For the approximately 50 million Americans living with some sort of chronic pain, striking a balance between suffering and sexual pleasure is a complex process, especially when balancing another person's preferences during partnered sex. There is (unfortunately) not one magical sex position that works for every person facing chronic pain, so it can also take quite a lot of experimentation because each condition can manifest in a variety of ways.
For some, chronic pain appears in the form of fibromyalgia or hyperalgesia—an increased sensitivity to pain. For others, it can appear after an injury or surgery. However it starts, chronic pain can wreak havoc on a person's daily life and their ability to access sexual pleasure.
"The most common issue that we see that interferes with sexual activity due to chronic pain is decreased desire," explained Lee Phillips, a Washington, D.C., psychotherapist and AASECT certified sex therapist. "Often, when people are experiencing chronic pain, sex is the last thing on their agenda."
Balancing a changing body with sexual desire
When you pair sex with a medical condition, it can become a minefield of awkward and painful moments. Developing chronic pain may affect how a person sees their body and can feed misconceptions about chronic pain patients' ability to have sex at all, particularly if there are concerns about causing further injury.
As overexertion triggers pain flares and chronic fatigue in those living with pain, some caution is necessary. However, pleasure is a remedy, too. "Sexual activity can be a wonderful outlet when coping with chronic pain," Phillips said. "It can bring relaxation, joy and healing."
But an orgasmic prescription for pain is not straightforward because there are risks to manage. Pushing your body past its comfort levels or ignoring pain signals could trigger flare-ups that take weeks to bring back under control, so easing into it is crucial.
Pacing is an essential technique for anyone living with a long-term medical condition, and essentially it comes down to taking a break before you need to. When first developing symptoms of chronic pain, learning to be aware of how your body responds to daily stimuli and activities takes time and practice—and navigating sex is no different.
Depending on their needs, the art of pacing will look different for each chronic pain patient. It might mean stopping sexual activity as soon as you feel pain, or it could be switching activities to minimize pain responses.
"Pacing during sex doesn't mean we have to stop completely—sometimes performing other acts of intimacy can be rejuvenating and allow our bodies or even minds a break from certain sexual activities," said Ness Cooper, a U.K.–based sexologist. "This could be by simply taking a moment to ask them how they are enjoying the experience together, giving you both a physical break, while also reducing the need to take the lead in the sexual creativity mentally—you're working together, after all."
Decenter penetrative sex
Mainstream media and pornography centers on penetrative activities—usually involving a penis and a vagina—but there are plenty of activities available to you, including oral sex, role-playing, the use of an array of sex toys and even tantric sex.
Communicating clearly with your partner will play a significant role in stepping away from any sexual activity that causes you pain.
"Those with chronic pain can worry about speaking up, and, yes, you should speak up, but there are times when it's difficult to talk about it, particularly during the throes of passion," added Cooper. "If chronic pain happens during your intimate sexual moments, letting your partner know that you need to change an activity is a lot better than falling into a deep flare for days on end by just continuing."
But the most crucial pathway to finding the best sex positions for chronic pain is to experiment with what feels good for you and your new body.
"Get curious about your partner and get creative with your sex," Phillips said. "Creativity is critical when a person's life has changed due to a chronic pain condition. They are now living in a 'new normal.'"
Another less physically demanding and penis-centric option is tantric sex. Usually depicted as a wild, hours-long marathon, tantric sex is actually more focused on paying close attention to pleasurable sensations during sex, and not having sex for physiological release.
The word "tantra" comes from old Sanskrit, meaning "the weave." Tantric sex specifically places an emphasis on being mindful of pleasure while having sex and not using sex to mask emotions. Essentially, tantric sex can be likened to mindfulness—but with sex.
Start with sitting across from one another and discussing what sensations feel good for one another. Take the time to truly focus on what each touch feels like and do not rush into more intense physical acts. Be patient. Too often, we engage with sex and simply go through the motions, but tantric sex is a wonderful way of opening up your sexual options, especially if you are living with chronic pain.
Use your mind as a sex toy
When it comes to sex, imagination is your greatest asset. Although some of us are more turned on by visual cues, our brain can be a powerful tool that feeds our sensuality.
Those with chronic pain can also be hypersensitive to physical sensations, which means physical sex may be off the table during flare-ups. So exploring sex in other ways is a great way to keep your sexuality alive without inducing more pain.
Try setting aside some time with your partner to discuss what you both enjoy in bed. Ask each other how you like to be touched, what fantasies drive you wild and what sexual acts you have always wanted to explore with someone else. Sometimes simply speaking about sex can be as satisfying as actually doing it.
"It is important to always listen to your body," Phillips added. "There is no right way to have sex and receive pleasure. Sex at its heart is all about communication."
You can also level up your sexual mind magic by experimenting with role-play. Sexual role-play involves acting out roles to bring sexual fantasies to life, but it does not necessarily have to involve physical touch or sexual exploration.
By verbally diving into a shared fantasy with a partner, you can nourish your sexual desire without triggering physical pain. As role-play can be a great way of overcoming sexual inhibitions, it might even help you move past any residual fears of sexual contact and chronic pain interacting badly.
Exploring alternatives to intimacy, and discovering what feels good, may take some time and additional effort. But it means that you don't have to abandon the idea of having a happy, healthy sex life.