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 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.
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.
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.
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.