The Intersection of Chronic Illness and Sex
According to the Centers for Disease Control and Prevention, chronic diseases affect 133 million Americans, representing more than 40% of the population of this country. By 2020, that number is projected to be an estimated 157 million, with 81 million having multiple conditions. Chronic illness can have profound negative effects on a relationship and sexual satisfaction. More Americans are living with not just one chronic illness, such as diabetes, heart disease or depression, but with two or more conditions. Almost a third of the population is now living with multiple chronic conditions.
Sexuality in a relationship involves a wide mix of feelings and emotions and when both the individual and their partner are together battling a disease, the future of their intimate lives becomes uncertain and both partners feel that loss. The ill partner feels overwhelmed and shame about the changes in their sexuality. Suffering from a chronic illness may mean not only restricting sex but also experiencing a reduced desire for sex. This can sometimes be the most difficult part of a chronic medical illness. They may feel less attractive, less confident, and concerned about how their body works and adapts to an illness. Both partners can become plagued with anxiety due to the worry around reduced sexual activity, and the changes in desire and arousal caused by the illness and it’s symptoms.
Many chronic diseases can cause problems with sexual function. These conditions can include diabetes, heart and vascular diseases, neurological, and autoimmune diseases. Recent research suggests that sexual dysfunction in couples may be one of the least talked about symptoms of chronic illness. Some of the sexual dysfunctions that are common due to a chronic illness are erectile dysfunction, low desire and arousal, vaginal tightness or dryness, dry orgasms or retrograde ejaculation, and the decrease in orgasmic intensity.
Experiencing a chronic illness can be earth-shattering. Individuals who are chronically ill often experience emotional distress. This includes the person’s ability to engage in occupational, social, and recreational activities. But what is its impact on sex and the couple? Sex can involve a mix of feelings and emotions when battling a chronic illness. Life becomes uncertain and you both feel at a loss. Your partner feels overwhelmed because you feel shame. You may feel less attractive, less confident, and concerned about how your body works and adapts to an illness. You both become plagued with anxiety due to the worry of sexual activity, and with desire and arousal issues.
When experiencing a chronic illness, some changes may be physical, such as the changes with your body, side effects from medication, sexual dysfunction, fatigue, and pain. You may experience psychological changes such as depression and anxiety. Most of all, there is constant fear around your sexual ability and your sexual performance. We all know that physical intimacy is paramount to the quality of life, and it is still important if you are living with a chronic illness.
Your relationship as a couple can affect the development and management of a chronic illness in a variety of ways. When the both of you are at the optimal balance between intimacy and autonomy, your boundaries touch yet remains distinct. It is critical the both of you are aware of each other’s needs and emotions. Why is this so important? Because this will drive and determine the sexual intimacy in your relationship. It is important to note that your previous success in resolving sexual intimacy concerns will determine how well the both of you will cope with an illness.
Since general coping skills and sexual function are linked in the chronically ill, it is important to identify and foster strengths in your relationship that can mitigate the stress of illness. Even during an illness, relationships should not be neglected. Illness can make each partner vulnerable to fear and loss and to loneliness. Taking time to communicate and to reduce the impact of the illness on intimacy is the key to maintaining happiness despite health problems. One part of that intimacy is sexuality. What people don’t know is that with a life restricted by pain and illness, sex can be a powerful source for comfort, pleasure and intimacy. You and your partner can learn what is possible as opposed to what was once achievable by enhancing their sexual awareness, communication, and sexual styles.
Here are my tips:
- Communicate your needs to your partner and have them communicate their needs. Problem solve together by making it a team approach. State your emotional needs around sexual intimacy and the other factors in your relationship.
- Consider couples psychotherapy. I recommend you see a sex therapist. I say this because they will have the knowledge and skill set in helping you and your partner with sexual problems such as the issues related to sexual functioning. They will also provide you with other suggestions to engage in if there is sexual dysfunction (i.e., desire and arousal issues, erectile dysfunction, and sexual pain).
- Read up on your condition and share this with your partner. Having knowledge on the illness can bring you closer together. This can build intimacy!
- Check in with each other. For the partner who does not have a chronic illness, watch for depression in them and keep an eye on their health as well. The goal here is to be lover not a caregiver, but we find at times, the partner may take on this role. They may want to seek individual counseling. This is healthy!
- Acknowledge your loss and build a relationship with the illness. This can help the both of you develop the “new normal” in your relationship. With acceptance, the issue isn’t whether or not you can come to some profound insight about the nature of the illness and your experience with the illness, but rather, it is about how to live your life day to day. The ultimate goal is to accept condition and learn to live well with it. Of course, this is not easy. I watch couples experience this all the time in my practice and when they finally decide to work as a team instead of opponents or avoiders, there is this sense of hope that emerges. This hope promotes what is possible instead of what is achievable. They also report a healthier sex life!
- Address stress as much as possible. I would not avoid the stress. Avoidance can make the pain worse or it cause a flare up. I see this all the time with my clients with fibromyalgia. I know this is easier said than done, but try to address the financial issues and the divisions of family responsibilities. Addressing these stressors can help promote the desire in being physically intimate.
- Try to be sociable. Socially isolating is common for people with a chronic illness. Try to find a balance where you can be sociable because this can make you feel more positive about life.
- Being kind is great. Doing something for your partner can build what is needed for sexual intimacy.
Resources:
Enzlin, P. (2014). Sexuality in the context of chronic illness. In Y. Binik & K. Hall (Eds), Principles and practices of sex therapy (5th ed., pp. 436-456). New York, NY: The Guilford Press.
Schover, L.R., & Jensen, S. B. (1988). Sexuality and chronic illness: A comprehensive approach. New York, NY: The Guilford Press.
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