'ReConnect': a model for working with persistent pain patients on improving sexual relationships

Role of sexuality in women with chronic pain: Results from an Italian cross-sectional study on chronic headache, fibromyalgia, and vulvodynia

Background/objectives

To compare sexual functioning, genital pain, and satisfaction among women diagnosed with various Chronic pain (CP) conditions. Additionally, it seeks to explore the role of sexual factors in predicting levels of central sensitization (indicative of CP-related mental and physical distress), physical, and mental quality of life (QoL) for each condition individually.

Methods

From April 2023 to January 2024, 1006 women categorized into five groups (Chronic Headache - CH; Fibromyalgia - FM, Vulvodynia - VU, Comorbidity group - CO, and Healthy Controls - HC) completed an online protocol.

Results

All groups reported sexual impairment: VU group exhibited the highest genital pain prevalence (97.93 %), followed by CO (74.29 %) and FM (55.91 %). ANCOVAs indicated lower sexual functioning scores for FM, VU, and CO compared to HC and CH. VU and CO reported lower satisfaction scores than other groups. Genital pain emerged as the primary predictor of central sensitization across all groups except controls. Regarding mental QoL, sexual satisfaction was significant for CH and CO, while genital pain and sexual satisfaction were significant for VU.

Conclusion

This study emphasizes the importance of integrating genito-pelvic pain assessment and addressing related sexual difficulties in CP diagnostics and care to enhance overall well-being and QoL.

Hard Flaccid Syndrome: A Biopsychosocial Management Approach with Emphasis on Pain Management, Exercise Therapy and Education

Hard flaccid syndrome (HFS) is a rather rare, acquired clinical entity affecting young men's well-being, sexual and social life. HFS presents with a cluster of symptoms including penile-specific somatosensory disturbances, a semi-rigid penis at the flaccid state without any stimulation or desire, erectile dysfunction, perineal and/or penile pain, associated urinary symptoms, emotional distress as well as other psychosocial and stress-related manifestations. Although its pathophysiology is still not well understood, initial penile trauma causing minor nerve and vascular disturbances to the penis and associated pelvic floor musculature is suggested to trigger the syndrome. Despite the scarcity of research on HFS, the present report describes a case of a young male clinically diagnosed with HFS, who benefited from a biopsychosocial management strategy, focusing on pain management, therapeutic exercise approaches, such as pelvic floor exercise re-education, graded exposure to activity as well as education on lifestyle and stress-related modifications. This holistic management approach has been clinically reasoned in this case report, and the need for more evidence-based studies developing diagnosing criteria, elaborating pathophysiological mechanisms and testing the efficiency of different therapeutic options is highlighted.

Interdisciplinary pain rehabilitation and sexual functioning: Treatment outcomes and patient preferences

BACKGROUND/OBJECTIVE

Sexual dysfunction is common for patients experiencing chronic pain. Prior research is limited on how treatment for chronic pain affects patients' sexual functioning. This study reports pre-/post-treatment measures of self-reported sexual functioning among individuals presenting for chronic pain treatment at an interdisciplinary pain rehabilitation program (IPRP) and reports patient treatment preferences.

METHOD

This study uses detailed treatment measures across multiple domains of sexual functioning to describe the prevalence and correlates of self-reported sexual functioning among individuals with chronic pain presenting for and discharging from treatment at an IPRP (N = 71). Domains include sexual interest, satisfaction with sexual functioning, vaginal lubrication, vaginal discomfort, and erectile function. Patients also completed a multiple-choice treatment preferences questionnaire created for this study.

RESULTS

Results from this study show a high prevalence of sexual dysfunction in chronic pain populations (51.5%) and show no significant difference in sexual functioning after completing outpatient treatment, except for a significant improvement in sexual satisfaction for males only. Results from the patient treatment preferences questionnaire indicate that most patients (83.3%) thought their pain was important to address within the context of an IPRP; however, many patients (58.7%) did not think their treatment addressed sexual functioning. In addition, many patients (34%) would prefer to discuss sexual functioning with their primary care provider or pelvic floor physical therapist.

CONCLUSION

Findings demonstrate that usual multidisciplinary pain management treatment is not sufficient to address patients' concerns with sexual functioning. Additional creative strategies will need to be studied on how to best treat these overlapping problems. Implications and future research directions are discussed.

Sexual Difficulties in the Population with Musculoskeletal Chronic Pain: A Systematic Review

OBJECTIVE

To review the current literature on the nature and prevalence of sexual difficulties in the population with chronic musculoskeletal pain, as well as to identify the biopsychosocial factors that maintain these difficulties.

DESIGN

Systematic review.

METHODS

Studies were found by using multiple electronic databases and examining reference lists. After application of inclusion and exclusion criteria, 10 studies were eligible for review. Data were extracted and characteristics were described for outcomes of interest (i.e., sexual dysfunction, pain condition, pain intensity, psychosocial factors, gender differences). Cochrane Risk of Bias was assessed for all included studies.

RESULTS

Ten studies (2,941 participants) were included in the review. Musculoskeletal conditions included low back pain and fibromyalgia. All studies examining sexual functioning found evidence of sexual difficulty among patients with chronic pain. Three studies demonstrated that sexual dysfunction was significantly greater in patients than in healthy matched controls. Nine studies found that greater pain levels significantly correlated with greater sexual dysfunction. Eight studies noted an increased prevalence of sexual difficulties in those with comorbid psychological problems. Heterogeneity between studies was identified, particularly with regard to gender outcomes. The risk-of-bias assessment also highlighted limitations in approximately half of studies.

CONCLUSIONS

This review reiterates the importance of investigating sexual functioning in the chronic musculoskeletal pain population, given the high prevalence of chronic musculoskeletal pain across all age bands. Given methodological limitations, future research should develop measures that sensitively cater to the various needs of patients with chronic pain. By modifying assessment to include biopsychosocial concerns, practitioners can tailor treatment to address transdiagnostic factors that maintain sexual dysfunction.