Illness and Sex

A reader recently posted this as a comment to my article on What Do You Do When Illness Makes Sex Impossible.  I am reposting it here because I think his situation is a common one, that often stays hidden because it is fraught with emotions and complications.  I'm also posting my response as a comment.  I encourage you to share your stories and approaches to the challenge of sex and illness.

Anonymous said...

I am a 66 year old male and married to a 62 year old women. We have been married almost 20 years. We had a sex life that was a few times a month until she got sick 7 years ago. She had cervical cancer. Went thru chemo and radiation, and a hysterectomy. Then cancer returned and about 5 years ago she had a 9 and a half hour surgery that took everything including her bladder. She voids her urine from her side , and has an ostomy bag. Needless to say normal intercourse is not possible. And other things really aren't either. She uses a wheelchair and Walker to get around . Her sexual interest is 0 and require a good bit of care which I do.
I have reached a point where I am considering looking for a lover. It's not that I don't love my wife but I still have a need for intimacy .
Do you have any advice or suggestions?

To Be (Intimate) or Not to Be (Intimate)

As Hamlet said about a quarter of the way into his famous soliloquy"  "...'tis a consummation devoutly to be wish'd..."

Hamlet was talking about death.  That's not the consummation I have on my mind.  I am thinking about physical intimacy with one's partner.  Many couples think that the switch that controls intimacy lives in the genitals and is binary - either on or off, either intercourse or watching a late night TV comedy show.

That switch actually lives in the brain, with hundreds of thousands of outposts permeating the skin.  The brain is the key sexual organ.  It takes its cues from the body, but ultimately the brain decides how much physical contact it wants and when it wants it.

For many couples living with illness, sexual intimacy is problematic.  They physicality of the act may not be possible, may cause pain, or may require activity that is just not on a radar screen already overflowing with medications, side effects, exhaustion, and anxiety.

However, sex is also a bridge.  A way of bypassing practical and emotional turbulence and surrendering to the flow of the physical.  An escape.  A way of connecting and feeling greater than you are separately - beyond the reach of what Hamlet calls the "mortal coil."  Indeed, a consummation devoutly to be wish'd.

So what do you do when illness interferes with physical intimacy, but the yearning for the passion and liberation of sexual connection is still active.  

Of course you wonder -- how can couples be intimate without touching?  The solution lies in using the brain as the sexual organ it is.

Your brain can make anything into something else.  Just close your eyes and imagine a perfect lemon. See the textured skin and the bright yellow color.  Smell the fresh lemony fragrance.  Now imagine biting into it.  Most people, as they imagine the bite, pucker their mouths at the imagined tart flavor.  If we can do all this by putting our minds to a lemon, think what we can do if we just imagine playing sensually with our partner and a sponge or a pile of clean laundry.

Both partners, through the words they use with each other and the sensuousness they can bring to everyday activities, can use their brain to create the feeling of the bedroom anywhere, any time.

Here are some ideas:

1)  You can really look at each other.  You can spend more than .05 seconds glancing at each other's face.  Linger on the the face.  Notice the contours, the textures.  Imagine you are touching through eye contact.  This can be a powerful catalyst to intimacy.

2) You can use language to show that you truly see each other.  In addition to saying, "I love you," you can say, "You are beautiful to me," or "It makes me smile to see you smile."  Use words to convey that you are "home" to each other.  There is no script.  Don't assume that your partner knows what's in your heart.  Speak it out loud.

Of course there are not only loving sentiments in your heart.  You may be carrying anger, fear, and despair.  If you can, put those feelings in a separate compartment, temporarily.  Dig down to wherever you shelter your love and compassion for your partner.  Give voice to that.  There will be other times to discuss the hard stuff.

3)  Coping with the demands of illness can be exhausting and demanding -- both states are antithetical to relaxing and connecting.  Playing together can counterbalance that tension and can lead to emotional intimacy.  Partners can convert the mundane into a playful event.  Loading the dishwasher or cooking together or wandering the aisles of Costco can be a chore, or it can be a time of silliness and connection.  Imagine how children would behave if engaged in any of these activities.  The dishwasher is a puzzle to put together.  Cooking is mud play.  Wandering the aisles of Costco is finding Neverland.  Try not to focus on accomplishing, but rather on enjoying - the activity and each other.

One woman I interviewed for our book said that one of the biggest brain turn-ons she had occurred when her husband was in intensive care after having had open heart surgery.  She was laying on the couch in his hospital room suffering her own pain flares and trying to quell them with an ice pack.  She said to him, "I feel so useless.  I wish there were more I could do for you."  He responded, "Just having you here helps me breath easier."   She said that this was a truly intimate connection, even more intimate than some of their physical love-making.

For some people brain intimacy can be enough, or can be all their physical condition will permit.  For others, brain intimacy can be the runway for physical contact.  In future posts I hope to explore how couples can be physically intimate when illness prevents intercourse.

How do you and your partner "do" intimacy when illness interferes with physical love-making?  How do you use your brain to be intimate with your partner?

Sex and Coping in Older Age

Excerpt from the Washington Post:

A GOOD SEX LIFE CAN HELP OLDER COUPLES COPE WITH ILLNESS AND OTHER DIFFICULTIES, by Kathleen Raven


"Among older couples, physical illnesses can strain a marriage, but maintaining a healthy sex life could make a difference in how happily both partners cope, a new study suggests.

Researchers have long known that the illnesses that come with age are linked to poorer marriage quality, but exactly why has not been clear. According to the new analysis, sexual intimacy is the link that keeps partners positive about their marriages in the face of difficult times, and a lack of sex makes matters worse."
 --------------------------------------------------------------------

Yes, but......

What if illness interferes with your physical ability to have sex?  And the medications you take flatten your libido into non-existence?  And let's not forget that the well partner's sexual-ness may be very different than the ill partner's sexual-readiness.

So what can a couple already coping with illness do to heighten their sexual connection?

Before touching, talk.  Tell each other what you want and don't want.  And if you've started touching, continue to tell each other what feels good and what doesn't.  The power of the sexual connection won't work if one partner is enjoying it while the other is faking it.

Don't assume that sex = intercourse.  It may; and it may not. Closeness and arousal can happen without penetration.  Sometimes touching and talking can be powerful sexual connectors.

Start with small steps.  Try stroking the back or legs or arms or face before moving onto the more traditional erogenous zones.

Keep talking.

Here's a giant dilemma.  What if nothing is possible and the well partner is still interested in being sexually active?  Once again, keep talking.  Perhaps the well partner can find contentment in a life without sex.  Perhaps the ill partner can touch the well partner, even if he/she isn't interested in receiving any form of sexual contact.  And, perhaps the couple can make peace with the well partner having just sex with someone else.

There is no one size-fits all solution for how to maintain a sexual connection with each other.

But no matter what, keep talking.

How have you managed (or not) to have a sexual connection in your relationship?

Loving After Cancer

Excerpts from an article in the Jerusalem Post about a subject that rarely gets addressed. The whole article is worth reading.

The article refers to the work of two clinicians: Prof. Sharon Bober, a clinical and research psychologist at Harvard Medical School’s Dana-Farber Cancer Institute and Dr. Rivka Klein, a Jerusalem-based clinical social worker and sex therapist who received her PhD in social work at the Hebrew University

How to bring the loving back after cancer

By JUDY SIEGEL-ITZKOVICH

It’s unfortunately an “unmentionable” subject that even makes many physicians blush – and many others avoid raising the subject at all. But as growing numbers of cancer survivors want to resume intimate relations with their partners, raising awareness of the problem and offering clinical help need to be put on the agenda.

... Returning to one’s previous level of intimacy can often be a problem, because surgery, chemotherapy, radiotherapy and hormonal medications may cause a lot of long-term side effects that interfere with sex.”

Sexuality, she says, is an experience at the junction of mind, body and relationship, and cancer treatment can affect all of those elements. From the first session, she tells patients that sexual dysfunction deserves as much attention as any other quality-of-life issue; that the problems should not cause embarrassment or shame; and that there are treatments that really work.

Cancer treatment may result in heart damage, kidney problems and disruptions of both male and female sexual function.

Men can become impotent, while women who had ovarian cancer can be propelled into early menopause. Other types of cancer can also have side effects.

....the example of one 38-year-old woman who suddenly lost her ovaries to cancer. “She hadn’t been told about what would come next in her life. She wasn’t ready for it. Her doctors told her she should be happy to be alive. But she and her partner suffered from her hot flashes, vaginal dryness, fatigue, dramatic loss of estrogen and lack of libido. She was depressed.”

Usually, either the patient is ashamed to raise the issue or afraid to embarrass their doctor – or the physician doesn’t know enough to raise it or afraid to embarrass the patient.”

The longer patients wait to undergo rehabilitation of their sexual functions, the harder it is to preserve.

“There are a lot of people who specialize in sexual medicine, but only a small subset who work with cardiac and cancer survivors and medical illness. Even younger cardiologists and oncologists may feel no obligation to talk about sexual function with their patients or don’t like to discuss it themselves. We have studied primary care doctors, many of whom weren’t prepared for broaching the subject.”

But “patients usually need psychological treatment, an integrative mind/body model. Women who have had a mastectomy, for example, usually feel very unattractive.

“It would be great if not only doctors were educated and willing to discuss these issues, but patients were also willing to hear about them,” they conclude. “There is no reason why people have to suffer in silence. They have suffered enough already."

What Do You Do When Illness Makes Sex Impossible?

What do you do when your partner is no longer interested in or capable of sexual intimacy with you?

Illness takes many tolls, on both partners. One of them is too often sexual intimacy. Medications, pain, and exhaustion can not only turn a libido off, but it can also make intercourse painful for the ill partner. The well partner may be just too drained after a long day of caretaking, working, caring for the kids, and running the household to want anything more intimate than falling asleep side-by-side. And the shift illness produces in some partner relationship -- turning a bond of equals into one of caretaker - patient -- can make sex feel like a taboo.

For some couples, their sexual connection had always been a source of joy that filtered into the rest of the relationship, making it glow. For other couples, sex was routine and its effects remained in the bedroom. For others, sex was never a strong part of the connection.

Whatever your pre-illness sexual habits were, illness too often disturbs them. Intercourse may no longer be possible. Even touching can be problematic. Some couples whose sexual experiences were mainly physical, now find they actually have to talk about what feels good and what doesn't.

Through talking about sex, couples may find themselves entering surprisingly deeper levels of connection, and describing desires that before illness were invisible.

Some couples find ways of being intimate without intercourse. Some are able to stay connected without any form of physical intimacy. Some break apart. Some partners seek sex outside of the relationship, with or without the knowledge of their partner. (note: for the sake of safety and integrity, I would recommend that this be discussed between the partners).

I'm interested in hearing about your situation. Has your sexual relationship changed? How have you managed to deal with illness and physical intimacy?