How illness reaches into intimacy
Henry Ford Health, a Michigan health system, notes that a chronic illness diagnosis can turn your world upside down, and that grief, fear, loss, anger and frustration are common. Sex may not be a priority at first, while you are learning to manage the condition, but it usually becomes important again.
Henry Ford Health describes sexual difficulties with chronic illness as coming from three directions: symptoms of the disease itself, side effects of treatment, and the psychological response to living with an illness. It lists several common experiences:
- Anxiety about how your partner feels about you
- Lower libido
- Feeling less attractive, desirable or confident
- Worry that sex may cause pain
- Concern about how your body works or moves
Depression and anxiety are common too, Henry Ford Health adds, and both can lower desire on their own. In most couples the physical and emotional threads are tangled together, which is why both medical and emotional support can matter.
Chronic pain
The National Institute on Aging (NIA) notes that pain can interfere with intimacy and also cause tiredness and exhaustion, leaving little energy or interest in sex. Some pain medicines affect sexual function as well, so it is worth telling your provider about side effects rather than quietly living with them.
The International Society for Sexual Medicine (ISSM) notes that any type of chronic pain can affect sexual functioning, and that pelvic pain can be especially damaging because it affects the pelvic floor. A pelvic floor that is too tense, whether from a pelvic floor disorder, anxiety or ongoing pain, can make sex itself painful. Fear of pain and pain itself can then feed each other.
Because treatment depends on the cause, the ISSM stresses getting a proper diagnosis first. It lists pelvic floor physical therapy, medications, psychotherapy, or a combination as options, and notes that couples therapy or sex therapy may help partners with relationship problems related to pelvic pain. Pain During Sex covers this in more depth.
Two common examples: diabetes and heart disease
Diabetes
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that high blood glucose can damage blood vessels and nerves, which can lead to sexual problems. It reports that more than half of men with diabetes will get erectile dysfunction, and that women with diabetes may have low desire and response, vaginal dryness and painful sex. It also notes that feeling tired, depressed or anxious with diabetes can lower interest in sex, and that sexual problems may be a sign that diabetes care needs adjusting. Keeping blood glucose in your target range, it notes, is an important way to prevent the nerve and blood vessel damage behind many of these problems, so your diabetes care team is a natural first stop.
Heart disease
The ISSM notes that poor cardiovascular health is linked with more sexual dysfunction in both men and women, and that stress and anxiety contribute to both heart disease and sexual problems. After a heart attack, the NIA notes, people and their partners may fear that sex will cause another one. It says sexual activity is generally safe, but to follow your own doctor's advice about when and how to resume.
When a partner is also a caregiver
Illness often changes roles. When one partner helps with medications, appointments or physical care, it can be hard for either person to switch back into being lovers. The person who is ill may feel like a patient rather than a partner. The healthy partner may hold back for fear of causing pain or seeming demanding. Each can mistake the other's caution for lost interest.
Naming this pattern out loud can take some of its power away. It can also help to keep some time together that has nothing to do with the illness, so the relationship is not only about managing a condition.
Some couples also find it useful to talk about the losses directly: the spontaneity that is gone, the plans that changed, the version of each other they miss. Grief that is shared tends to bring people closer, while grief that each partner carries privately can quietly widen the distance between them.
Finding a new normal together
Henry Ford Health encourages people with chronic illness to find their "new normal", while recognizing that what is normal can change from day to day. It suggests being willing to experiment with new ways to share intimacy, and talking openly with your partner about what is working, what is not, what feels good and what does not. Discussing fears and concerns, it notes, may make physical intimacy easier. Some practical ideas:
- Plan around energy and pain: the NIA notes that rest, warm baths, and changing the position or timing of sexual activity can help with arthritis pain.
- Talk about worries before you are in the moment, not during it.
- Agree on a simple way to pause or change course without it feeling like rejection.
- Keep everyday affection going on hard days, when sex is not on the table.
Non-Sexual Touch and Affection explains why that kind of closeness matters so much when sex is limited.
Where therapy fits
A psychologist cannot treat the illness or the pain, but can help with what comes with them: grief for the life and body you had, anxiety about sex, low mood, and the strain illness puts on a relationship. Dr. Lehmann's work on intimacy and sexual concerns focuses on that emotional and relationship side and works alongside your medical care. These concerns can be part of individual or couples therapy; ask Dr. Lehmann which format fits your situation when you call.