Sexual Function & Chronic Pain: Results of a Systematic Review
The impact on sexual function of chronic pain conditions has received little research inquiry and requires much more focused clinical attention.
In the management of chronic pain, the primary goal is to maximize the patient’s level of functioning; usually the focus is on the ability to perform at work or school or to accomplish household chores.
One important area of life for many people, however, is often overlooked by healthcare professionals: sexual functioning.
A recent systematic review published in Pain Medicine examined the current research on how chronic musculoskeletal pain may affect sexual functioning.* The review included studies of patients with pain persisting for ≥3 months and sexual difficulty before any intervention. Studies were excluded if participants had other disorders, such as diabetes, that could impact sexual function or where the pain disorder was located in the sexual organs.
The slide show below offers the review's top-line findings.
In general, it appears that physicians do a poor job in assessing their patients’ sex lives either out of fear of embarrassing the patients or because they have limited knowledge of how to address the problems that may be revealed. Patients, too, may have difficulty discussing problems with sexual function with the possible exception of those experiencing pain in the reproductive organs such as dyspareunia and vaginismus.
10 studies on pain and sexual function published from1981-2018 with a total of 2941 patients.
Pain disturbs sexual function. All studies reported some sexual difficulty or reduced sexual functioning among participants. Reduced libido and/or sex drive following onset of chronic pain also commonly reported.
Most painful coital positions for people with chronic pain: 89% lying on one’s back. 24% top position. 6.3% side-lying position
Pain, psychological functioning, & sex were evaluated in 8 studies. All found that greater levels of comorbid anxiety and/or depression were associated with greater sexual dysfunction.
Pain Rx and sexual function was evaluated in 2 studies. Results of one study found current
opioid use did have an impact on sexual functioning; the other found that medication side-effects may impair sexual function.
Differences between the sexes in impact of pain on sexual function were not clear.
More research and clinical focus are needed on the impact of chronic pain on sexual function.
Impact of opioids on sexual function needs to be made clear to patients.
Psychological evaluation for patients with chronic pain is always essential.
Reference: Katz H, Newton-John TRO, Shires, A. Sexual difficulties in the population with musculoskeletal chronic pain: a systematic review. Pain Med. 2021;22:1982-1992.
