For Teachers & Professionals

Fibromyalgia and Sexuality

Fibromyalgia syndrome (FMS) is a long-term condition that causes pain all over the body (musculoskeletal pain), accompanied by fatigue, sleep, memory, and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way the brain and spinal cord process painful and nonpainful signals. Symptoms often begin after an event, such as physical trauma, surgery, infection, or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are more likely to develop fibromyalgia than men. It’s worth to noticing that more than a mental somatic symptom disorder, fibromyalgia patients may have a stress-induced neuropathic pain syndrome. Sexually dimorphic dorsal root ganglia (the first neurons of the sensory pathway) physiology may explain why it is women who more often develop fibromyalgia. Understanding fibromyalgia as a real stress-evoked neuropathic pain syndrome may lead to more compassionate patient care. It's not clear exactly how many people are affected by fibromyalgia, although research has suggested it could be a relatively common condition.

1. Male sexual function

Published studies on sexual dysfunction in FMS focus mainly on female patients, thus less is known about male sexuality. It has been observed that the ratio of sexual complaints in male patients with FMS is significantly higher in comparison with people without FMS and all of the areas of sexual functioning seem to be significantly lower in patients with FMS compared to the healthy controls. The widespread pain, disturbed quality of life and advancing age have a greater impact on the sexual function rather than the psychological state in males with FMS. Sexual dysfunction seems to present an important problem and must therefore be addressed by physicians during routine evaluations.

2. Female sexual function

For what concerns female patients, fibromyalgia has negative effects on the female sexual function that are aggravated by depression. Reductions in generalized pain, the severity of disease, depression, and sleep disorders may also reduce sexual problems in patients. Female patients report a decrease in desire, less lubrication, and of course pain during intercourses. Pain is associated not only with penetration but also with other partner touches during caresses and foreplay. But it’s worth noticing that for some women pleasure related to sex is beneficial, as it generates relaxation and, consequently, pain relief. Adequate pelvic muscle performance is related to better arousal and orgasm since they participate in female sexual function and modulate motor responses during sexual apex, as well as vaginal receptivity. When there is hypertonia, vaginismus can develop and lead to dyspareunia or other sexual pain disorders.

3. Couple sexual function

Fibromyalgia syndrome compromises the couple’s sex life. The frequency of sexual relations progressively decreases until it almost disappears. The way sexual relations take place also changes and they become restrained and predictable. The situation results in a loss of spontaneity in male sexuality, which is inhibited by fear and caution in order not to harm the woman. The coping process is a difficult struggle in which the partner (often a man) constitutes the main source of support for women with FMS. Male partners of women with FMS understand the problem, experience the process, and seek solutions with them. Men retain their sexual desire but suffer from frustration and monotony, resigning themselves to the progressive deterioration of their sex life and relationship. Men lead adaptation strategies to increase female sexual desire, minimize their discomfort and encourage imagination/creativity in sexual encounters.

4. What can be done

Alternatives to penetration, encouraging the recovery of desire, rediscovering seduction, patience and imagination, toys, movies, and massages or other relaxation techniques, understanding rejection as well as enhancing intimacy, skin-to-skin contact (during acute FMS outbreaks), finding new positions and use of sex toys can increase female desire and help the couple cope. Pelvic floor exercises and breathing techniques are also of great importance. In this process, men report the need for information, advice and help from sexology experts to improve coping. Patients and their partners could benefit from professional support and it is essential to normalize the sexuality-related difficulties that the couple will have to face during their lives. Sharing experiences with other couples could also help soften the negative effects on their sex life. Some medications as antidepressants also have negative effects on sexuality, adjusting the dose or finding a better drug may help. For the majority of men, supporting the woman as a partner prevails over the loss of quality of their sex life, is thus important to be able to give support to the couple.

REFERENCES

1. Batmaz, İ., Sarıyıldız, M.A., Dilek, B. et al. (2013). Sexuality of men with fibromyalgia: what are the factors that cause sexual dysfunction?. Rheumatol Int 33, 1265–1270. doi.org/10.1007/s00296-012-2567-1

2. Martínez-Lavín, M. (2021). Fibromyalgia in women: somatisation or stress-evoked, sex-dimorphic neuropathic pain? Clinical and Experimental Rheumatology, 39, 422-425.

3. Romero-Alcalá P, Hernández-Padilla JM, Fernández-Sola C, Coín-Pérez-Carrasco MdR, Ramos-Rodríguez C, Ruiz-Fernández MD, et al. (2019) Sexuality in male partners of women with fibromyalgia syndrome: A qualitative study. PLoS ONE 14(11): e0224990. doi.org/10.1371/journal.pone.0224990

4. Yilmaz H, Yilmaz SD, Polat HAD, Salli A, Erkin G, and Ugurlu H. (2012). The effects of fibromyalgia syndrome on female sexuality: a controlled study. J Sex Med 2012;9:779–785.