Intimacy with a chronic illness
Published 2 Jun 2020 • By Léa Blaszczynski
Sexual dysfunction is estimated to be 2 to 6 times more frequent in patients with chronic illness or disability. Diabetes, cancers, cardiovascular diseases, psychiatric disorders, kidney failure, neurodegenerative diseases, respiratory ailments... These pathologies all have a strong impact on sexual and emotional life.
What are the most common dysfunctions? How can we talk about them? What are the treatment options?
When chronic illness strikes, every aspect of daily life is turned upside down. Sex life is not left untouched, in fact it is quite the contrary!
The dysfunction may have an organic or physical origin caused by the illness. For example, erectile dysfunction is three to four times more common in people with diabetes. Nearly 50% of men with chronic kidney failure also complain of erectile dysfunction, while a greater proportion of women and men with uraemia experience a noticeable decrease in libido and frequency of sexual intercourse.
According to a study on sexuality of people with various chronic conditions, sexuality is a problem for 27%:
- Dyspareunia (pain during intercourse) for 18%
- Low libido: 42% in women and 26% in men
- Anorgasmia (inability to achieve orgasm) for 40%
- Erectile dysfunction (inability to achieve or maintain an erection) for 23%.
- Premature ejaculation for 41%
Certain physical symptoms of the disease can also make sexual activity impossible. This may be the case with breathing difficulties, paralysis or, more simply, fatigue or pain. Some medications, such as antidepressants or psychotropic agents, can also cause a sexual disorder as a side effect. .
Consulting a sexologist
Chronic illness can change the way a person looks at themselves: loss of self-confidence, weight gain, depression, anxiety, etc. A patient's mental state can deteriorate, making the very notion of intimacy complicated. .
Moreover, sexuality can be a great source of anxiety for a patient affected by a chronic sexually transmitted infection (HIV/AIDS, Hepatitis B and C, etc.). However, apart from the compulsory use of male or female condoms, there is no reason why a patient should not have a fulfilling sex life.
Sexuality is still a taboo subject that is still deeply rooted in patients' lives. Patients should not hesitate to discuss it with their medical team in order to find a solution. Hospital services and associations also offer specialised consultations with a sexologist. This is a chance to take stock of one's sexuality and the difficulties encountered and to benefit from therapeutic care. Certain disorders such as erectile dysfunction, premature ejaculation or vaginal dryness can be treated. Erectile dysfunction is, for example, treated with tablets (SILDENAFIL), injections or gel (VITAROS) into the urethra. Vaginal dryness can easily be improved with a water-based lubricant or with hyaluronic acid.
Benefitting from psychological support
Consulting a sexologist or a specialized psychologist is equally important to obtain relevant information in order to open one's horizons: not limiting oneself to penetration, discovering the range of sexual activities, using specialised objects and products. The sexologist can thus propose alternatives or advise to adapt certain positions according to the difficulties and/or pains. Of course, communication is essential between the couple. Each must be able to express their feelings to the other to avoid any frustration and to be able to discover a new form of sexuality together.
In addition to discussion groups often proposed by patient associations, the Carenity forums can be full of resources for these sometimes delicate issues. "Reading your testimonials did me a lot of good," wrote one of our members. "I thought I had a problem with frigidity, even though at the beginning of our relationship everything was fine with my husband. At that time I had only a few flare-ups a year and no chronic pain like now. I lost my libido when I increased my painkillers but I think it's mostly due to the pain and the mobility issues..." Feel free to browse through your group discussions or open a new topic by clicking here.
Living with low libido
First of all, not having sexual intercourse has no consequences on the body, explains Dr. Catherine Solano, sexologist. And that does not mean the absence of a sex life. Every night when we sleep, the body has involuntary and unconscious sexual activity.
Illness can, of course, affect sexuality. Certain conditions that affect female anatomy can have a "harsher" impact on a patient's libido, says Audrey Le Merer, psychologist and psychotherapist. This can be the case for breast cancer (with or without mastectomy) or endometriosis. It is important to help these patients find the right psychological support.
"Depression also often inhibits a person's sexuality because there is often no desire at all," explains Dr. Solano. Antidepressant drugs reduce desire but also lubrication in women and erection in men as well. It is important to understand that this condition is related to the disease and not necessarily to the relationship, and you should not hesitate to talk to a doctor about it.
The absence of sexual intercourse may well be possible for couples as long as desire is fulfilled elsewhere and there is no suffering related to this absence within the relationship.
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Allô Docteurs, Peut-on vivre sans sexualité ? diffusée sur France 5