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 are men. It’s worth to notice 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 car
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 the 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 male with FMS. Sexual dysfunction seems
to present an important problem and must therefore be addressed by the physicians during the
routine evaluations.

2. Female sexual function

For what concerns female patients, fibromyalgia has negative effects on female sexual function that
are aggravated by depression. Reductions in generalized pain, severity of disease, depression and
sleep disorder 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 to
notice that for some women pleasure related to sex as 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 in order 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 about
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.

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