Quite a few injured workers mention their lost libido or inability to perform and similar concerns. They want to blame it on their back, but it is rare for a back injury to directly create such problems. There are likely several things occurring in such cases, and, yes, I routinely hear this complaint.
First of all, the obvious problem is that back pain (and, indeed, most injury pain) makes it difficult to engage in pleasurable activities, even intimate ones. Pain is a terrible distraction, and for males, it can be a terminal event in that sense.
Secondly, finding a comfortable position may be extremely difficult, and if this is a very conventional individual, there may only be one position that is under consideration, and that one simply hurts too bad. Thirdly, ED is a side effect of many medications.
Additionally, and of critical importance, is lost libido. A person who is depressed will have changes in basic biological drives such as hunger, sleep and desire. They often withdraw and simply want to be left alone. This results in the most critical aspect, the feeling, expectancy and fear that as a consequence of lack of interest and/or lack of capacity, the patient’s spouse will find someone else to meet those needs. Most often this is simply an irrational fear, born of insecurity and helplessness.
But trust me, this is not always the case. The worst fear of the injured worker with regard to infidelity is often realized. The spouse has become restless, perhaps never was that deeply invested, is resentful of their financial setback and has tired of being part of this injury. Finding someone else to meet specific needs is not terribly difficult. Perhaps worse than having the concern for infidelity is having that fear confirmed.
Equally difficult is the cycle that arises; pain -> inability to perform -> fear of future or permanent ED -> self-medication -> recurring inability to perform.”