How to Have Great Sex If You Deal With Chronic Pain

Erica Sloan
·12 min read

Marie Bertrand/Getty Images

We’ve all felt random worries pop into our brains during sex: Is my breath okay? Am I being too loud? Uh…did I forget to lock the door? But for folks like Akilah Cadet, DHSc, who lives with chronic pain due to multiple conditions, there are also things like stiffness in her back or the risk of dislocating a finger to think about. She has Ehlers-Danlos syndrome, a genetic condition that weakens connective tissues in the body and can lead to unstable joints, as well as ankylosing spondylitis, a type of arthritis that causes inflammation in the spine.

Dr. Cadet is certainly not alone in feeling these anxieties: Research shows that up to 78% of people with chronic pain have difficulties with sex. A 2023 study also found that almost 70% of nearly 250 people receiving treatment for chronic pain experienced some form of sexual dysfunction, like having no interest in sex, issues with vaginal lubrication or erectile function, or a lack of satisfaction in bed.

“When you’re in a flare-up or you have pain, the last thing you’re thinking about is sex because all your energy is going into taking care of yourself,” Lee Phillips, PhD, LCSW, a licensed psychotherapist and AASECT-certified sex therapist in New York, tells SELF. After all, pleasure can feel worlds apart when your head is pounding, your joints are screaming, or your back is so sore you can barely move.

The thing is, a healthy sex life can also play a meaningful role in helping you feel a little better: All the hot, intimate, gushy, or just plain good feelings of sex—solo or partnered—can sometimes offer a bit of relief. Here, we asked experts to break down how chronic pain can cut the heat from your sex life and what you can do to crank things back up to 100 (safely, of course).

First, let’s talk about the various ways chronic pain can put a damper on your sex life.

If you’re dealing with pain on the regular, you may (understandably) want to hold back on some kinds of physical movement—sex included—to avoid triggering or worsening your symptoms. A gnarly injury (say, in your shoulder, neck, or back) or a condition like arthritis or fibromyalgia “may make it physically challenging to achieve common positions for intimate contact,” Christie Cobb, MD, FACOG, a board-certified ob-gyn in Little Rock, Arkansas, tells SELF.

Certain conditions can also directly affect your ability to have penetrative sex and reach orgasm. For instance, diabetes can lead to vaginal dryness (which can make penetration feel very rub-and-tug) or erectile dysfunction, Dr. Phillips says, and fibromyalgia is connected with pelvic floor dysfunction (which can mess with your chances of coming). And any condition that’s characterized by intense cramping or pain in your lower pelvic area, like endometriosis, vaginismus, or a chronic bowel condition like Crohn’s disease, can “make receptive penetration unpleasant, if not impossible, sometimes,” Dr. Cobb says.

What can ironically make things even worse is certain medications that counteract the pain: Opioids, especially if you use them long-term, can reduce your body’s production of sex hormones, and this can potentially lower your libido, Samantha Rafie, PhD, a clinical psychologist and co-author of Chronic Pain and Opioid Management: Strategies for Integrated Treatment, tells SELF. Antidepressants, anxiolytics (anxiety meds), and some muscle relaxants can all dampen different aspects of sex too, she adds.

And that’s not even factoring in the whole mental side of this. “It can be emotionally challenging to maintain arousal and desire in the face of pain,” Dr. Rafie says. “Just dealing with persisting body pain puts a lot of people into a low mood, and that alone can [lead to] loss of interest in things that used to be pleasurable.”

Sex can be especially helpful for people with chronic pain for all sorts of reasons.

When you have sex and orgasm, your body releases a bunch of feel-good neurotransmitters like oxytocin and endorphins, “which can acutely improve pain and mood,” Dr. Rafie says. Meaning, sex can bring about a blissful moment of relief (even if, no, it can’t actually take away chronic pain).

Sex can also be a great distraction for your brain. “If someone’s engaged with a very stimulating activity, that’s going to dramatically shift their brain’s ability to process sensations coming from painful body parts,” Dr. Rafie says. (Basically, if your partner is going down on you and you’re well on your way to O-land, you might be just busy enough to forget about that nagging backache for a sec.)

For Dr. Cadet, who is also the author of White Supremacy Is All Around: Notes from a Black Disabled Woman in a White World, focusing on a different kind of physical sensation is key. “I like to have a regular cadence of sex because it [gives me] a fleeting moment of realizing that my body isn’t always a source of pain—it can be a source of pleasure.”

Aside from the physical, sex can also boost feelings of emotional closeness and intimacy if you’re having it with a partner, and that can be really validating if your health is making you feel isolated, Dr. Cobb says. The more closely connected you feel to someone else, the bigger buffer you’ll have against the low feelings—like fear, anxiety, and lack of self-confidence—that can come with managing chronic pain, Dr. Rafie says.

How to have better sex when you’re living with chronic pain

1. Make it less about the actual sex part.

Yes, this list of tips starts with…forgetting about capital-S sex for a second! The point is to let go of any pressure to do anything penetrative (or even oral) if the act of doing so may hurt you or if you just can’t bring yourself to feel interested.

Instead, start by doing whatever would feel good, Dr. Cobb says: “A foot massage can be foreplay.” And as Dr. Cadet puts it, “There can be times when maybe I just had back injections, so I don’t necessarily want to get it in, or maybe I have to be in a position that’s not going to be around a tender spot. I’m always happy to pivot [to] other forms of intimacy.” (Think cuddling and making out.)

The goal, Dr. Rafie says, is to just enjoy “small gestures of touch and play and sensuality” that allow you to feel connected to a partner (or yourself).

2. Pinpoint what really gets you going.

Having trouble figuring out exactly what sensual or sexual stuff to dive into? Dr. Phillips suggests getting to know your “sexual values,” or all the things that might turn you on, with the understanding that chronic pain may have changed some of them. He suggests asking yourself: Is there a specific way I like to be touched, especially when I’m not feeling well? Is there a position I prefer to be in because it’s more comfortable? Would I enjoy using toys?

The best thing you can do is give yourself permission to explore. That might look like buying that clitoral vibrator (no penetration required!) or diving into erotic books or audio to see what makes you feel some type of way. And remember: There’s no wrong answer—even if the thing that puts you in the mood comes as a surprise. The more freedom you allow yourself, the better your chances of landing on something that feels both exciting and accessible to try.

3. If you have a partner, openly share your feelings about sex.

Chances are, they’re just as invested as you are in boosting the sex life you share—but unless you’ve told them what you’re looking for or what you’re struggling with pain-wise, they may have no idea how to help, Dr. Phillips says. And if they aren’t currently having the type or cadence of sex they prefer, they might feel hurt or insecure, which doesn’t exactly open the door for free-flowing conversation.

For that reason, Dr. Cobb suggests starting a conversation by conveying your appreciation for your partner when you’re not in the heat of a sexy moment. You might say something like, “I appreciate our intimacy and the time we have together,” or “I know that it can be hard for us to connect sexually sometimes, but it means a lot to me that we make this a priority.”

When you’re engaged in this convo, you can also open up about what you like in bed, specifically, or what isn’t working for you, and ask your partner to do the same. Dr. Phillips suggests trying something like, “I really love when you [insert type of touch here]…” or “Sometimes your touch feels…” to dive in, and also using statements like, “When I’m in a flare-up or feel like I need to be careful during sex, I [insert behavior here]...” or “I wish I could change the way that I…[insert behavior here] during sex.”

It’s also okay if you don’t have an immediate idea about how to make things better if you end up discussing a specific problem you’re facing, Dr. Cobb adds. Saying something like, “I don’t always know what will feel most comfortable, but making sure we’re both enjoying ourselves is important to me,” or “I am curious to try new positions that may be more comfortable for us both” can help take some of the pressure off.

4. Lean into masturbation (solo or alongside a partner).

Masturbating isn’t just a great way to learn what you like (and bring more pleasure into your life). It can also increase your desire for sex by putting you into closer contact with your sensual side—which can all but vanish at the hands of constant pain. And logistically speaking, solo sex “allows for total control over pleasure and your threshold for discomfort, and may be more readily available than partnered sex,” Dr. Cobb says.

If you have a partner, Dr. Rafie also suggests broaching the idea of masturbating alongside them while they have their own solo sex moment. This can be superhot in its own right while also allowing you to move at your own pace and stay in a comfy position.

5. Plan for intimacy at your “sexual peak.”

Before you cringe at the concept of scheduling sex, know that it doesn’t have to feel like prepping for a standing meeting—seriously. Think of it like planning a vacation or a party instead: There’s a degree of exciting anticipation and the opportunity for everyone to show up feeling their best.

Scheduling sex also allows you to choose a time when you’re most likely to be feeling well and in the mood, which Dr. Phillips calls your “sexual peak.” For example: Maybe you used to have sex before bed, but now you find that you’re totally zapped by nighttime and you have more energy and less pain when you wake up—that would be a great time to schedule sex, at whatever cadence feels right to you.

With sex time on the calendar, you can also plan to do certain things beforehand to make yourself more physically comfortable, like hop into a warm bath or shower, get your heating pad going, or take your pain meds. Consider it all just a little extra in the way of foreplay.

6. But leave room for some spontaneity too.

Even if you plan to have sex every Wednesday morning, for instance, there will probably come a Wednesday when you wake up feeling crappy and choose to skip it (totally okay). And in much the same way, you might also find yourself unexpectedly pain-free on a random Tuesday night—which may turn out to be a great time to have sex (also okay).

“It’s best to stay flexible and be willing to get creative with what works for you and your partner [if you have one],” Dr. Phillips says.

7. Find a new way in (and out).

A cool thing about partnered sex is there are so many different ways to have it—and getting creative about your positioning with penetrative moves can make it feel like less of a stretch, physically.

If you have back pain, for example, and you’re going to be the receiving partner, Dr. Phillips suggests lying stomach-side down on a wedge sex pillow or just leaning over the bed while standing up so that your partner has access from behind—both of which are positions that can put less pressure on your back than missionary. (Another option is child’s pose, which can give you more control over the positioning of your back.) Or, if pelvic pain is making certain positions feel dicey, Dr. Phillips suggests hopping on top, so you can control the depth of penetration and keep it shallow. Sex ramps and chaises—big curved pillows and lounge chairs, respectively, that can prop up certain body parts—can also come in handy for finding (and holding) more comfy moves.

If you’re struggling to find a pain-free position, think about what typically feels best for your body in everyday life, Dr. Phillips says, and then see how you might adapt it to become something that works for you in bed (or how your partner might fit their body around yours). And remember: It’s always an option to swap the in-n-out for oral sex and fingering, Dr. Cobb says. If you have a clitoris, you can ask a partner to focus on stimulation there or explore other erogenous zones, like your neck, breasts, or perineum (the area between your vulva and your anus).

Whatever you land on, be sure to keep the lines of communication open once you get into it, Dr. Phillips adds. Some experiments could very well fail, but with each one, you’ll learn something new. After all, there are plenty of different routes to pleasure, and any one of them is likely a welcome detour from the pain.

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Originally Appeared on SELF