• drleephillips

Chronic Illness and Sexual Desire

Updated: Mar 30

In my practice, I work with many of couples where one partner has a higher sexual desire and the other partner has a lower sexual desire. This is actually a very common scenario in relationships; in fact, it has been found that up to 80% of couples regularly experience situations where one partner wants to have sex and the other doesn’t (Day, Muise, Joel, & Impett, 2015).


When one of those partners has a chronic illness in addition, the desire discrepancy can become even wider. There are a number of aspects of chronic illness that can directly affect libido, including depression over the diagnosis, side effects of medications, a changing body image, and the stress of managing the illness. Either partner can be affected. For example, medication side effects and body image could lower the libido of the partner with the chronic illness, but depression and stress over the diagnosis of their loved one can also easily cause diminished sexual desire in the healthy partner.


Sexual Desire Discrepancy (SDD) can certainly cause tension within a relationship. SDD can lead to frustration and confusion about how often a couple should be having sex, what sex should look like, and how high a priority sex should be within their relationship. Often the partner with the higher libido feels guilt and shame over how often they want sex, and can also interpret their partner’s lower sexual desire as rejection, leading to feelings of frustration and low self-esteem. Meanwhile, the partner with the lower sexual desire can often feel like their partners only want them for sex, and that all of their other great qualities and the qualities of the relationship are overlooked. They can interpret their partner’s higher desire as pressure to have sex, which can lead to an even more diminished libido.


While desire discrepancy can be stressful within a relationship, there are ways to approach sex that can help both partners feel more sexually compatible and satisfied.


Empathy and Communication


Before anything about a couple’s actual sex life can be changed, each partner must see the other as a teammate and not the problem. The most important thing to remember is that there is nothing wrong with either person in the relationship. Instead, there is just an imbalance that can be addressed through communication and exploration. It is important to listen to one another’s needs with empathy and use this understanding to find solutions that work for both partners.


Since the higher-desire partner can be prone to feelings of rejection, it’s helpful for the lower-desire partner to communicate that they’re attracted to their partner but are just not in the mood so their partner doesn’t think they’re rejecting them. And because the partner with lower desire can often feel like they’re only appreciated for sex, it’s important for the higher-desire partner to make a conscious effort to acknowledge their partner’s non-sexual qualities as well.


Expand the Definition of Sex


Over time, couples can develop assumptions about what sex should look like. They can begin to believe that sex has to include intercourse and must result in orgasm, or it somehow “doesn’t count.” But this belief can be limiting for couples, especially when one or both partners may not be up for intercourse but still want to be physically intimate with their partner. Sex can - and should - include so much more than intercourse. I regularly recommend that my clients experiment with explorative touch, erotic play dates, and toys. This can be immensely helpful for couples with sexual desire discrepancy, as both partners have options that may appeal to them even if one of them isn’t up for intercourse.


Couples can also expand their definition of when, where, and how sex can take place. Maybe the partner with lower desire tends to be in the mood more often in the morning, so the couple can work with that. Perhaps planning sex and building up to it throughout the day with sexy texts is just the thing to set the mood. It’s important to be open to creativity and experimentation.


Pleasure, Not Performance


Along with the narrow definition of sex that couples can develop over time is the idea that the goal of sex is orgasm. This belief can be frustrating for both partners if one of them has difficulty reaching orgasm, whether from medication side effects, stress, or any other impacts of a chronic illness. The partner with lower desire may not want to engage in sex at all because they know they are unlikely to achieve orgasm, and the higher-desire partner may feel like they’ve failed if their partner doesn’t climax.


Pleasure-based sex means dropping expectations of what sex should look and feel like. With this approach, couples can enjoy the process of sex: touching, kissing, massaging, experimenting with props or toys, or anything that feels good. Orgasm is a bonus, not a requirement. With the pressure to climax taken away, both partners can relax and enjoy each other, which leads to a far more pleasurable experience of sex.


Desire discrepancy can absolutely be worked through with some communication, experimentation, and a shift in expectations. A willingness to be flexible and practice these behaviors can lead to a more pleasurable and satisfying relationship, both in and out of the bedroom.


References


Day, L. C., Muise, A., Joel, S., & Impett, E. A. (2015). To do it or not to do it? How communally motivated people navigate sexual interdependence dilemmas. Personality and Social Psychology Bulletin, 41(6), 791–804.

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