Chronically Ill? Your Sex Life Need Not Be Over

After working through the "hard to believe, hard to understand and hard to accept" aspects of a chronic illness diagnosis, and having faced and answered the questions and worries you had when initially given the news about the illness, questions about managing and controlling your sexuality may arise.

Chronic diseases are long lasting and cannot be cured, but they can be controlled and managed. Seeing as control and management of a chronic disease feature a great deal in the maintenance of active sexual functions, you are obviously at the center of this process and the one person who determines your future health and sexuality.

However, let me reassure you, regardless of the level of advancement of your chronic illness: Your sex life is not over. You are, and always will be, a sexual being. Chronic illnesses obviously impact each person differently, and usually vary in advancement according to the person's attention to and control of the three modifiable risk factors for a chronic disease. These modifiable risk factors include an unhealthy diet, physical inactivity and tobacco use.

Sexual dysfunctions are prevalent within the U.S., with 43 percent of women and 31 percent of men who experience sexual symptoms that cause great distress, and sexual dysfunctions and sexual disorders are increased in people with a chronic illness. Chronic illnesses include diabetes, hypertension, renal failure, stroke, heart disease, cancer, AIDS, multiple sclerosis, obesity, spinal cord injury and intellectual, physical and developmental disabilities, among others. Let me emphasize that chronic illnesses vary a great deal in the way they demonstrate their impact on sexuality. Some sexual dysfunctions may take some time to happen, and some may not happen at all, so please do not assume that you are going to be impacted sexually overnight.

It's impossible to describe every chronic illness with its associated sexual conditions, interventions and specific levels of severity. Consequently, let's look at chronic diseases and sexuality from three different points along a timeline that includes some descriptions of signs and symptoms of both the chronic disease and the potential sexual issues that might develop. Here are three potential representations of the chronic illness and some of their potential associated sexual issues:

Person or Partner With a Chronic Illness Who Is Independent and Without Symptoms That Compromise Health

-- Depending upon your control of the modifiable risk factors for chronic illness, your sexuality (with or without a partner) may continue unchanged or lessen.

-- You will continue to enjoy sexual activities, especially intercourse, and may need more penile or clitoral stimulation.

-- Prior sexual rituals may assume a different format, with a little more preparation time needed.

-- Addition of some variety of location, time and activities often helpful.

-- Use of soft music, props, pillows, lotions, oils, candles and other creative activities is helpful.

-- Use romantic videos before soft-core pornography, and before hard-core pornography videos when using for first time.

-- Medications for erectile dysfunction (Cialis, Levitra, Viagra) in men, and Flibanserin for low sexual desire in women on an as needed basis.

-- Open communication about sex is essential between you and your partner. Sex therapy probably not needed.

-- Continue treatment and risk factor prevention for chronic illness.

Person or Partner With a Chronic Illness Who Is Moderately Dependent, With Some Symptoms That Compromise Health

-- If you and your partner have the sexual desire, but chronic illness symptoms require a change or modification to your usual coital positions, do not select one of the exotic positions depicted in sex magazines. Instead, adopt positions that provide comfort and support, minimize pressure and do not tire you out too quickly. A physiotherapist can suggest positioning that is best for you both, and how to maintain with position pillows.

-- If you are not able to maintain a body position of comfort, discuss the use of oral sex with your partner. If this is new sexual activity between you both or outside your value system, a sex counselor or pastor would be very helpful to facilitate discussion.

-- There are many sexual assistive devices that are available at reasonable prices to enhance the sexual experience for both partners, such as sex toys, lubricants, clitoral stimulants and devices.

-- If easily fatigued, work a little differently; perhaps become less intercourse-oriented and become more proficient in the use of the soft, gentle touch of Sensate Focus. Its emphasis is on lubricated, moisturized touch and stimulation of all of the senses, and its temporary ban of intercourse can be very satisfying, comforting and soothing, together with promotion of intimacy.

-- If you have other chronic disease symptoms, such as nausea, vomiting, depression, anxiety and pain, medications will alleviate such symptoms and facilitate a symptom-free sexual experience.

-- Counseling approaches include couple therapy (counseling about any couple or sexual problems), cognitive behavioral therapy (changing adverse learned behaviors), sex therapy and bibliotherapy (reading therapy).

-- Open communication between both partners is absolutely essential, especially if difficulties are experienced. Sex therapy or social worker intervention are also helpful.

-- Continue treatment and risk factor prevention for chronic illness.

Person or Partner With a Chronic Illness Who Is Almost Completely Dependent, With Many Symptoms That Compromise Health

-- There may be no interest, a little or some interest in sexuality as we usually view it, but sexuality of this couple at this stage is usually expressed differently. There is a strong, reciprocal demonstration of love between partners, with visible expressions of love, intimacy and tenderness, as well as touch, comfort, warmth and communication, especially among two people who understand and accept that one person is very ill.

-- Reduced desire and libido may occur in the person with a severe chronic illness as a result of tiredness, stress, anxiety, depression, and mood; extreme fatigue is especially severe with cancer.

-- According to Macmillan Cancer Support in the U.K.: "Sexual problems are the most common long-term consequences of cancer."

-- The person with a severe chronic illness may be confused, which in turn may cause a hostile attitude toward the partner, an inability to recognize the partner and communication problems like verbal abuse.

-- Nursing staff and other health care providers are experienced in management of the above issues.

While management and control of sexual problems in individuals with a chronic illness have never been easy processes, great progress has been made over the past 20 years in the fields of sexology, sex therapy, pharmaceuticals, psychology, psychiatry, support devices and medical equipment to improve upon past sexual outcomes. Obviously, the degree of success achieved depends upon the advancement of the chronic illness, management and control of all risk factors, and the response of the person to the therapeutic interventions used.