The Healing Value of Sex
By David Spero, BSN., RN. , reprinted with permission
Once, while working as a telephone nurse advisor, I spoke with an elderly man who wanted a medication refill. He was taking a number of drugs for advanced cancer, chronic pain, and heart disease, but he didn't need those. He wanted more yohimbe, a West African herbal aphrodisiac.
Another time, a woman in the Intensive Care Unit was lapsing in and out of a coma. Every time she woke up she asked to be given one of her birth control pills. When asked why, she said, "I plan to get out of here some day, and I want to be ready." Stories like these illustrate two points: the importance of sex, and the excessive degree to which our society equates sex with erection and penetration. But anyone watching the stock of Pfizer, the company that makes Viagra, already knew these things.
Sex can be a wonderful reason to keep going when everything else seems bleak. It can be a way of connecting with someone we love, of giving our bodies attention, of relaxing, even of mild exercise. It's good for fatigue and excellent for pain relief. And there really is no disability that makes sex impossible, if we define sex not as intercourse, but as physical contact for the purpose of sharing intimacy and pleasure.
People with chronic illness sometimes forget about sex or give up on it. In many chronic illnesses, about 50% of women and 75% of men experience some kind of sexual problems. We might lack energy and want to save our limited strength for other things. We may have discomfort, loss of sensation, or unpleasant feelings in our genitals or other parts of our body, discouraging thoughts of sex. Men may not be able to get erections; women may lose the ability to become lubricated and relaxed. Bowel and bladder problems can be a major turn-off. Legs or arms that don't work well or go into spasm can make sex less enjoyable and more laborious.
Psychological factors can also block our sexuality. We may feel unattractive or undeserving of pleasure. Feelings such as depression, worry, and anxiety may limit our interest in sex, while partners may fear that sexual activity will worsen our condition.
We can and should overcome most of these problems. Yes, sex does require some effort, but sexual desire is also Nature's most powerful source of energy, one that can reduce your fatigue for days. Pleasure derived from sex can raise your quality of life, and improved quality of life has been shown to slow the course of illness. Sex also strengthens your connection with your partner and gives you a chance to forget about illness for a while, real blessings for many of us. We learn that our bodies can still be sources of pleasure, not only of frustration.
Overcoming Barriers to Sex
But how do we enjoy the benefits of sex when illness (and other things) get in the way? How do we overcome the fears, the fatigue, the frustrations and discomforts and really enjoy our bodies? First, we have to open our minds.
Dr. Randall Schapiro says, "Healthy sexuality involves mutuality, warmth, tenderness, and lovenot just genital contact!" Stroking, kissing, looking, holding, talking sexythese can all give the pleasure of sex without requiring intercourse. The body is full of sensitive places most of us never find, because we don't look. By exploring the body for responsive areas, even quadriplegics can often enjoy good sex lives. So people with less devastating conditions definitely can find pleasure.
Dr. Schapiro says, "Learning how your body works, and finding alternative methods and choices regarding sex helps you remain in control of your sexuality." Take your time. Explore. Don't feel pressured. Foot rubs, neck rubs, holding hands, and hugging should feel like safe ways to start enjoying physical pleasure. Popular books might give you some activities to try and ways to get aroused. A sex therapist, occupational therapist or other health professional may have some good ideas. Various forms of masturbation can also produce arousal and provide pleasure, especially for those of us without partners.
Some counselors say the key to enjoying sex, with or without disability, is to relax. Let whatever happens happen. It's not a competition or a performance; it's a chance to connect with our bodies and our partners.
Obviously, couples' finding better ways of pleasuring each other depends on communication skills. Psychologist Fredrick Foley says, "If, for example, a man's illness has resulted in his depending on his partner to help him with bathing or toileting, he may not feel like an attractive, sexual adult. His partner may have difficulty making the transition from caregiver to lover." Dr. Foley advocates honest communication as a way of resolving theses issues. Talking about sex can feel threatening or uncomfortable, but we have to be willing to tell our partners what feels good and what doesn't. We may also need to talk about feelings, to reassure ourselves that we are still desirable and desire each other. We may have to experiment with different positions, strokes, or equipment to find what works for us, and we have to share what we find with our partners.
Medical Treatment and Practical Tips
For erection problems, many doctors will prescribe Viagra (sildenafil), which is quite effective in many chronic conditions. Some women have found that Viagra raises their sexual interest, too. There are herbs and folk remedies you can try. Also, be aware that medications such as antispasmodics and some antidepressants can decrease sexual desire and response. Depression may also be a major part of low sex drive. It is worth being evaluated for depression, and treated if necessary. While it's normal to feel down about chronic illness, depression causes problems of its own and is fully treatable.
Like any other symptom, we need flexibility and coping skills to adapt to sexual changes. Sexologist Dr. Sandar Gardos suggests planning sex early in the morning to avoid fatigue problems; using side-lying positions instead of climbing on each other; and using vibrators when sensitivity is affected. If bladder or bowel incontinence is a problem, remember to empty the bladder and/or bowel before lovemaking. Catheters can be taped out of the way. (Women can tape catheters on their abdomens; men should double the catheter back along the penis and tape it, which might actually increase stimulation).
Feeling attractive - Attracting others
When we are sick or disabled, or consider ourselves disfigured, it is sometimes hard to imagine ourselves attractive even to a longtime lover, much less to someone new. But most people struggle with feeling unattractive anyway, no matter the state of their health or the condition of their body. Your partner probably considers you much more attractive than you do. Some couples benefit from counseling to help them deal with sexual relationship changes, communication problems and other stresses caused by illness.
If we don't have a partner we often feel we will never find a good one, especially when we have health problems. We fear the pain of rejection, so we don't make ourselves available. It may take time to build confidence to where we can envision finding someone. You will probably be amazed, however, to discover how many good potential partners are out there, even with illness or disability. Of course, we have to get involved in social situations to let them find us, but other people can often see the good qualities you can't see in yourself. One mixed blessing is that some people are looking for someone to take care of. Support groups or volunteer organizations are good places to meet people. Ninety percent of finding someone is making yourself available.
Sex is a valuable part of life and health, a sacred gift we shouldn't throw away if we can avoid it. Try some new approaches; get some help, talk things over with your partner. Sex with a chronic condition may be different, but it can still be good.
© Copyright 2003, David Spero.
David Spero is a nurse, health educator, and journalist. He was diagnosed with progressive multiple sclerosis in 1989. This article is adapted from his book, The Art of Getting Well: a Five-Step Plan for Maximizing Health When You Have a Chronic Illness* (Hunter House, 2002). He writes regularly for Diabetes Self-Management, Arthritis Self-Management, and MS Focus magazines. Read more about David's book, classes, and health coaching practice at www.davidsperorn.com
*NOTE: By clicking on the title and buying this book from Amazon.com, you help support LPO.