Well this has been a subject we have ducking for some months. It is something we can all find hard to talk about from time to time - after all, dealing with chronic pain is enough for most, and sometimes we feel we don't have enough time to talk with the doctor about this problem.

Full filling our sexual needs is important to everyone.

So where do we start?

Get professional help from a health care provider who has had experience in dealing with chronic pain patients, sexual and personal relationships.

TEN TIPS... about sex and chronic pain

1. Be totally honest with your partner. Most partners are afraid of having any physical contact with the pain sufferer for fear of hurting them. Do explain what hurts and what does not, where they can touch and where not and just how much pressure to apply, for example some pain is activated by a light touch, others much deeper.

2. If you are the pain sufferer, honesty extends to telling your partner that you feel you want sexual contact or intercourse. This may be difficult if you are not usually the initiator of the contact. I remember one pain sufferer was most upset when she felt that her partner was ignoring her when she felt like intercourse some months after surgery. As I explained to her, how was he meant to know if she did not tell him how she was feeling.

3. Most people think of sexual contact occurring at bedtime. Chronic pain does lead to fatigue and most sufferers only want a mug of cocoa at the end of the day, not sexual activity. Work out when your pain is at its lowest level, could this be the time for sexual activity? There is no rulebook indicating that afternoons cannot be used. This could be difficult if you have small children around but this problem could be overcome with planning.

4. Do time your medication in order that it is having most effect when you make love. There is no reason why TENS machines cannot be used whilst lovemaking, but do be aware that with movement you could have an increase or decrease of stimulation from the electrodes. They may also be pulled off if the leads are not adjusted.

5. Depending on the type of pain and disability, the "traditional" positions for intercourse may be impossible to use, but there are many others that can accommodate most physical problems. The organisation SPOD (Association to Aid the Sexual and Personal Relationships of People with a Disability) has an excellent series of leaflets, which discuss differing positions, aids and other advice, which includes a counselling service. SPOD can be contacted at:

286 Camden Road,
London N7 OBJ.
Tel: 0171 607 8851.

6. Many pain sufferers have a loss of libido or in men fail to achieve an erection, very often due to the pain and fatigue they experience, but many drugs do have a significant effect on libido. Although it may be difficult for you, do not hesitate to discuss these problems with your doctor. Often switching to another drug may help.

7. If achieving or sustaining an erection is a problem, there are many aids available to assist with this problem. SPOD can provide details of those available but, again, do discuss this with your doctor. Intercourse may be difficult due to a loss of vaginal secretions but there are many vaginal lubricants on the market. Possibly the most readily available is KY Jelly which will overcome this problem. However, do not always think of your pain as the cause of problems. Women who are near the menopause should not be afraid to discuss this with their doctor.

8. Most people think about intercourse when sexual relations are concerned. If intercourse is not possible, there are many ways to have a full and meaningful relationship without. Many people will describe finding other parts of their bodies which when caressed by a loving partner can give great fulfilment. Touch is so very important.

9. Another taboo subject is that of masturbation, and yet this is an excellent way to explore your own body and find areas that give pleasure. Also experiment with the different positions suggested for intercourse and this may give you the confidence to try them out with your partner. Remember hurt does not always mean harm and relaxation does help pain. Why not use masturbation as a technique to give your partner pleasure if full intercourse is not possible?

10. There are many resources available. SPOD has already been mentioned but also the Internet has a variety of web sites, which deal openly and sensitively with this subject. If you use a search engine, type in 'disability' and 'sexuality' and you will find information resources and also a chance to read about other people's experiences. The Pain Concern (UK) Fact Sheet also has books, which refer to the subject of pain and sex.

Carole is a Pain Concern (UK) Helpline nurse and a former nurse lecturer specialising in pharmacology and biological sciences at St. Bartholomew's Hospital, London. She is writing a contributing chapter for a book for health professionals on sexuality in relation to chronic illness and disability.

TEN TIPS... about sex and chronic pain © Carole Webster All Rights reserved. First Published in the Pain Concern Lothian Group newsletter.

Keeping Close During Illness

Here is something that was sent from a friend in Australia.

Where there is a physical interruption of the body's sexual response pattern due to a disease or its treatments, look for some form of sexual intimacy that brings satisfaction and a feeling of closeness to both.

What can be done to keep the sexual relationship alive when there is little energy for each other or when functioning is not there?

1.Identify the problem - Recognise the havoc this illness is playing on your relationship. Don't blame yourselves or each other. Give the relationship a chance.

2.Build communication - Take time to talk to each other. Tell each other what you would like both relationally and sexually. Find out and share what feels good and is possible. Experiment with touch, and tell each other what kind of touch turns you on.

3.Schedule time - Take time for the two of you to be together without any demand or expectation of sexual intercourse.

4.Learn about yourselves sexually.

5.Learn to give and receive pleasure - Learn to touch and to enjoy the warmth of each other's bodies.

6.Take responsibility for your own sexual response.

7.Distract from anxieties and demands - When we are physically drained or feeling unsure of our bodies, or their responses, we may avoid physical closeness. We are afraid we will fail. However, if our only goal is to find mutual enjoyment together, then there is no way to fail. Distracting from the demand to perform by saying it the way you feel it can provide incredible relief, especially when the message is received for what it is meant to be.

8.Experiment with alternative methods of sexual enjoyment - Other methods of finding sexual satisfaction may be necessary when sexual intercourse is not possible. It may be necessary to enjoy the intimacy of being together. When sexual arousal isn't happening, the focus on mutual body pleasure for the enjoyment of the touch can maintain the sexual closeness.

9.Maximise general health. Sexuality is closely linked with physical appearance and performance. It is necessary to unlink these and find sexual satisfaction even when the illness affects our physical appearance and sexual performance. You can do it! It is the only way to maintain your sense of well being as a whole sexual person who can enjoy all the intimacy of a marriage relationship...