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Being in too much pain to even think about making love is a signal to talk with your doctor about your treatment plan. Perhaps it’s time for a different or stronger medication, a revised exercise routine, or other medical adjustments to improve pain control.

Still, it’s important to get rid of the exhausting, athletic and unrealistic expectations of lovemaking created by the media. Sex can be a gentle, tender experience that heals. In fact, satisfying sex doesn’t always have to include sexual intercourse. Romance and intimacy can be just as satisfying. Be creative. A gentle massage from your partner during times of fatigue and pain can be very romantic.

Psychologist Jackson Rainer, PhD, suggests redefining sexuality as “an energy that is healing, warming, and operates more outside of the genitals than in one specific place on the body.” With that understanding of sexuality in mind, you are almost never too miserable to experience sexual contact.

For example, holding hands in a darkened movie theater is pleasurable for most people. “Skin-to-skin contact is very important,” says Rainer, “but it doesn’t have to happen in some prescribed way. If it’s painful to close your hand, or if your partner feels pain when you hold her hand, then use an open hand to touch, to rub.” Let your partner brush her fingers lightly over your palm or inside your arm. Ask him to rest his hand gently on your knee.

You can’t fully enjoy your sexuality if you’re afraid of getting hurt. It is vital that a couple coping with chronic pain – both the person in pain and the partner – has a clear, shared understanding of what feels good for each person and what causes discomfort.

Rainer recommends “sensate focusing,” an experience that allows each partner to develop a “road map” of the other’s body. In the privacy and comfort of a warm bedroom, one partner slowly explores the other’s body with touch and with questions, in order to find out what feels good, what causes pain, what is desirable, what is undesirable. Each partner gets a turn. The goal is to explore rather than to be involved in any type of activity that leads to orgasm: The only rule is that you don’t touch genitals. In this way, you begin to develop an intensely personal language of touch.

As a practical matter, plan your pain medication schedule with your lovemaking date in mind. Take your pain medication so it peaks at the time you anticipate a sexual encounter. If you take your analgesic every 12 hours, for example, plan to be four to six hours into a dose.