It's something we can find hard to talk about sometimes. After all, dealing with chronic pain is enough for most, and often there just isn't enough time to talk with the doctor about this problem. Full filling sexual needs is important to everyone. So where do we start? Firstly, get professional help from a health care provider who has had experience in dealing with chronic pain patients, sexual and personal relationships.

Here's ten really useful tips from Carole Webster 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: +44 (0)20 7607 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. 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.
   
9. 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.

Ten Tips about Sex and Chronic Pain © Carole Webster. All Rights reserved. First Published in the Pain Concern Lothian Group newsletter.