Dear Urologist: My Partner’s Chronic Pain Is Ruining Our Sex Life

Chronic pelvic pain has a worldwide prevalence of 2 to 16 percent and is the most common urologic disease in men under 50.

In addition to pain and discomfort, studies show that chronic pelvic pain syndrome (CPPS) can also cause sexual difficulties like ejaculatory pain, low sexual desire, and erectile dysfunction (ED). Chronic pain of any kind can also interfere with quality of life and mental well-being.

Here, urologist Dr. Peter J. Stahl, MD, SVP of Men’s Sexual Health & Urology at Hims & Hers, responds to a reader’s concerns about their partner’s chronic pain—specifically how the pain impacts their mutual sexual satisfaction.

Dear Urologist,

My partner has suffered from chronic pelvic pain for several years. His pain often feels worse during sex to the point that he sometimes has trouble performing or even avoids sex. Besides using medication for pain management, what else can he do to get our sex life back on track?

—Chronically Unsatisfied

Dear Chronically Unsatisfied,

Chronic pelvic pain is a disorder that’s relatively poorly understood, even by experts. Making matters worse, most doctors don't have the adequate knowledge or training to help patients manage the condition. The formal name for the condition is chronic prostatitis/chronic pelvic pain syndrome, often referred to as CP/CPPS or just CPPS.

Part of the reason why it’s so challenging to provide medical care for patients with CP/CPPS is because objective findings on diagnostic testing are absent in most cases. This is not only incredibly frustrating for patients who want to understand what is causing their pain but also leaves clinicians without obvious objective abnormalities to treat with standardized therapies.

If your partner has CP/CPPS, and his symptoms are impacting your shared sex life, chances are he hasn’t been properly diagnosed and evaluated by an experienced expert. The good news is that, once you know what kind of care to seek, there are effective treatments available.  

Pelvic Floor Dysfunction

One very common and typically overlooked cause of pelvic pain that occurs during sexual intercourse is pelvic floor muscle dysfunction, which refers to a variety of disorders that affect the muscles in the pelvic floor. Pelvic floor dysfunction, or PFD, can cause painful symptoms like tenderness of the pelvic floor muscles, sexual dysfunction, and anxiety. 

The pelvic floor is made of a network of muscles and connective tissue that support the pelvic organs, including the bladder, prostate, rectum, and seminal vesicles. These muscles also help regulate bladder, bowels, and sexual function. However, the pelvic floor can sometimes get too tight and inflamed. 

As is the case with any other muscles or connective tissue, contraction or movement in the presence of tension and inflammation can be painful. Pain can be especially exacerbated by the intense contractions of the pelvic floor that occur during orgasm and ejaculation.

Is your partner under a lot of stress? Mental health issues like stress and anxiety are often the cause of pelvic floor tightness, which, when left unchecked, can progress to pain. Over time, as the pain progresses and worsens, a vicious positive feedback cycle can develop. Tension leads to pain, which leads to more tension, which leads to more pain, and so on and so forth.  

Other Causes of CPPS

Other potential causes of chronic pelvic pain include:

• Urological conditions. These conditions can include bacterial prostatitis, interstitial cystitis, enlarged prostate, urethritis, urinary tract infections, or sexually transmitted infections.

• Neurological issues. Potential neurological causes include pudendal neuralgia and the musculoskeletal condition fibromyalgia.

• Gastroenterological disorders. Chronic inflammatory disease and irritable bowel syndrome are associated with chronic pelvic pain, according to research.

Pelvic Floor Therapy

The most effective treatment for pelvic pain sufferers is physical therapy with a specialized pelvic floor physical therapist. Treatment, which has a 70 percent positive response rate, focuses on learning to relax the pelvic floor muscles. Often, the sessions lead to reduced tension and inflammation through internal trigger point massage.

While Kegels, or pelvic floor exercises, can help strengthen the pelvic floor, they may not work as well for chronic pelvic pain because most men with this condition have an overactive or hypertonic musculature that requires relaxation, not more strength.

Anti-Inflammatory Pain Medication

Chronic pain patients can also reduce their pain levels during intercourse with the aggressive use of anti-inflammatory pain medication taken before engaging in sexual activity. 

Erectile Dysfunction Medication

People who deal with CPPS may also benefit from erectile dysfunction medication, as men with pain can have a difficult time getting and staying aroused.

In fact, studies show that patients with chronic pelvic pain syndrome and chronic prostatitis have a higher rate of ED than that reported for the general population. In most cases, ED is mild or moderate in severity.

Anti-Depressants

Some research also suggests that antidepressants may relieve chronic pelvic pain by either acting directly on the neural mechanisms of pain or by addressing the depressive symptoms that contribute to one’s capacity to cope with the pain.

Supplements

Besides medication, some supplements may help, particularly the flavonoid quercetin, which is present in red wine. Research has concluded that quercetin may help to regulate pelvic floor spasms due to its antioxidant and anti-inflammatory effects.

But, before trying any treatment, it’s always important to get evaluated by a healthcare provider. They will exclude possible underlying medical problems, such as bacterial infections, that could benefit from antibiotics, and help you land on the best option for you.

Chronic pain can impact many areas of your life, including your sexual relationship, but with the right support, you can get back to having the sex life you deserve.

Remember:

• Chronic pelvic pain can interfere with your sexual experiences. Chronic pelvic pain, which affects 2 to 16 percent of men, can lead to sexual difficulties like erectile dysfunction, ejaculatory pain, and low libido while also impacting mental health.

• There are many potential causes of pelvic pain during sex. These causes include pelvic floor dysfunction and a range of urological, neurological, and gastrointestinal conditions.

• Help is available. Physical therapy, anti-inflammatory medication, and erectile dysfunction treatments can help improve sexual function and overall well-being.

Want to learn more about available treatments for sexual dysfunction? Get advice from a medical professional today.