Sometimes pain is the direct cause of sexual problems. You simply hurt too much or feel too tired for sex. If your pain is so severe that sex seems out of the question, talk to your doctor. You may need different or stronger pain-control medication.

On the flip side, pain medication can sometimes cause sexual problems. Some medicines diminish sex drive (libido) or inhibit sexual function by causing changes in your nervous system. Drugs also may affect blood flow and hormones — two important factors in sexual response.

Chronic pain can also drive an emotional wedge between you and your partner so that neither of you desires the other very much. Or, if pain has left you unemployed and unable to contribute to housework, your self-esteem could be so battered that you feel unattractive and undesirable to your partner. Awareness that your physical and emotional distance is hurting your partner may add to your anxiety, fear, guilt and resentment.

Sometimes underlying difficulties in your relationship come to the surface when you have a medical problem. If this happens, you may need to explore these previously hidden conflicts with your partner. Counseling may help.