Fibromyalgia is one of the most common chronic musculoskeletal pain disorders. It is defined as chronic widespread pain and pain to touch of at least 11 of 18 tender point sites throughout the body. Fibromyalgia occurs in about 2 percent of the population in the United States. Women are much more likely to develop the disorder than are men, and the risk of fibromyalgia increases with age. Fibromyalgia symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event.

Fibromyalgia patients experience chronic pain and therefore, the challenges to sexuality in this patient population are similar to those that exist in all patients who experience chronic pain, disability, or illness. These challenges are both physical and psychosocial and they include, although are not limited to the following: fatigue and emotional stress, depression and anxiety, effects of medications, alterations in role identity and body image, and relationship adjustment.

Sex is a vital component of life and having sex can help restore energy, strengthen intimate relationships, and even, according to some studies, act as an analgesic and actually help reduce chronic pain. But when sex feels like too much trouble, couples can lose interest. It is important, therefore, for patients with fibromyalgia, their loved ones, and their health providers to understand what the specific challenges are that are unique to each woman and couple in order to address the situation appropriately. For example, fibromyalgia is associated with anxiety and depression, which decreases libido, and the medications used to treat depression often decrease pleasurable sensations and delay or inhibit orgasm. For some women, depression is not a factor; however, sexual side effects from the drugs taken for pain, which in many cases are antidepressants, may affect sex. Understanding this is helpful in finding solutions, such as switching medications or timing sex with drug holidays.

It is also important to determine in which specific ways sex is affected. Studies show overall decreased sexual desire in women with fibromyalgia, however, these studies don’t often look at the specific factors preventing sex, and how experiencing bodily pain during sex affects desire. In fact, one study found masturbation frequencies were actually somewhat higher in women with fibromyalgia than in healthy controls. While the study sample was too small to draw conclusions, this finding should encourage women that having fibromyalgia does not mean sacrificing sexuality.

Fibromyalgia is primarily a musculoskeletal disorder and, therefore, difficulties with sex are often related to back and hip pain that occurs with sexual intercourse. Positioning tips for patients with back pain are applicable in these situations (link to article on sex and back pain). Some evidence points to the central nervous system as causing alterations in central processing. That simply means that the brain interprets what should be perceived as touch, for example, as being painful. This low pain threshold may partially explain the relationship of fibromyalgia with vulvar pain and other conditions such as irritable bowel syndrome, headaches and temporomandibular joint pain. While the sexual restrictions related to vulvar pain are obvious, there are other limitations to sexual activity related to these concurrent conditions. For example, pelvic and abdominal pain may be worsened by pressure on the abdomen, which may prevent lying on the stomach. Back lying may be uncomfortable as well, as the partner may place pressure on the abdomen. Therefore, side lying in these cases may be a preferable position. Deep penetration may cause rectal pressure when abdominal symptoms of gas and bloating are present. Therefore, a woman with fibromyalgia may request of her male partner not to penetrate too deeply.

Stroking points on the body that are tender to touch may limit sexual touch, while even light petting may be perceived intolerably when there is hypersensitivity to touch. A helpful suggestion would be for the person with fibromyalgia to touch and massage the partner using strokes to demonstrate how she or he would like to be touched, how much pressure to apply, and what areas to avoid. Facial pain and decreased oral mobility may impact oral lovemaking. Often women with fibromyalgia report they cant provide oral stimulation due to the lack of mouth opening necessary to contain their partner’s penis. Facial massage is a wonderful and relaxing way to loosen up muscles around the jaw and mouth. Furthermore, licking using a partially closed mouth, seeking erotic zones throughout the body and not just the genitalia, may prompt discovery of new and exciting ways to pleasure one another.

With open and honest partner communication, willingness to try new things and a little creativity, women and couples affected by fibromyalgia can continue to enjoy a rich and satisfying sexual life.