Ask the Doctors: Chronic Pain & Sex, Part 4

The Q&A continues and concludes my reply to Sharon’s long letter, the first segments of which are posted here, here, and here. Sharon is 59 and is dealing with chronic pain and disability and its effects on her sexuality.

I am having a crisis about my body image. I have gained a great deal of weight¦ over time about 60 lbs¦ due to the meds, especially steroids. I cannot perform the kind of exercise normally recommended for fibromyalgia as it throws me into a god awful flare and basically leaves me crippled for days and even weeks. I’ve tried everything¦ with only stretching, using my own weight to “lift weights, and isometrics, which I’ve adapted to my own use.

I am obese. I used to be quite slim, and exercised (martial arts) daily. It was very easy to keep the weight off. I don’t believe I will be able to do what is necessary about losing weight (obvious direct benefits) until I accept the changes. I am having a lot of trouble around the impact of aging on my body, including the southward movement of my once gorgeous breasts, about which I was very vain.

Part of the problem is that I aged immediately, not slowly. I had bacterial meningitis and encephalitis.  The door on the first 52  years of my life closed. Suddenly, my body was old and I heard things from doctors like “you have the cervical spine of an eighty year old. I am going to work with my therapist around all of this, but thought you might be able to recommend some reading material.

Sharon, I’ve already addressed the question of exercise in my previous posts; I know that some of my suggestions may have been beyond what you can do now. I want to address weight and exercise first, then we will look at the question of body image, which, as you already know, is woven through your ability to deal with your sexuality and possibly even your need to lose weight.

While plenty of women who are 60 pounds over their “ideal” weight are fit and active, that isn’t the way it works with joint pain. Any extra weight makes the pain worse. That means that, aside from the question of eroticism and feeling sexy (and you can feel sexy at any weight, at least potentially), you have a quality of life issue than gets worse with extra pounds.

So let’s talk diet for a minute. Not going on a diet, necessarily — but evaluating your diet, first for its effect on your health. You already know that cortisone, the anti-inflammatory drug, can actually promote weight gain, so you’ll have to look for anti-inflammatories elsewhere — not just drugs, but also in what you eat. If you don’t already keep to a diet without preservatives, dyes, additives like corn syrup, too much salt, hydrogenated oils, and artificially white (bleached) products like sugar, wheat, and rice, do that first. If a baked product is made with white flour, just don’t eat it.

You might really want to keep a food diary, too, since it is possible that any wheat or other gluten-containing product–or other kind of food–will set you off, and if you have a food sensitivity like this, that will add to inflammation and make you put on pounds. Extra weight itself can be said to add to the body’s load of inflammation. Make sure you have a balanced diet and that you are eating ample fruits and vegetables, especially the ones with anti-inflammatory properties.

Now that we’ve considered what you eat, consider how. Do you eat past a feeling of fullness? Do you use food as a comfort or a sensual pleasure? There’s plenty of delight to be had in eating a careful, healthy diet (I know, I’m on one myself), but if ice cream is taking the place of sex in your life or you eat cookies when you’re sad, you may wish to take a hard look at how one source of coping is actually making other issues worse.

I don’t know whether you have an emotional connection to your food that is playing into your situation, but your therapist can help you consider this and put a plan in place to change, if that’s advised. Remember, some people looking at fibro think there may be a connection between it and food (or other environmental) sensitivities. It’s possible that you may have more to gain than an easement of arthritis symptoms.

Don’t give yourself grief over this. Find the healthy things that you really love to eat. Figure out the foods that feel like treats, and treat them that way — eating less of them if it has been your habit to overindulge, but not cutting them out of your life. Two words: dark chocolate! Also, get buy-in from your husband — if he’s going to eat differently than you, have him do it elsewhere or at a different time than your meals, and get him to share at least some meals with you.

If you are eating better, you may find that it causes a fairly rapid improvement to your body. If that’s the case, you will be able to exercise more. Again, choose the kind of exercise that you can do and that is most pleasurable for you. Build as much pleasure as possible into this process (remembering masturbation as one element of your pleasure-and-health-seeking priorities). And make sure you and your husband are able to consider the question of emotional pleasure (if not sexual, as often as you’d like) — expressing your love and care for each other in any ways you can, and doing things together, to the limits of your ability, that you enjoy. Maybe you can also make a Pleasure Diary to keep track of how much you’re getting: solo sex, with your partner, fabulous experiences, a moment when you’re pain-free enough to dance around a little…

On to body image. In a sense, almost all of my book Exhibitionism for the Shy is about this topic. Its basic argument: accept your body as it is, and revel in pleasure, showing off, and exploring fantasies — to the degree that you can, given where you are. In your case, that may mean focusing not on how your body looks but how it feels, during those moments when you can engage in erotic connection or self-pleasuring. Or considering whether there is some supremely sensuous item of clothing, like a silk robe maybe, that feels as good on your skin as is possible, given your fibro, and that can be your “love gown” (wearing it could be a signal to your husband that you feel good enough to try a little tenderness). Or turning the lights down low and instead of feeling shy about being looked at in your current incarnation, talk with your husband and conjure up memories of sexy, satisfying times you’ve had.

Take this process step by step, and stop where you need to or where you like.

By the way — and I mostly have to remind women who’ve had gorgeous breasts of this fact — regardless of their southern turn, I am betting that plenty of people would still find them gorgeous and sexy. With luck, your husband is even one of those people! Remember, as you go through your process, that there are people who prefer breasts that have begun to slope; larger-than-the-doctor’s-metabolic-chart hips and bellies; and the soft feel of skin as it begins to age.

Remember also that many very gorgeous people are hard on themselves about their looks. Your best bet, if you can do it, is to love yourself as you are today, living in a body that is testimony to all you have experienced. Feed it well and healthfully, provide it all the pleasure you can, and affirm that you’re worthy of these things. I’m not suggesting that living in the body you have will stop being difficult and sometimes painful, but I believe, from your thoughtful letter, that you have what it takes to negotiate the best life possible with your body and your health. I wish you the very best, and please keep me in the loop when you start working on that book!

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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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