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Living well with chronic pain

The Healing Powers of Sex

How sexual intimacy can help in the management of chronic pain.

The most common advice on how to approach sex when you suffer from chronic pain is...carefully. The typical message is that intimacy is challenging and uncomfortable but ultimately worth it for the sake of the relationship. However, this advice neglects evidence that sexual intimacy may reduce pain which means that chronic pain may be more reason, not less, to engage in sensual acts.

Of course when your body hurts, you may not feel particularly sexy. You may fear further discomfort, making you reluctant to experiment. The following research findings may serve as an aphrodisiac, or at least encourage people to overlook current pains for the promise of pleasure.

My first search for support of the "sex helps" thesis was unsuccessful. Googling "sex" and "chronic pain" yielded many results—but nearly all focused on the inevitable difficulties that arise when one partner suffers from a chronic condition. However, I divided the search into two separate questions: (1) what happens when you have sex? and (2) How may this affect chronic pains? And I found a completely different story.

Sex apparently unleashes a bevy of chemical compounds into the brain, starting with oxytocin, otherwise known as the bonding or cuddle hormone. Studies show oxytocin levels become elevated in women during childbirth and breastfeeding, as well as in fathers who are involved with their partners and babies. Oxytocin similarly increases with sensual touch between adults, and peaks during orgasm. Google led me to amusing articles that speculated about the evolutionary role of bonding and the different ways oxytocin may lead to post-coital fatigue in men but a greater drive to spoon and chat in women.

Conjecture aside, research consistently shows that oxytocin not only increases emotional connection, it also promotes a sense of calm and well-being, and reduces the effects of stress (as measured by blood pressure and cortisol), all of which are relevant in reducing perceptions of pain. In fact, oxytocin is currently being tested as an avenue of treatment for neuropathic and inflammatory pain. Scientists are also seeking to manufacture a synthetic version to deliver "enhanced well-being," but have not yet been successful. However, each of us has the power to boost our oxytocin levels through loving touch, and even thoughts. A study of women in happy marriages found that thinking about their partners caused a surge of oxytocin into the women's bloodstream. Oxytocin also heightens the desire to touch and be touched, which in turn increases the likelihood of further oxytocin production.

Additional substances, released through skin-to-skin touch with peak effects at orgasm, similarly contribute to pain relief and well-being. These include serotonin, our body's natural anti-depressant; phenyl ethylamine (also found in chocolate) which activates the brain's pleasure center; and endorphins, a natural painkiller that reduce pain awareness and generate feelings of elation and euphoria. Endorphins, one of the body's natural opioids, have a chemical structure that is similar to morphine. Indeed, synthetic opioids are the narcotic medications prescribed for severe pain.

You've likely heard of endorphins and the "runner's high" that they can elicit. Take comfort that you do not have to be a marathon athlete to benefit from the good feelings they can produce. When you feel calm and blissful after a good belly laugh, lovemaking, or other pleasant experience, opioids are at work. The length of such effects is unclear. According to one report I found, enkephalines, another natural opioid, remained elevated in certain regions of the brain for up to two or more days once it has been activated.

So, if chronic pains have been putting a damper on your drive for closeness--reconsider the potential benefits. If you are lucky enough to be in a loving relationship, look to the connection with your partner as a source of comfort, even pain relief. Consider ways to add soothing touch, orgasms, and other forms of pleasure to your toolbox of self-care strategies to reduce pain. Remember, you can also elicit feel-good chemicals by reflecting on loving thoughts. If you are on your own, be creative. You may find similar effects from hugs, professional massage, petting your cat, or mindfully applying lotion to your hands, face, neck, and body. Experiment and track your response (see my previous blog).

This prescription for touch comes with a few caveats and clarifications. Turning to sex as a constant escape from pain would create problems. And if your pain is directly associated with sex (as in vulvar pain), intercourse may be contraindicated, as would any activities that are risky or harmful--but sensual touch that feels safe and welcome would not. If you have enjoyed sex and closeness but are currently avoiding it out of fear or disinterest associated with pain, you may want to revisit this decision. Consider rules as a couple to ensure that you feel safe as you experiment together to find what feels most satisfying. You might want to look at literature on how to approach sex "carefully" so that you are sufficiently comfortable to get started, and then... enjoy!

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For more information on using experiments to improve life with chronic pain, see my book and companion website, with its free, customizable tracking tool.

Deborah Barrett, Ph.D., MSW, LCSW is a clinical associate professor in the School of Social Work at the University of North Carolina at Chapel Hill.

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