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Causes of sexual problems:
Although the physical disease may not affect sexual function directly, it can have a profound psychological influence due to anxiety, and altered body image and self esteem.
Acute illness: the primary concern is survival and recovery, but once the crisis is over, there may be anxiety about sexual function. You should ask your doctor about the possible effects on sexual function, and whether they are temporary or not, to prevent performance anxiety from resulting in a sexual dysfunction. If the condition requires that you stop or reduce sexual activity for a while- say after a heart attack- you should continue caressing and hugging, and ask when and how you can safely resume making love and having intercourse.
Chronic illness: disability, injury and some surgical procedures may affect your occupation, as well as the emotional and physical aspects of your relationship. The effects can be minor or devastating, and depend on your condition, age and personality of and those of your partner. Anxiety and depression which often accompany serious illness also affect sexual response, and may result in little or no sexual contact at the time when it would be most healing.
Physical causes:
Altered body image: depends on the deformities, and their effect on attractiveness [for example after mastectomy or amputation]. You are still the same person with the same values even if your outward appearance has changed, and it is important to believe in yourself.
Disease: diabetes, limitation of movement, loss of sensation, weakness, muscle spasms or incontinence can affect sexual function.
Pain: may be chronic and aggravated by movement, and medication for pain may impair sexual response.
Drugs: sedatives, anti-depressant and anti-hypertensive medications may impair sexual reponses. Discuss this with your doctor, as timing of taking the medicines or a different type may make the difference.
Psychological causes: are associated with reduced self-esteem and body image, and feelings of uselessness or helplessness.
General: bitterness, depression, withdrawal, guilt (particularly if the accident was "avoidable") are anti-erotic. You will need to discuss these feelings with your therapist, and also with your partner and children.
Social: loss of independence, job and economic stability may result in changes in traditional roles and responsibilities in the home. Changes in family lifestyle may occur as a result of social isolation due to physical limitations or negative peer attitudes. Try to ensure that your friends as well as your children’s friends are made to feel welcome, and arrange outings that you and your family enjoy together.
Sexual: physical diseases [like spinal cord injury] affect men more dramatically than women, as sexual adjustment is easier for women as it is usually possible to have intercourse, and fertility is rarely affected. Some women find it difficult to initiate sexual encounters or use the 'woman above' position if this was not practiced prior to the illness. Many men like to take the initiative and to assume the 'man above' position, and this may become impossible due to the disability, and lead to avoidance of sexual activity.
Relationship: ill health can put a great strain on a relationship and create awkwardness or even a crisis. The injured or ill partner [the patient] may feel inadequate, and possibly resist the idea of having sex, while the partner may fear making demands or causing pain. The effects depend on both partners understanding about sexual responses, their previous sexual function and expectations, as well as on their acceptance of sensual expressions other than intercourse, on communication skills, and the ability of both partners to take the pressure off performance, and adjust to the changes. Relationships need sexual interactions, and stopping lovemaking may signify letting go of the partner, or preparing to die. For many, making love conveys being human and alive.
Sexual performance is less important than giving and receiving physical pleasure and emotional closeness.
You are both going through a period of adjustment and need to allow time, as a change in sexual function is a real loss and feelings have to be allowed to run their course.- ask questions and get informed about the progress of the disease and possibilities of sexual activities for both of you.
Marriages: appear to have a higher chance of stability than among able-bodied people if the individual is disabled prior to marrying. However, when the disability occurs after marriage there is a much greater chance of breakup [1]. Companionship, affection and physical intimacy may be sufficient for some, while for others intercourse and orgasm are essential. If it is unstable, the relationship may be unable to withstand the restriction and sacrifices imposed by the disease or disability.
Some couples are brought closer through illness, but others are separated by it.
