Talking to Your Partner about Sex When You Suffer from Chronic Pain

When sex hurts, communication is key.

When sex hurts, communication is key.

When sex hurts, communication is key.

Millions of people suffer from ailments, such as migraines, endometriosis, and fibromyalgia, that cause chronic pain. It can affect every area of their lives including their relationships. Sex in particular can be difficult if you or your loved one suffers from chronic pain. Common disorders like irritable bowel syndrome, multiple sclerosis, and rheumatoid arthritis not only upset the sexual experience due to the pain itself, but also the side effects from medication or a decreased libido also factor into the difficulty. 

In the general population couples that talk about sex have better sex, and people who have pain that can interfere with sex need to communicate even more. It can be hard on both sides of the relationship. Your partner may understand that you are in pain, but they still feel rejected. If you are the one with pain, sex can be the last thing on your mind, and talking about it can feel vulnerable. Here are some guidelines to keep in mind when talking about sex.

  • Try talking about sex when the pain is not at its worst. When you are under intense pain, it can affect your ability to listen and focus on the conversation.
  • If you have pain during sex, educate your partner on what causes the pain. For example maybe intercourse itself is painful or lying on your back can trigger a flare up. You are the expert on your body and remember your partner can’t read your mind.
  • If you are the listener, make sure to ask some questions about your partner’s pain. Don’t assume anything. Show concern and interest in learning about your partner’s pain. 
  • If your pain or medication causes low libido, talk to your partner about how to increase your desire. Being aware of your own and your partner’s accelerator and brakes on both ends is a good way to understand turn-ons.
  • You may have to get creative. If pain takes a lot of sexual acts off the table, then brainstorm together ways you can be sexual together. A wide array of suggestions and are available online. Download the Gottman Card Decks app to check out the Salsa Cards for ideas.
  • It may help to come up with a ritual for how you communicate pain levels or interest in sex. Some examples could be rating on a scale of 1 to 10 for your pain as well as your desire and opening a discussion. Some couples like to use objects or symbols to communicate their desire to have sex. You can place a special object on the nightstand as a signal.
  • On days when sexual intimacy isn’t an option because of pain try to find other opportunities to connect with your partner. Ask your partner how you can make them feel loved and what they need from you that day. You can share appreciations with your partner, spend some quality time together, attend to your partner’s pain, or engage in other physical intimacy like hand-holding or kissing.
  • Keep in mind general rules to avoid conflict. Express your feelings and needs, accept responsibility, and if you feel flooded, take a break, practice self soothing, and then come back together.

If you’ve dealt with pain for years or your pain is progressive, it can feel like your sex life is ending. In most cases it certainly doesn’t have to. Bring your partner to a doctor’s appointment so they can learn about your pain and you both can ask your doctor any questions regarding managing your disorder while having sex. Your doctor will probably have some great resources to help you cope. The key to remember is having open conversations with your partner about sex and checking in often about your connection.

Kari Rusnak manages her telehealth private practice and is currently licensed in Mississippi, Colorado, and Utah. Kari is a Board Certified Telemental Health Provider and trained in EMDR. She is a Certified Gottman Therapist and her practice focuses on LGBTQ+, those in open/poly relationships, chronic pain, and sexual health. Visit her website at

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