Ask the Doctors: Chronic Pain & Sex, Part 3

This Q&A continues my reply to Sharon’s long letter, the first segments of which are posted here and here. Sharon is dealing with chronic pain and disability (Sjögren’s Syndrome, fibromyalgia, and osteoarthritis, plus related restriction of movement), associated weight gain and mobility limitations,  and the effects of these on her sexuality.

Even with narcotic pain relief, I am always in serious pain. I need help with positions. I have had trouble finding help specific for chronic pain sufferers. Lots for specific issues, like the joint issues I’ve described, but nothing on pain everywhere.

Sharon, I want to get to your question about positions today, but in addition, this involves talking more about exercise and endorphins. Exercise is difficult but will make a difference not only to your weight, but also in generating endorphins, and so even before we consider what positions you might find best, let’s talk about endorphins a little more. These are “endogenous morphines” — the body’s own pain-killing chemicals — and if you are not moving around much, as I know you are limited in doing because it hurts you to do so, you are missing out on the support you could be receiving from these. I realize this is a terrible Catch-22. It hurts to exercise, and it hurts without exercise. As with my previous answers, I want to ask you to consider as best you can how various kinds of movement work for you, including the movements (and own endorphin-producing elements) of sex.

A recent New York Times article reported on positive results of Tai Chi practice for fibromyalgia sufferers. The link above includes more on exercise. How about swimming or water aerobics? Your weight gain has exacerbated your joint pain, most likely –this happens to many people at midlife even without fibro and with as little as 10-20 extra pounds– and water’s natural buoyancy may make a big difference, especially if the water is warm.

There’s even a form of shiatsu bodywork called Watsu which is conducted while you float in warm water. I don’t know whether there are Watsu practitioners in your area, but I understand they make home Watsu pools now, and perhaps this is even a practice your husband would want to learn so he can do sessions with you. It is an extremely connected kind of bodywork –connected to the practitioner, I mean, since the person is floating/supporting you and moving your limbs– and an intimate partnered connection with the Watsu practitioner would probably be pretty amazing.

Even if you don’t have access to this, does it help ease your physical pain to take a warm bath? That might be a foreplay element to work in on a regular basis. Waterproof vibes are widely available now and you could use them solo or with your husband. (It’s worth mentioning that some people seem to get fibro relief from ice, too.)

It’s possible that when it comes to the amount of exertion and movement you can handle, you’d have to pick exercise or sex on any given day. I am still looking at the endorphin generation of both sex play and exercise as potentially (at least sometimes) cumulative: if you are able, please try to figure out whether the pleasure of arousal and orgasm (with your husband or solo) allows you some extra comfort in movement, or vice versa.

Does masturbation allow you to feel better enough for some additional movement? Again, this can include your husband or not, and really has to do with maximizing your ability to exercise. Exercise can positively affect your weight, your mood, your pain level, and in fact your libido, if you can manage to do it.

OK now, positions. First, if you don’t already have egg-crate foam, memory foam, or a pillow top on your bed, consider getting one. You might also want to have a look at the various kinds of sex furniture available;  the pillows allow you to recline or bend over them and take over the job of supporting your weight, while the Bonk’ers allow you to use cuffs to assist in supporting and positioning your body. I’m not sure how these cuffs will feel against your sensitive skin, but you should know about these as at least a potential positional assist.

There are two comfort-related things to consider when you try a position: the joint discomfort you experience, which will affect how you can position yourself on a bed or elsewhere, and how much body-to-body contact the position involves, because of your fibromyalgia.

Again, consider whether the sensation of your bodies pressed together is easier on your fibro than a light touch or stroke; if it’s better with as little contact as possible, you may be able to utilize rear entry positions, with the help of the sex furniture or pillows to support you, while if bodies pressing together is actually easier than light touch, try spooning (on your good side), with him behind you and holding you as closely as is comfortable. (Put a pillow between your knees to support the weight of your top leg.) Or do a variant of that position, extending the lower leg straight and roll over slightly onto a nest of pillows that can support your top leg and upper body. (If you have feather pillows, make sure you’re not allergic to them.)

You might also be able to enjoy the Yab-Yum position, a classic Tantric pose in which you sit on your partner’s lap, facing him. This will involve some body contact and it might prove more comfortable if you could also recline a little bit into that pillow nest. In the classic Yab Yum your legs would be wrapped around your husband’s back; you can modify it by stretching your legs out, providing your hip mobility is enough to spread them out in the first place. Here are some books on sexual positions, in case it would be helpful to have visuals to inspire you.

More erotic options that are not (as) likely to challenge your body’s limitations:

The Yab Yum is not the only position favored by Tantra practitioners, but there is more to Tantra than a Kama Sutra’s worth of different positions. If the two of you are willing to try Tantric practice, which you can learn about via books, videos, or workshops, you will find an intimate form of erotic connection that includes but very much does not depend on intercourse or specific positions. You might also find that learning about Tantra together both reignites your erotic curiosity and desire together, and also assists you in talking about sex and asking for what you want.

Any other things you can do that increase your sense of erotic expression without causing you pain should be on the map for exploration, like erotic talk and fantasy-sharing (or reminiscing about your earlier years together and favorite erotic experiences you had together); role-play; having your partner next to you while you get in your optimally comfortable position and use toys (he can masturbate right along with you — couples who have never done this are often delighted at how intimate and hot it can be — or he can read erotica to you, or you both can watch videos if you like them).

Although you are essentially being forced to reconsider what sex and sensuality can be, many people have gone on such a journey simply because it excited them to find out what all their erotic options are, and hopefully you can bring some of that delight in discovery to this process.


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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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