Sex File: My orgasm has gone missing

When your brain is focused on pain avoidance it can't simultaneously attend to erotic cues. Picture: iStock 

I'm on medication for a back problem, which has made my libido vanish. When I do have sex with my boyfriend, I can't reach orgasm. In all honesty, I'd rather not bother for a while, but I'm worried that if I let our sex life die it will be hard to get it back on track. I'll be on these meds for a few more months. How do I keep our relationship intimate in the meantime?

I know you have spoken to your doctor about your medication, but have you explained that the sexual side-effects are getting you down? Research by the department of rheumatology at El Ayachi Hospital in Rabat found that up to 81% of patients with chronic low-back pain reported sexual problems, yet 66% of them never discussed this issue with their healthcare provider. 

You obviously have to stay on these medications for the next few months but sometimes, with support from your specialist, there may be additional medication you can take which can help with sexual function, or you can get permission to take a short drug holiday every few weeks.

Strong pain meds are fantastic at helping people to manage major back problems, but they play havoc with sexual function because they reduce sexual interest and arousal. 

They also affect sex hormone production and decrease nerve sensitivity which, in turn, diminishes pleasurable sensations. Collectively, these side-effects negatively affect the likelihood of ejaculation in men and orgasm in women.

Physical pain has psychological consequences, too. When people worry about the possibility of something triggering a pain response they become hypervigilant, constantly anticipating whether an activity will or won't cause pain. 

When your brain is focused on pain avoidance it can't simultaneously attend to erotic cues.

When sex is potentially painful and doesn't deliver the usual rewards, it begins to feel a bit pointless, but it is, as you recognise, fundamental to intimacy. 

Improvise and compromise

Fortunately, there is more to sex than penetration and although you and your partner may have to improvise and compromise while you are unwell, with a little imagination, you should be able to sustain sexual intimacy.

Last year a study at UZ Brussels university hospital explored sexual health in sexually active patients with chronic lower-back pain. Most agreed that it had a negative impact on levels of sexual activity and the quality of their overall sexual life. 

However, despite reduced sexual desire, by modifying how they engaged in intercourse most participants were able to continue to have sex. 

In many cases, this involved changing positions to alleviate strain on their back. Using props such as pillows to reduce pressure, or choosing more relaxed positions such as spooning or doggy style helped the participants to make intercourse more comfortable.

While you wait for your back and your sexual function to return to normal, you and your partner should use this time to talk and think about sex in a way that is more creative and less focused on traditional intercourse. 

Necessity is the mother of invention and interestingly, the couples involved in the UZ Brussels study felt that as a result of their challenges, they actually ended up being more innovative and more sexually adventurous.

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