context: If you have fibromyalgia, you may also face challenges in your sex life. You could be experiencing loss of libido or having difficulty with sexual performance. It's also possible your libido is healthy, but the deep muscle pain and stiffness of fibromyalgia keep you from enjoying sex the way you used to. It's not unusual for people with any chronic illness to complain about having problems with their sex life. But a healthy sex life is important for many reasons. Not only does sex strengthen an intimate relationship, but sexual activity boosts endorphins. Those are the body's natural opioids that help decrease pain and increase well-being. Talking openly with your doctor and following a few practical tips can help you resolve problems associated with fibromyalgia, pain, and sex. Then you can begin to enjoy this aspect of your life again. Some of the medications used in the treatment of fibromyalgia, such as duloxetine ( Cymbalta) and milnacipran ( Savella), as well as SSRI antidepressants like paroxetine ( Paxil) and sertraline ( Zoloft), may cause reduced sex drive. If you take medication for fibromyalgia and have problems with libido, talk to your doctor. A simple change of medication or a reduction in dose may improve your sex drive and allow you to enjoy your relationships more. But don't stop or make any changes to your medicines unless your doctor tells you to. Also, for some patients, having to deal with the uncomfortable symptoms of fibromyalgia, including the ongoing pain, fatigue, anxiety, and stiffness, is difficult enough without thinking of being physically active with sexual activity. Learning to self-manage these symptoms with medications, exercise, and lifestyle habits may help to boost your sex life. Some fibromyalgia patients give up romantic aspirations for fear of further injury and pain. Yet being intimate with your partner is still possible. With fibromyalgia pain and tender points, you need to work with your partner to find the most comfortable position during sexual intercourse. For instance, if you have fibromyalgia with low back pain, you may find that having your partner on top or lying on his or her side is most comfortable for you. Or, if you're a woman who has fibromyalgia and hip pain, you might use a pillow to stabilize your body during sexual intercourse. Just because you've "always had sex this way," does not mean that's the only way. You need to be patient, take it slowly, and find the best sexual positions that allow you to be intimate without causing further pain. Keep in mind, there is not just one right way to be intimate with your partner. Moist heat, including soaking in a warm bath, can help ease fibromyalgia pain and may allow you to enjoy sex -- or any exercise -- without added pain. Heat increases blood flow to the site and decreases stiffness, a key symptom of fibromyalgia. Regular moist heat applications or warm baths may help temporarily to alleviate muscle pain or tender point pain, reduce muscle spasms, and decrease inflammation. When using moist heat, make sure it is not too warm or you can burn your skin. You might soak in a warm bath for at least 15 minutes before sex or other physical activity to get the full benefit. You may also soak in a warm bath after sexual intercourse or other physical activity. Other popular types of moist heat include a warm shower (sit on a chair, if needed), warm whirlpool or hot tub, heated swimming pool, and a moist heating pad. Stress may trigger fibromyalgia symptoms. Yet managing stress may help control your symptoms and balance your daily life, which can boost your libido. Stress management may include a combination of exercises, relaxation techniques (deep breathing or meditation exercises), a good sleep routine, and proper nutrition. Exercise releases endorphins, which are the body's natural stress-fighting hormones, so any type of physical exercise is a good stress-control measure. Relaxation therapies such as deep abdominal breathing, visualization or guided imagery, and meditation are also helpful in managing stress. If you have fibromyalgia, talk to your doctor and see if medications can boost libido and/or sexual performance. Improving your overall health by treating any other medical problems may also help.