Sex, Chronic Pain, and Intimacy: How Sensate Focus Can Help

Chronic pain extends beyond physical symptoms; it can significantly impact emotional well-being, relationships and sexual intimacy. Persistent pain often interferes with the ability to engage in or enjoy physical closeness, leading to reduced sexual activity and emotional disconnection.

Many people with chronic conditions feel disconnected from their bodies. Some worry about how their partner perceives them. As a result, sexual activity can become challenging, uncomfortable, or no longer prioritised.

However, addressing sexual health remains an important component in overall well-being. Intimacy matters. It is a valuable part of a relationship, contributing to emotional connection and quality of life. Even with chronic pain, it is still possible to enjoy sex and touch with supportive communication and appropriate guidance.

How Can Chronic Pain Impact Intimacy

Living with chronic pain means navigating a body that doesn’t always cooperate. This can impact sex and physical closeness in several ways.

Physical Discomfort and Fatigue

Pain may be exacerbated by touch, movement, or certain positions. Fatigue can also make initiating or engaging in intimacy feel like an insurmountable task.

Medication Side Effects

Many pain medications come with unwanted side effects that can affect libido or make sexual intimacy more difficult. Discussing these concerns with your GP/pain specialist may be helpful, as well as considering breakthrough medications which can be taken after intimacy in anticipation of a potential flare-up.

Emotional Barriers

The emotional weight of chronic conditions, depression, anxiety, grief over a changing body, and fears about being ‘too much’ for a partner can make it difficult to be desirable or present during sex. Body image issues and embarrassment are common and often not spoken about openly.

These challenges can affect people of all genders and relationship styles. All partners may struggle with shame, guilt, or disconnection. Recognising these feelings is not a sign of failure; it’s a normal part of living with complex health needs, and it is not isolated to only one person.

The Importance of Communication

The first step is talking.

When chronic pain becomes part of a relationship, many partners stop talking openly about sex and intimacy. But staying silent can lead to misunderstanding and emotional distance. Honest, compassionate conversations can reduce shame, strengthen connection, and help partners navigate changing needs together.

It’s important to share what feels good and what doesn’t. Tools like a 1–10 pain scale or having a simple signal to pause or stop can make intimate moments safer and more comfortable. Talk about hopes, worries, and needs, even if they’ve changed over time. These conversations don’t need to be perfect; what matters most is openness and honesty.

Sensate Focus, as a technique, relies on trust and mindful listening, and that same level of attentiveness applies to all types of intimacy. Checking in, being present, and ensuring both partners feel safe and at ease are key to maintaining a meaningful sexual connection.

Watching a partner experience chronic pain can also bring up feelings of helplessness. Expressing those emotions and discussing practical ways to support each other, like helping with daily tasks or arranging cushions for comfort, can foster closeness and turn care into a form of intimacy.

What is Sensate Focus?

After communication, the next step is to find ways to connect again, physically and emotionally. One approach that can help is Sensate Focus.

Sensate Focus is a gentle, structured way to explore touch without pressure. Masters and Johnson developed it in the 1960s to help couples reconnect through sensation, not performance.

Here’s how it works:

Partners take turns touching and being touched.

The goal isn’t sex or arousal.

Instead, it’s about noticing what feels good for you and communicating this to your partner.

There’s no ‘right’ way to do it. It’s about curiosity and presence.

Many chronic pain conditions have components of hypersensitivity. Meaning that sensations, such as touch, can feel painful compared to normal. This is known to be due to stress-related nervous system dysregulation and not necessarily the body being harmed. Desensitisation techniques have been known to be effective in changing this response. Sensate Focus techniques can be useful in helping with this process, as it is a gentle way for people to build up their tolerance by exploring sensual touch regularly.

This technique can be a way to reconnect with your body and reduce fear slowly. It allows both partners to rebuild trust and comfort around touch, without pressure for penetration or climax.

A written full guide on how to try Sensate Focus at home is attached.

Other strategies that can help support intimacy:

Positioning aids

Pillows, wedges, and supports can reduce strain. Try new positions that reduce pressure on painful areas (This is explored in a previous blog post, so do check it out!)

Timing

Knowing when to choose to be intimate is just as important as being intimate. Therefore, timing is everything. Choose times of the day when pain is lowest or when medication is most effective. Different people have different pain patterns, so plan and prepare for a time that’s right for you and your partner. This allows for a more relaxed and comfortable experience, where flare-ups are minimised and manageable.

Non-penetrative Sex

While intercourse is often seen as the main form of intimacy, it can be particularly challenging for those living with chronic pain. However, intimacy doesn’t have to centre around penetration. Exploring alternatives such as touch, cuddling, massage, oral sex, mutual pleasure, or sensual play can offer satisfying and less physically demanding ways to connect.

These approaches often reduce the physical strain and discomfort that can accompany chronic pain. Techniques like Sensate Focus, as previously mentioned, can be especially helpful. This gradual, non-penetrative method of intimacy can ease partners back into sexual connection at their own pace, or serve as a fulfilling substitute during pain flare-ups, allowing for closeness and pleasure without the need for intercourse.

Kink and Chronic Pain: Creative, Consensual Exploration

For some people, especially within the kink or BDSM community, exploring erotic play through a creative lens can help manage and reframe chronic pain. While it may seem surprising, the overlap between pain, pleasure, control and support can be incredibly meaningful and empowering.

Kink can offer:

A sense of control and power over your body as you are choosing when and how sensations are experienced.

The use of supportive gear such as slings, cuffs and harnesses can double as joint support.

Roleplay and power dynamics that help explore vulnerability or safety in new ways.

Intentionally chosen pain, such as spanking or pressure, for some people, helps shift their body’s focus from chronic, uncontrolled pain (like TENS distracting the nervous system but with a fun consensual twist).

People living with chronic illness or disability are finding new, creative ways to experience intimacy, especially when traditional ideas about sex don’t meet their needs. For many, kinky play offers a way to reclaim a sense of power, pleasure, and self-expression. It can open possibilities for connection and enjoyment when more conventional approaches to sex feel limiting or out of reach.

Communication and trust are still the most important components of intimacy. If you’re exploring kink and pain together:

Start slowly, especially if pain levels change day to day.

Use clear safe words or signals.

Consider working with a kink-aware sex/physio/occupational therapist or educator if you need support navigating the overlap between pleasure and discomfort.

For more on how individuals with chronic pain are exploring BDSM as a means of managing their condition and enhancing intimacy, you can read this article.

Professional Support

When it comes to pain, you must be working with someone who listens and validates all your concerns, including sex.

A pelvic floor physiotherapist can help with pain, tension and musculoskeletal issues.

A sex therapist can help partners navigate fears, grief, and new ways to connect.

A pain specialist can review medications and help optimise pain control.

An occupational therapist can provide strategies and aids to reduce pain and discomfort.

Sex is Still Possible Your Way

Living with chronic pain does change a person’s way of living compared to the societal norm, but it doesn’t end your right to intimacy. With good communication, support and some creativity, many people find new ways to enjoy sex and feel close again.

Every relationship is different. What works for one might not work for another, and that’s okay. Be patient with yourself and each other, slow things down, and celebrate the small wins. The best sex life is the safest and most enjoyable for you.

About the Author

Hi, I’m Bebe, a final-year Physiotherapy student at the University of Brighton with a keen interest in women’s health and pelvic floor physiotherapy. I’m passionate about breaking the stigma around pelvic health and creating space for open, honest conversations, especially about topics like sex, intimacy, and the emotional impact these issues can have. Through this blog, I aim to share insights from my studies and advocate for greater awareness, understanding, and support in this often-overlooked area of healthcare.