For many individuals with chronic pain, the condition shapes not only daily functioning but also intimacy and relationships. Despite its profound effects on quality of life, sexual health remains one of the least addressed aspects of care.

Cristina Mena Ruiz, MD , a urologist and sexologist from the Department of Urology, University Hospital of Araba, in Vitoria-Gasteiz Álava, Spain, addressed the issue during the symposium Everything You Want to Know About Pain and Sex but Are Afraid to Ask at the 22nd Congress of the Spanish Pain Society, attended by more than 1000 national and international specialists.

“As healthcare professionals, we must take sexuality into account when assessing patients with chronic pain, not only in cases of pelvic pain but in any painful condition that may lead to sexual dysfunction,” Mena said.

Mena discussed how chronic pain affects patients’ sexual and emotional well-being. According to Mena, sexuality remains a taboo topic for both patients and healthcare professionals.

“Pain profoundly changes individuals’ lives. When individuals stop feeling healthy and begin living with a chronic condition, their self-esteem, relationships, role within a partnership, and experience of sexuality can change. In addition, many pharmacological treatments can negatively affect sexual function,” she said.

Despite these effects, sexuality is rarely addressed during routine history taking in pain units, primary care practices, or specialty clinics.

Training Gaps

According to Mena, one of the main barriers is the lack of formal education on sexual health during medical training.

“In many medical schools, sexuality continues to be approached in a reductionist way, focusing primarily on the genitals and heteronormative relationships. Sexuality is much broader than that and requires open-ended questions that go beyond sexual intercourse,” she said.

Mena acknowledged that during her medical training, she was not given tools to address these issues either. Her work in functional urology ultimately led her to pursue additional education in sexology after recognizing that she was not providing comprehensive care.

In her view, healthcare education stays heavily focused on biological aspects while giving insufficient attention to pleasure, intimacy, identity, and sexual diversity.

Rocío Barreira, PhD , a clinical psychologist from the Pain Unit, Araba University Hospital, Osakidetza, Vitoria-Gasteiz, Spain, emphasized that clinicians should not focus solely on the effects of pain on sexual intercourse.

“It is not only about discussing pain during sexual activity but understanding how individuals with chronic pain experience and navigate their sexuality,” she said.

Mena often treats patients with neurologic disorders, such as multiple sclerosis and amyotrophic lateral sclerosis, who experience sexual difficulties despite never having been asked about this aspect of their health.

“We are all sexual beings throughout our lives. Sexuality should be integrated into every stage of life and considered in every patient, regardless of age,” she said.

Team Approach

Mena advocated multidisciplinary care and highlighted the work of the Pelvic Floor Committee at Araba University Hospital, which for the past 5 years has brought together urologists, gynecologists, clinical psychologists, and other specialists.

“Working together has allowed us to provide far more comprehensive care and improve the management of these patients,” she said.

She also stressed the importance of creating a clinical environment that promotes privacy and trust, thus making discussions about sexual health easier.

“It is essential for healthcare professionals to know how to initiate these conversations, so patients feel comfortable. They may not discuss these issues during the first visit, but they often will during subsequent consultations,” she said.

Mena also highlighted the ongoing diagnostic challenges associated with chronic pelvic pain, noting that diagnosis may be delayed by 5-7 years before referral to specialized units.

According to Mena, chronic pelvic pain primarily affects women and continues to be influenced by significant sex-related biases.

“When no clear organic cause is identified, some patients feel that their pain is questioned or minimized. Many have had negative healthcare experiences before reaching a specialized clinic,” she said.

Gender Bias

Mena believes that cultural stereotypes continue to influence healthcare delivery, particularly in relation to female sexual health. She recommended incorporating simple questions about sexuality into routine clinical interviews, rather than treating the subject as an exception.

She also advocated for a broader understanding of sexuality, particularly among individuals living with chronic pain or physical limitations.

“Some patients cannot engage in penetrative sex because of pain, but they can still enjoy their sexuality and experience pleasure or orgasm through other forms of stimulation. We should help them explore alternatives and move beyond rigid sexual models centered exclusively on intercourse,” she explained.

She emphasized that sexuality involves much more than genitals and that there is no single correct way to experience it.

From a clinical psychology perspective, Barreira noted that chronic pain significantly affects physical health.

“Individuals with chronic pain often experience occupational, emotional, family, and social difficulties. All these factors also affect their emotional and sexual lives,” she said.

Factors contributing to sexual difficulties include fear of pain, reduced self-esteem, anxiety, and changes in relationship dynamics.

Biologic Differences

The neuroscientific perspective was presented by Enric Verdú Navarro, PhD, a professor of physiology from the University of Girona, Girona, Spain, and a researcher in the Clinical Anatomy, Embryology, and Neuroscience Group.

During his presentation on sex differences in pain, he reviewed clinical and experimental evidence demonstrating differences in acute, neuropathic, and nociplastic pain between men and women.

According to Verdú Navarro, a better understanding of these differences could support the development of personalized treatment strategies.

Amanda Pérez Torrent, physiotherapist specializing in pelvic floor rehabilitation at FisioAmanda Clinic, Picassent Spain, highlighted the complexity of chronic pelvic pain and the importance of coordinated care across multiple disciplines. In her view, only a multidisciplinary approach can adequately address the biologic, psychological, and social factors involved.

The experts participating in the symposium reported having no conflicts of interest related to the topic under discussion.

This article was translated from El Médico Interactivo, part of the Medscape Professional Network.