experimenting with sexual positions and activities can minimize painful intercourse. Tell your partner what feels good and what is painful. Encourage your partner to engage in other sexual, erotic and intimate activities that do not involve intercourse or orgasm.
Psychological Factors
Over time, individuals with chronic pain often change the way they view themselves. They frequently feel that they are not contributing to the family or to society. As self-esteem diminishes, sexual desire and feelings of desirability also diminish. Depression, anxiety, fear, guilt and resentment contribute to the loss of desire and self-confidence in sexual performance. Discuss these concerns with a health-care professional.
Pharmacologic Factors
Medications used to treat pain can diminish libido or may inhibit sexual function by causing changes in blood flow, hormones, or the nervous system. Antidepressants, antihistamines, sedatives and antispasmodics can alter sexual function. Discuss these concerns with your physician as some drugs may have less adverse effects than others.
Suggestions for a more fulfilling relationship:
Open communication. Relationships suffer from the lack of communication. Tell your partner “I really miss our sex life.” Love unconditionally, make a commitment to understanding how fibromyalgia affects both of you and keep a sense of humor. Be appreciative of your significant other and enjoy each other.
Rediscover the romance. The mood should be relaxed and romantic. Schedule a date night with your partner, perhaps using soft music. Touching, handholding, kissing, couple’s massage and couple’s hot tub, can be excellent forms of intimacy. Take time to find sexual positions that produce the least pain using pillows.
Provide a comfortable environment. Drafts can increase muscle pain so ensure you have a comfortable room temperature. You may need more time and attention to get aroused and should not be approached when physically exhausted.
Professional counseling. If fibromyalgia interferes with this total process of showing love, then both partners need to acknowledge this and make a commitment that this interference will only be temporary as you learn to redefine intimacy. A qualified sex therapist can provide a supportive atmosphere in which partners can discuss sexual problems and concerns regarding their intimate relationship.
Sexual intimacy strengthens the closeness and caring bond between partners. Dissatisfaction with the sexual aspects of a relationship and the loss of shared intimacy and trust can lead to feelings that threaten the total relationship. A health professional can provide a treatment approach related to the nature of the sexual problem.
