In the course of a couple’s lifecycle, medical conditions, chronic illnesses or diseases can become a reality for one or both partners. While medical practitioners offer guidance and treatment for the purpose of improving health and quality of life, questions regarding the effect of illness, medications and other treatments on sexual health and functioning often remain unaddressed.

The reasons for this are many, and include the fact that patients and their partners may be too embarrassed to ask about sex, or aren’t sure that their practitioners are equipped to address these matters. Some physicians fail to ask about sexuality out of awkwardness, fear of embarrassing their patients, lack of knowledge in addressing the issues and lack of awareness about their importance. Furthermore, they may perceive that when faced with a diagnosis of an illness that may be life threatening or altering, people are far more concerned with matters of life or death, rather than sex and intimacy.

In fact, many couples do cease sexual activity due to stress, exhaustion and illness, internalizing the message that they should just “be lucky to be alive.” However, studies indicate when faced with their mortality, people often cling to the desire to continue sexual activity as an affirmation of life. It is a way to feel normal when so much of life has changed.

Engaging sexually with one’s partner, even when confronting disease or disability, is a way to continue to feel alive and vital.

There are many barriers to sexual intimacy on physical, psychological and relational levels, when dealing with illness. Common feelings for the patient include anxiety, depression, frustration and anger. The experience of being ill, including undergoing painful and embarrassing procedures and treatments, may feel depersonalizing, and can affect feelings towards one’s self and body. After being poked and prodded, any kind of additional touch may feel uncomfortable or invasive. Patients may suffer from negative body image due to weight gain or loss, scarring, or the removal of a body part or limb. This may be particularly true in cases of alteration or removal of parts associated directly with sexuality, such as breasts, uterus, ovaries, testicles or prostate. Illness may involve discharges, catheters and decreased control over bodily functions, which could be a source of embarrassment and vulnerability.

Partners also may struggle with anxiety over the prospect of disability or death. They often become the caretaker and experience their own ambivalence about sex, whether feeling guilty for wanting to engage in sex, or for not feeling as attracted to their partner as they once felt.

On a physical level, many factors related both to the illness or disability and to the treatment might affect sexual functioning. Fatigue, pain, stiffness and decreased mobility; side effects of medications, radiation and chemotherapy, such as nausea, dry mouth and vaginal dryness or atrophy; lack of arousal or erectile dysfunction, all can affect sex. The illness or its treatment may affect blood flow, hormonal balance, nerve functioning, skin sensation or any of the other various systems of the body, thus impacting on sexual functioning.

The best predictor of sexual satisfaction during and after illness is a satisfactory sexual relationship prior to illness. When both partners are motivated to continue to engage together in sexual activity, then communication, planning, the flexibility to try new and different activities and an open mind about ways to feel pleasure, as well as a sense of humor are all helpful.

Sexual health is part of overall health and well being. Therefore, healthy eating, pain management, energy conservation including stress reduction and mindfulness, getting plenty of rest, and general and pelvic floor exercise, will all be helpful in improving sexual functioning.

Whether partners continue to engage in sexual intercourse, or limit their sexual activity to non-demand touch, or simply cuddling, it is important that both partners feel able to connect, not out of guilt or sense of duty, but mutual desire to continue and affirm love and devotion to one another, even in this challenging time.

Questions should be raised about sexual health and functioning with one’s physician and information and resources should be offered that can be helpful this meaningful part of life. Mental health professionals working with clients and their partners facing disease or illness should be able to guide couples in this meaningful and vital area of intimate life.

Health professionals, counselors and therapists wishing to increase their knowledge and improve their skills in addressing intimacy and sexuality with their clients, are invited to download the Intimacy Bundle webinars