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 an estimated 157 million, with 81 million having multiple conditions. Many chronic diseases can cause problems with sexual function. These conditions can include diabetes, heart and vascular diseases, neurological and autoimmune diseases. Hormonal imbalances can also impact sexual functioning.
Individuals and couples who are affected by illness often feel at a loss and fear they will not be able to enjoy the pleasure they did in the past. They may not have the same desire and arousal as they did prior to a diagnosis. Couples often tell me they are lost. Couples often reach this point of isolation, hopelessness, and rejection before finding a sex therapist. What it boils down to is that sex is still possible when a person is diagnosed with a chronic illness, and it can still be an important part of their life. Sex therapists can help the couple or individual with sexual adjustment. Sexual adjustment refers to self-perceived sexual health, which is a state of biological and psychosocial well-being in relation to sexuality that goes beyond the absence of disease.
In this blog, I am going to focus on the management of female sexual dysfunction. I am finding in the research for my book that when a woman is diagnosed with a chronic illness, she may assume she can no longer be sexual in a “normal” or “proper” way. She is at risk for being desexualized and devalued by the culture at large, and then by herself to the extent that her identity is tied into her body image and approval by others. Our culture tends to overvalue spontaneity and undervalue planning.
For women with chronic illness, the following are some of the issues that a sex therapist may need to address to help a woman make a satisfactory sexual adjustment:
· Timing of sexual activity in regard to energy levels or around medical procedures: It is helpful for the woman or couple plan sensual or sexual activity when energy and opportunity for pleasure are optimal. I have several female clients with chronic fatigue syndrome and when they have somewhat of an energy level, I recommend this is a great time for sex. This also works for many women with Postural Orthostatic Tachycardia Syndrome (POTS) and Fibromyalgia.
· Attention to the creation of a warm, romantic, comfortable, and private environment: The couple can create an environment by using music, candles, soft lighting, and by consuming fluids and snacks to maintain energy.
· Stimulation for arousal and lubrication: The woman may find vibrators and other sex toys useful for stimulation. Massage can be a great way to arouse, relax, and increase awareness and flexibility.
· Expansion of the sexual repertoire: The repertoire may include oral techniques, tantra breathing and eye contact meditation, the display of skills in self-pleasuring and many more. Individuals and couples who suffer from chronic illness have found tantra to be beneficial when faced with sexual dysfunction. The goal of tantric sex is to allow us to experience more breadth in our sexuality. The goal is to not necessarily orgasm, but rather an enriching of the whole sexual experience.
· The practice of tantric sex requires a shift away from thinking about the body as the most important part of who we are. Without the focus on orgasm, tantra’s goal becomes increased awareness, leading to greater understanding of ourselves, which eventually leads to enlightenment. There is no pressure “to get over the top”. This is paramount for people that suffer from sexual dysfunction because one of the causes of sexual dysfunction is the pressure that goes into performing. I always tell couples in therapy there are other ways to receive pleasure.
To help a woman with chronic illness and her partner to make a “sexual recovery” it is critical for a sex therapist to appreciate the loss from their perspective, but then go on to challenge the couple to accept life on its own terms.
