ILLNESSES THAT MAY DECREASE SEXUAL DESIRE – PAIN: ELEN AND DAVID’S CASE HISTORY

Like many chronic pain sufferers, Ellen often talks at great length about her discomfort as well as everything she has don to try to relieve it. In fact, most of Ellen and David's first therapy session was devoted to the topic. As Ellen spoke, David's body language alternately conveyed extreme boredom or barely containable fury. He had, he told us, "heard it all a million times."

He loves Ellen, he added emphatically. He has tried to be patient and understanding; but he simply did not know how much longer he could endure a life that revolved around Ellen's back pain.

Ellen was frequently irritable or depressed and exhausted. Responsibility for most of the household chores fell upon David, who often got home from work to find Ellen stretched out on the floor with a heating pad on her back or in bed, where she would remain until she had to get up for work the next morning. Their medicine chest was clogged with miracle pills that had proved to be less than miraculous, and Ellen's trips to doctors and clinics all over the country were beginning to strain the couple's finances. They had not taken a vacation together since the accident and any social plans they made were likely to be canceled at the last minute by Ellen, who "just didn't feel up to them." When Ellen did got out socially, she subtly and sometimes not so subtly let David know about the physical and emotional price she was paying.

Four years after the accident, Ellen was a slave to her pain, David was drained dry of patience and understanding, their relationship was a mess, and, as you might expect, the impact on their sex life had been dramatic. Over the years, they had abstained from sex whenever Ellen was in pain, when her pain medication knocked her out, when one of the many "experts" she consulted advised her not to have sex, and even on numerous occasions when Ellen was not in pain but feared that sexual activity would make her back start hurting again.

Since Ellen rarely felt sexual desire anymore, when she did have sex with David it was out of a sense of guilt or obligation. "I know this situation isn't fair to David," she sighed. "So sometimes I have sex with him even though I don't really feel like it and know I'm going to suffer after it."

"Don't you think I know that?" David responded angrily and directly to his wife. "Don't you think I feel like an insensitive creep the whole time? You can stop playing the mart| Ellen. I won't bother you anymore." He folded his arms across his chest, silently fuming as Ellen began to cry.

David may seem insensitive, but after four years of trying to accommodate every aspect of his life to Ellen's condition, emotional turmoil was as real and debilitating as her physic pain. They came to us asking for advice on how to have sex ; ways that would not cause Ellen more physical discomfort, but it was clear to us that even with a repertoire of new sexu^ techniques, their individual psychological states and the conflict and stress in their relationship was likely to prevent them fro* improving their sex life.

*72\261\8*

Men's Health-Erectile Dysfunction