FOR most people, sexual intimacy is an important part of a committed relationship ¹. Discovering that no aspect of your life together, even the most intimate, is safe from fibromyalgia syndrome (FMS) is shattering ². If FMS has lead to decreased responsiveness and frequency of intimacy in your relationship, you may feel outraged and devastated.

Although fibromyalgia may change how you are intimate with your partner, you can find new ways to have a sexually satisfying relationship. Both partners need to accept the changes fibromyalgia brings, honestly communicate with one another, and be willing to explore new ways of being sexually intimate.

Some Facts

Fibromyalgia creates unique problems regarding sexual intimacy. Pain is the primary issue. Muscles that ache from pressure and squeezing can be aggravated during attempts at intimacy. FMS often causes low back and pelvic muscles to hurt. This causes painful intercourse. Muscles may cramp in the middle of intercourse, creating a "major distraction" ³.

Another fibromyalgia related–problem is fatigue. Sexual activity requires energy. Because FMS disturbs sleep patterns, your partner often needs plenty of sleep to combat feeling fatigued. Your partner's desire for sleep may interfere with your desire for intimacy.

Specific medications used to treat fibromyalgia can interfere with sexual responsiveness. For example, drugs that increases the body's serotonin level (called selective serotonin re–uptake inhibitors) can decrease sexual responsiveness ⁴. Women may lack sexual desire (libido), or be unable to achieve orgasm. Men may lack libido or have difficulty achieving erections. The side effects of other medication can cause extreme sedation, preventing your partner from being sexually alert. Still others may cause gastrointestinal problems.

Fibromyalgia can coincide with emotional problems as well, such as depression, negative self–image, anxiety or fear of rejection. Even though your partner may be able to respond sexually from a physical standpoint, self–perception, increased vulnerability and emotional pain may limit your partner's interest in intimacy. Making matters worse, some treatments for depression can cause further problems in a relationship. Some of the most prescribed antidepressant medications can decrease sexual desire and function.

The stresses fibromyalgia causes in daily living and your fear of causing your partner physical pain may further decrease intimacy and sexual contact ⁵.

Accepting Body Changes

Chronic pain, fatigue, and other changes due to fibromyalgia may affect your partner's physical mobility. These changes do not alter who your partner is as a person; however, they can cause your partner to feel less attractive, less youthful, and less confident sexually or socially. Nevertheless, it is possible to overcome these negative feelings, to accept the changes fibromyalgia brings, and to maintain personal interest in life. Here are some ways you can help your partner accomplish this:

• Learn as much as possible about fibromyalgia. The more both of you know about FMS, the better you both can plan for alternatives that will still enable you to enjoy a fulfilling sexual relationship together.

• Accept change. Your partner and you may have feelings of resentment, anger, grief, blame, or depression about fibromyalgia. Not knowing from day to day how your partner will feel is frustrating. In order to cope, you may be denying that FMS is causing problems in your relationship.

It is natural to feel anger and frustration towards FMS. Ignoring your feelings, or your partner's feelings about FMS, may lead to interference in your relationship both in and out of the bedroom. Accepting such feelings is the first step towards working through them. Instead of focusing on the negative changes in your partner's body, focus on his or her strengths as a person and what is still possible in your relationship together.

• Take care of yourselves. Careful grooming and daily exercise can help improve self–image. Regular exercise is an important part of managing fibromyalgia symptoms. Exercising together is time shared and can bring you closer together.

Communication Is the Key

Talking with your partner about making love can be difficult. But good communication is one of the most important factors in a satisfying sexual relationship ⁶.

There are two basic methods to communicate ⁷ sexual information to your partner. One is to do it nonverbally through the use of body movements during love making. The other is to verbally talk to your partner during love making or some other time. If you use nonverbal communication, you risk not making yourself clear. Conversely, sometimes words cannot describe your needs and desires as clearly as physically showing what you want. "What's essential is to develop some comfortable means of communicating sexual preferences, whether it be verbal or nonverbal. At the same time, it is important to realize that the first few attempts at communication, no matter what method is used, are likely to be somewhat awkward" ⁸.

"Each person's physical and emotional needs must be considered if sex is to be a joyous, unself–conscious experience" ⁹. Share whatever anxieties or fears you may have and find out how your partner feels. Reflect on the sexual and intimate needs both you and your partner had before the onset of fibromyalgia and how those needs may have changed. Encourage new ideas about things you both would like to try, to compensate for the changes FMS has made in your sexuality. "Consider this an adventure well worth your time and energy" ¹⁰.

Planning for More Comfortable Sexual Contact

"With the two of you working on it together, satisfying sex need not be an insurmountable problem" ¹¹. Honest communication, a generous spirit, and determination are the ingredients of success. "Through discussion and experimentation, new ideas that appeal to both partners can be generated" ¹².

If you put the kind of time and effort into sex that you put into keeping other areas of your relationship vital, you may find that sex too can take on added dimensions, despite the presence of fibromyalgia ¹³. Here are some suggestions for having satisfying sexual intimacy:

• Plan ahead. Pick a time when you both feel your best ¹⁴. Sex doesn't always have to happen at night. Prior to sexual contact, avoid activities that will leave your partner and you worn out. But if your partner is too tired, arrange another time for sex. Your partner should not be approached when physically exhausted.

• Create a comfortable setting. The room should be at a comfortable temperature, not drafty. Use pillows to support the body and soft surfaces.

• Set the mood. Creating a sensual scene can enhance your lovemaking ¹⁵. Soft, silky bedding can heighten the sense of erotic touch. Candles or soft lighting creates a relaxed frame of mind. Soothing music can help distract the mind from thoughts of a hectic day. The pleasant aroma of perfume, cologne, soaps, scented candles can be arousing. Make certain that the fragrances you chose are appealing to your partner. Negligees and sexy underwear can be enticing for both partners. Taking a warm bath or shower can help relax muscles and can be the beginning of foreplay. "Looking attractive, allowing yourself to feel sexy, and even giving yourself permission to act sexy can add excitement for both of you" ¹⁶.

• Find comfortable positions. Certain positions may be painful for the partner with fibromyalgia, while others are not. "Positions that involve arching the back, straightening the legs, twisting the spine, or positions that require a lot of support from only one leg or one arm can be often painful for an individual with fibromyalgia and can lead to muscle cramps" ¹⁷. Instead, experiment with side–lying positions, lying on the back with knees bent, sitting positions, or positions where the back is supported. Avoid staying in one position too long, as this again can lead to muscle cramps. Talk openly with your partner and discuss what hurts and what helps (you may want to have this conversation when you are not engaged in sex and preferably not in the bedroom). Your partner may need more time and attention to get aroused. "Remember that sexual activity will not damage fibromyalgia muscles, so have fun" ¹⁸.

• Don't poke, squeeze, or slap. Use massage oils, feathers, and other sensual materials to rediscover "gentle" erotic touching ¹⁹.

Alternative Ways to Be Intimate

Intercourse isn't the only way to be intimate with one another. Have fun exploring new ways of pleasuring each other. Oral sex, gentle massage, cuddling, masturbation, sex toys (from games to vibrators ²⁰), and couple's hot tub are a few examples of the ways you can pleasure one another.

Again, communication with your partner is vital. When modifying your sexual practices, reassure that you love and trust your partner. If you are uncomfortable, tell your partner and suggest other alternatives you are willing to try.

Obtaining Additional Help

Be assured that sexual concerns are legitimate concerns. It's perfectly normal to seek the advice of professionals. If your partner and you are concerned that fibromyalgia and/or depression is affecting your sex life, talk to your healthcare provider. A health professional can provide valuable insight and can alter medications and dosages, which may alleviate negative side effects.

Trained counselors in sex therapy can help couples communicate with one another, and give new ideas for intimacy. Fibromyalgia support groups provide an opportunity for couples to meet others with similar experiences. Contact your local health clinic to find out about counselors and support groups in your community.

There are many books covering the topic of sexual intimacy available at your local library and bookstores. The New Joy of Sex,by Alex Comfort, is a popular example. Another is For Each Other: Sharing Sexual Intimacyby Lonnie Barbach. For Each Other,in particular, focuses on female sexuality. These books are excellent resources for those who wish to enrich their sexuality and break old habits. Both books are appropriate for you and your partner to read and use together.

Reflection

"Remember, underneath the fibromyalgia is still the same person that you love" ²¹. That your partner has FMS does not make him or her any less sensual or less able to give and receive pleasure. Showing love for one another is a mental and an emotional process, not just physical. "If fibromyalgia has interfered with this total process, then you both need to acknowledge this and make a commitment that this interference will only be temporary as you learn to redefine intimacy on your new terms" ²².

2. C McGonigle, Surviving Your Spouse's Chronic Illness: A Compassionate Guide,(New York: Henry Holt, 1999).

3. MJ Pellegrino, The Fibromyalgia Supporter,(Columbus, Ohio: Anadem Publishing, 1997).

4. Pellegrino, The Fibromyalgia Supporter.

5. Arthritis Foundation, "Living and Loving: Information About Sexuality and Intimacy," (1993).

6. L Barbach, For Each Other: Sharing Sexual Intimacy,(New York: New American Library, 1984).

7. Lonnie Barbach, Ph. D. devotes an entire chapter to "Communication" in the book For Each Other: Sharing Sexual Intimacy.

8. Barbach, For Each Other,105.

9. Barbach, For Each Other,279.

10. Arthritis Foundation, "Living and Loving," 2.

11. Williamson, Fibromyalgia,141.

12. Barbach, For Each Other,279.

13. Barbach, For Each Other.

14. Williamson, Fibromyalgia.

15. Barbach, For Each Other.

16. Barbach, For Each Other,277.

17. Pellegrino, Fibromyalgia Supporter,65.

18. Pellegrino, Fibromyalgia Supporter,66.

19. Pellegrino, Fibromyalgia Supporter,65.

20. According to Lonnie Barbach's book For Each Other: Sharing Sexual Intimacy, a tasteful selection of vibrators, bath oils, and other pleasurable products chosen specifically for women can be obtained through Eve's Garden,119 W. 57th Street, New York, NY 10019. A large selection of new age games and toys including some designed to enhance sexual pleasure are available through Uniquity,215 4th Street, P.O. Box 6, Galt, California 95632.

21. Pellegrino, Fibromyalgia Supporter,66.

22. Pellegrino, Fibromyalgia Supporter,66.