Ask the Doctors: Chronic Pain & Sex, Part 2

The Q&A continues my reply to Sharon’s long letter, the first segment of which is posted here. Sharon is dealing with chronic pain and disability (Sjögren’s Syndrome, fibromyalgia, and osteoarthritis, plus related restriction of movement) and its effects on her sexuality.

The pain and meds make it difficult for me to orgasm without clitoral stimulation¦ which takes time. I’ve asked your staff to recommend a vibrator and am thinking that would help, but am feeling a bit shy about talking to my husband about it, which is strange as I am the sex go-to girl for all my friends. I always stress communication, which I think is the sexiest part of sex, followed closely by the intimacy of skin to skin exploration and touching. My husband is a very gentle and loving man, but I need to help him understand that it is OK to initiate sex with me. I’ve tried various approaches, but the man finds the concept of hurting me unbearable. In addition, his drive has fallen off as he has aged and with some of the medication he takes. We are down to three times a year¦ not very satisfying. Even with my illness, I’m still a fairly sexual and sensual woman and this seems like just another loss — I’d really like to get back to at least a couple of times a month and use the vibrator for the rest of the time. — Sharon

Your instinct that you’d like to work up to a much more active sex life isn’t likely to add just to your erotic pleasure and your connection with your husband — I think you know you’re likely to get both of these effects from an increase in erotic activity, whether it’s partner sex or masturbation. But you’ll get two more important things as well: another source of pain relief, and a (partial, at least) reversal of an illness-related loss.

Any significant experience of arousal you have, even if it doesn’t result in orgasm, will trigger an endorphin response, which is what your narcotic pain relievers are prescribed to mimic — and if you can climax, all the better in terms of the pain relief (and of course the pleasure also) you can expect from the experience.

If it takes a long time to get to orgasm, in a way that’s a plus, since it puts you into erotic space and hence into a physical state in which your experience of pain and discomfort is likely to change for the better for a while. The other thing that you may be able to do to access the benefit of endorphins (I will address this more in the next letter) is exercise. Any movement you can work into your sexual experiences, great. As I said before, if there are times of day, or times relative to your medications regimen, that your pain is likely to recede, allowing you to get busy with your vibrator, your husband, or both, try to track them.

This can be the point of entry for talking with your husband about your desire for increased sexual contact. The gentle man who cannot bear to hurt you might receive significant permission if he understands that sexual activity is likely to help, not hurt.(Granted, you will have to communicate about ways to have sex –positions, etc.– that hurt less, but my guess is that your shyness re: talking to him isn’t about those types of things, but rather the overarching request for him to initiate more often.

Part of this communication can also be information about when sexual contact is likely to be easiest for you, and thoughts about positions that might work the best. This sort of information would be useful whether or not he was hesitant, but might be especially important given that your pain condition seems to be a significant barrier to him reaching out to you at all.

About initiation: I’d like to ask you whether you really believe, in whole or part, that initiating sex is a man’s job in a heterosexual relationship, or whether your sense of yourself and your sexual attractiveness is wound up in the changes your body has undergone.

Put another way, are you, too, initiating or suggesting sex? Both of you are addressing physical challenges related to sex (your pain and disability, the effects of both of your meds, any age-related effects that might be part of the mix), plus emotional ones (fear of causing/feeling pain, sense of loss over your “new normal”). I think you two need to address this head-on: How will you communicate your desire/openness to sexual contact to one another? Are there signals you can send him that let him know a particular time is “safe” for initiating, or can you assure him that if he initiates at a bad time, you’ll lovingly let him know to try again soon? And are there erotic activities you two can do even IF you aren’t pain-free enough to engage in intercourse or other touch–based stimulation? Can you touch him while he pleasures himself, for instance? That way he still gets a positive, erotic, intimate response to his initiation, regardless of whether you are feeling frisky.

You can probably also figure out a way to initiate so that he takes the ball, if his desire for sex with you is a critical part of your pleasure in responding. While it is not one person’s job to always initiate, ideally, I know that for some, being the recipient of an erotic invitation is crucial to getting turned on.

If sex drive has become an issue for him, you both might benefit from the insight of sex therapist JoAnn Loulan, who points out that an active libido isn’t required for sexual connection and pleasure: willingness to have a sensual, intimate, or sexual experience is the key ingredient. This insight may allow you both to consider the question of initiation in a new way. Whether or not either of you is hot to trot, armed with some agreements about how you’ll communicate about your pain level and what you can tolerate touch-wise at any given time, you can actually set up an every-two-weeks schedule to check in about spending erotic time together.

Whether he agrees to initiate (or at least check in about it) or you trade off doing so, this may take some of the mystery and yearning out of when you will next be in an erotic mood together. And, as you know, self-pleasuring can tide each of you over or give you access to other ways to focus on pleasure and sexual functioning.

Have this discussion in positive terms. I know this whole issue causes you a certain amount of grief over the loss of your “old normal.” That is entirely to be expected. It likely causes him the same. But I’m guessing the two of you have processed much of this together (as well, possibly, as silently and alone) over the past seven years. If it’s hard to bring up in the first place, show him this exchange that we’re having. Or write him a letter and tell him how much it means to you that he is standing by you, but that you want to reconnect sexually and try to move forward with this part of your shared life. It’s possible it’d be more comfortable doing this with a therapist in the room (one who works with chronic pain/disability, ideally), but I bet you two can get into the juicy details yourselves, too.

Another resource I tracked down while I was doing research was a piece in Wired by my pal Regina Lynn. I liked it quite a bit, and hope you will too–it might be another thing to share with your partner to spark that discussion, and doesn’t include your own experience so might be easier to start with.

Finally — about taking the vibrator to bed with your husband. I hope you know that many women, including those with no experience of disability, also find it easier to orgasm with a vibrator, so you are far, far from alone in this. Perhaps the idea of a vibe threesome will be no issue to him at all, but if it is, encourage him to try the vibrator on himself also –many men find they really like the feeling, and it can just become a fun addition to sensation-seeking– and remind him of the pain-relieving aspects of high arousal and orgasm. It isn’t just a pleasure implement with you, it’s a kind of palliative as well.

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Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at

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