Sex With Chronic Fatigue: Too Exhausting or a Secret Energy Boost?

When chronic fatigue appeared in my life, I imagined sex would be a symptom-free zone where I could escape reality through multiple orgasms. Instead, for the price of an orgasm, my first sexual outing post-diagnosis put me in a fugue state: I was on bed rest for more than a week. Brushing my teeth and eating meals became insurmountable obstacles.

Chronic fatigue affects the lives of millions of Americans and most famously manifests as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but it's also a symptom of many other chronic conditions, such as fibromyalgia. The condition is characterized by acute exhaustion, and not the kind of tiredness we all get after a long day: It's a bone-deep, painful fatigue that transforms the simplest of tasks into a series of brutal marathons.

"Chronic fatigue can make it very challenging to even complete normal daily activities like showering and cooking for oneself, let alone working or dealing with additional stressors," said Katherine Zagone, N.D., a naturopathic doctor and sexual wellness expert in San Diego.

When it comes to sex, especially partnered sex, chronic fatigue is a killjoy bent on blocking pleasure. "Chronic fatigue often comes with low desire or low libido, medically termed hypoactive sexual desire disorder," Zagone continued. "Biologically speaking, since reproduction is not vital to survival, the body will forgo using energy and resources for sex in order to put those resources toward sustaining vital functions."

Despite these difficulties, people with chronic fatigue can enjoy full, satisfying sex lives—it just requires a few extra steps.

Know the effects on the body

Chronic fatigue has far-reaching effects on how the body functions, so it's important to recognize how this impacts everyday life, let alone your sexuality. People with ME/CFS or chronic fatigue symptoms may also struggle with muscle or joint pain, headaches, sore throat or sore glands, flu-like symptoms, feeling dizzy or sick and heart palpitations.

"I rarely get deep sleep, so I don't wake up energized or refreshed," said Lydie Cerantola-Eid, an alternative health and personal development specialist who lives with chronic fatigue, irritable bowel syndrome, fibromyalgia, frontal lobe hyperperfusion and hypermobility. "Managing my energy levels so I don't use them all up too soon in the day is a constant balancing act. In my dreams, I accomplish many more things than I actually am able to handle in a day."

Chronic fatigue can also involve problems with thinking clearly and concentrating—known as "brain fog"—which is a symptom I experience, so I'm careful not to go into sex too distracted. If I do, I can end up losing track of how my body is feeling and risk pushing it too far.

Engage in solo play first

Before you delve into partnered sex, it's important to understand your own needs. Experimenting with self-pleasure will help you understand how orgasms impact your chronic fatigue symptoms.

For example, since I started paying close attention to this relationship, I noticed I typically experience a rush of energy post-orgasm. I explored solo pleasure using toys and my hands to find the best techniques, and, recently, I tried masturbating in my favorite sex positions to figure out how they impact my chronic fatigue. This resulted in me eliminating a few strenuous positions, like reverse cowgirl, from my repertoire.

Understand the ups and downs

Symptoms of chronic fatigue fluctuate daily, so creating a harmonious relationship between sexuality and chronic fatigue isn't always easy. "It's unpredictable," said Ness Cooper, a U.K.-based sexologist. "You've not got a clear idea of when it's going to hit you and how long it's going to last, and a nap is not going to fix it. Making people aware that you just need to plan ahead a bit more can be a big step."

Once, when my chronic fatigue symptoms were triggered by a complex combination of health issues, including ulcerative colitis and localized scleroderma, I lost all confidence. My body felt like an alien invader poorly equipped to live out any sexual fantasies. Making a concerted effort to look at my body regularly and touch it with kind, sensual touches in front of a mirror assisted in my evolution from desexualized to sexually confident.

A sudden change in how our body functions can impact self-esteem, as it did for me. "[Chronic fatigue] can affect body image as well, because you're not always able to work out or have a healthy routine, because the digestive system can be affected, too," Cooper added. "You may not have the body that you used to have, so it can be hard not to have the self-confidence."

Talk to your partner

Communicating your symptoms clearly with sexual partners can mitigate the physical stresses a chronic illness creates. Conversely, if your partner doesn't understand your limits, a fun encounter could mutate into a fatigue-inducing nightmare.

"Sometimes we don't need to disclose our disabilities because our disabilities aren't what define our sexuality and sometimes we feel the need to disclose it," Cooper said. "But making an individual aware that you're one of these people who needs a bit more planning ahead can be a big step."

Earlier in my life, telling sexual partners about my chronic fatigue never crossed my mind and I kept overdoing it to meet their needs—it felt shameful to admit that I needed to slow down. But after shrugging off the stigma, talking openly about my health needs opened a doorway to mind-blowing sex.

Expand your definition of sex

Broadening what you mean by "sex" will help forge a healthier and deeper connection between your new, fatigued body and your sexuality. Sex doesn't have to be intensely physical or penetrative to be mind-blowing.

"It's all about learning what you like, and if orgasm is going to make you overly fatigued rather than giving you a super boost of energy, it's worth looking into other forms of sexual pleasure and enjoyment, such as massage and experimenting with taste," said Cooper. "Don't just stick to one routine because one routine will become very tiring and boring no matter what, even if you don't have a chronic illness."

With sexual partners, I love basking in the simple pleasures of sensual movements, like spooning or touching. Engaging in these acts preserves my energy for the days when I can play with more physically demanding sexual activity.

Most people can't comprehend navigating a sex life with chronic fatigue plaguing every sensual touch, but it's a beast we wrangle with constantly. Luckily, chronic fatigue gives us the gift of necessity—to keep searching and playing until we discover what works for us.