anonymous on September 12, 2011

My husband’s ankylosing spondylitis sometimes makes orgasms extremely painful for him. What can we do to enjoy sex?

My husband is 43, and he has ankylosing spondylitis. While our sex life is good, sometimes his orgasms cause him severe pain in his groin area, which can make him ill (diarrhea, vomiting, back pain, etc.) for days. This makes it difficult for either one of us at times to enjoy sex because he/we never know what the end result will be. As long as he stays active, the pain stays minimal but the sex is always a surprise as to whether or not it's painful. I want to help him so we can really enjoy sex, not be punished because of it. Can you help?

answered by Mitchell Tepper, PhD, MPH on September 12, 2011

Thanks so much for your question. I can imagine that the unknowns in your situation are both frustrating and nerve-wracking. I’ll do my best to offer a few tips that may help, but every case ofankylosing spondylitis is unique…so I also encourage your husband to share his body’s intermittent reaction to orgasms with a specialist.

As you know, ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine. People with AS often experience back pain and sometimes the spine fuses. About 50% of people with AS experience joint pain in other areas of the body, too, which may also affect your husband’s sexual enjoyment.

An AS specialist may be able to identify the right treatment to lessen your husband’s pain with orgasm. Typically, a doctor will do a physical exam ⎼ taking note of pain points ⎼ in addition to discussing a patient’s experience with pain levels associated with particular movements (in this case, orgasms). From there, the doctor can hopefully determine a helpful treatment.

What are some possible treatments for AS? Non-steroidal anti-inflammatory drugs (like ibuprofen) can be helpful for up to 80% of people with AS, according to a study by researchers at theCharité Medical University in Germany. Many othertreatments for AS exist, as well. Finding the right treatment of combination of remedies for your husband may take a little time, but will hopefully pay off in the long run…during sex and otherwise.

As you mentioned, exercise and staying active are also an integral part of AS management. If your husband doesn’t already have a physical therapist who can help him, England’sNational Ankylosing Spondylitis Societyprovides some useful exercise tips.

Some other ways to manage AS in relation to sex? Your husbandmay find that twisting and bending “warm-up” exercises can help his back and other muscles relax before sex. Giving him a massage on his buttocks as part of foreplay may also help keep his muscles from spasming. Lastly, your husband can train himself to have non-ejaculatory orgasms. There are mechanical techniques available or more alternative, energetic ways experienced through the practice of Tantra, which you can learn together.

Thanks again for writing, and I hope that your husband soon finds an answer to his discomfort so that you may resume your sex life without fear of his possible pain and illness afterward.

Related info:

Mitchell Tepper, PhD, MPH

Dr. Tepper directs sexual health education at An AASECT-certified sexuality educator and counselor, his areas of expertise include sexual dysfunctions, sexuality following disability or illness, pleasure and orgasm, relationships, and military and veteran couples' counseling. Dr. Tepper was educated at the University of Pennsylvania and Yale University.

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