Fifty married patients who were referred to a pain-management program and their spouses were interviewed independently concerning marital-sexual adjustment. The effect of pain on frequency and quality of sexual activity, and the effect of sexual activity on pain, showed a consistent trend toward deterioration in sexual activity after the onset of pain complaints in both patient and spouse groups. Ratings of overall sexual adjustments and adjustment in marriage were essentially the same for both groups before the onset of pain; but after pain onset a significantly large number of spouses rated their marriage below average, whereas most patients rated it average or above average. For the pain patient and his or her spouse, it seems very important that open and candid communication exist about the constant problem of adjusting to chronic pain, and the spouse should participate in the treatment program.