I saw a patient recently that I have been treating for a few years. He originally sustained a very bad trauma – a gunshot wound to his dominant arm and was in his early 40’s at the time of the incident. His injury was so bad that it required a shoulder replacement as the ball portion of the joint could not be salvaged – it was totally shattered. He had some permanent damage to the bone and muscles around the shoulder which was not totally fixable.
Unfortunately he still has limitations: mostly weakness and pain with lifting beyond 10 or 20 lbs. He also has difficulty supporting his weight on the involved arm. These impairments are likely permanent. And we have talked about this on multiple occasions. Sadly I cannot make everyone 100% better. These are the tough cases. The ones you wish you could help more.
As we talked about limitations and expectations, he mentioned a topic that I don’t hear in my office that often: sex. He was kind of half joking (but it clearly bothered him) that certain positions (missionary in this case) were just uncomfortable and he was frustrated.
I reflected for a bit and thought that he can’t be the only one to have this type of issue. I frequently hear that shoulder pain disrupts patients’ sleep, but rarely does anyone mention that it disrupts their sex life. Maybe it’s embarrassment. Or maybe it’s just that most shoulder pain is treatable and thus temporary, but I just don’t hear it from my patients that often.
I suspect it’s much more prevalent of a problem that we think. And maybe we need to be more sensitive to this aspect of our patients’ lives when we educate them after shoulder injuries and surgery.
I did a quick search on Pub Med – a national database for scientific research and could not find any papers about shoulder pain and how it relates to a change in sexual habits/ health. And I don’t know of any validated shoulder assessment scores that take sex into account.
When I was a resident I remember that patients were given some literature about “safe” sexual positions after hip and knee replacement. With hip replacement especially there was a concern for dislocation of the new hip in the early period after the operation that likely prompted the materials.
I don’t know if any formal work has been done in this area for shoulders. I suspect people have figured it out on their own as they always do. But maybe communicating these issues more effectively among ourselves would lend support – if only moral- to patients who are struggling with sex and shoulder pain.