A couple’s relationship can affect the development and management of a chronic illness in a variety of ways. As a psychotherapist who helps couples battle chronic illness, I find that we need more research on how marital status influences the quality of life of the chronically ill. When a couple is the optimal balance between intimacy and autonomy, their boundaries touch yet remains distinct. The couple must be aware of each other’s needs and emotions. Why is this so important? Because this will drive and determine the sexual intimacy in their relationship. It is important to note that a couple’s previous success in resolving sexual intimacy concerns will determine how well they cope with an illness.
Since general coping skills and sexual function are linked in the chronically ill, clinicians treating sexual problems should identify and foster strengths in the relationship that can mitigate the stress of illness. Even during an illness, relationships should not be neglected. Illness can make each partner vulnerable to fear and loss and to loneliness. Taking time to communicate and to reduce the impact of the illness on intimacy is the key to maintaining happiness despite health problems. One part of that intimacy is sexuality. A couple’s unspoken agreements can help or hurt them as they undergo the stress of illness.
The skills that shape the couple’s relationship such as allocating roles, respecting boundaries, communicating effectively, and agreeing on relationship rules, can promote a healthy sex life. Part of my work as a psychotherapist includes helping couples with allocating sexual roles. Many couples give all responsibility for initiating sex to one partner. This is not always the case with all couples, but it becomes a problem when one partner becomes ill. I had a couple where the husband was diagnosed with Chromic Obtructive Pulmonary Disease (COPD). His illness became so bad that he had to retire from his job. He kept busy in the house, but reported he was depressed. He and his wife failed to discuss this change and they started to become more isolated. Soon enough, the husband developed erectile dysfunction. During sex he often lost his breath and then he lost his erection. As time went on, the wife reported that her husband would come to bed later to avoid her. He was ashamed and she never asked for sex because he always initiated it. She then feared that sex would be a demand and she was afraid her husband would feel more incapable than he already did. I eventually helped the couple overcome this by helping them allocate their sex roles. She finally got to the point where she was comfortable to intiate sex and this even helped with his erectile dysfinction. They were able to learn to live well with the illness and reclaim their sex life. Their sexual communication improved.
When confronted by an illness, couples must reexamine their sexual communication and sexual rules. They need to take a less performance-oriented attitude towards sex, exploring new ways of pleasuring each other. Playfulness can ease tension and each partner can focus on their partner’s attractive points rather than striving to match perfection.