Physical Illness and your Sexual Life – Sexual Life: Stephen B. Levine, MD
The sexual consequences of illness are not pleasant topics and they are not readily addressed by most mental health professionals or other health providers. In hospital-based contexts, the focus is usually on the individual’s new dependency, self-image, regressed behaviors, and subtle organic cognitive dysfunctions. In ambulatory settings, the focused is usually on the changing roles in the family. Insights about the illness experience have helped with understanding the new worries, emotions, and conflicts of the ill and their potential to revive earlier life struggles.
Sexual function is impaired by 6-separate mechanisms.
1] Pathophysiology of the Disease. When kidney disease reaches end-stage renal insufficiency, the chemical milieu of the entire body changes – often destroying sexual drive and arousal for both sexes. At least 50% of diabetic men at age 50 can no longer depend on their erectile function. Many men with childhood-onset, insulin-dependent Type-I diabetes lose their potency several decades earlier than those with Type-II diabetes. Depending on the location and the extent of the spinal cord lesions, interruption between neural transmission between the brain and the genitals can result in problems with erection, lubrication and orgasm. Sjorgren’s syndrome interferes with lacrimal, salivary and vaginal secretions. The dry vagina that results creates dyspareunia. Chronic alcoholism can lead to alteration in the metabolism of androgen and estrogen, creating testicular atrophy and brain degeneration and interferes with peripheral atrophy and brain degeneration.
2] Effects of Surgery. For men, operations like prostatectomy, colectomy, cystectomy, and aneurysmectomy of the terminal aorta can cause the inability to have an erection. For women, hysterectomy and oophorectomy generally produce no lasting change in sexual function, especially when hormone replacement therapy is provided postoperation.
3] Medication Effects. Most sexual functioning problems come from medication. The drugs that seem to be most harmful are those that impair the sympathetic nervous system through alpha-adrenergic stimulation or beta-adrenergic blockage.A depressed person may develop anorgasmia in response to antidepressants. Women with breast cancer are often given an estrogen receptor blocker, which can create sexually problematic vaginal dryness. Men on some medication for congestive heart failure may lose their drive and potency in response to the lowered testosterone, increased estradiol and increased luteinizing hormones {LH} levels.
4] Radiation. When directed to the pelvis, radiation may impair potency or make vaginal intercourse impossible. When directed to the spinal cord or brain, tissue damage may interfere with neurotransmissions and create sexual drive, arousal and orgasm problems.
5] Patient’s Emotional Reactions to Illness. Serious illness creates new feelings about the self & self-esteem, grief about the loss of capacities, and a new balance of power in the nonsexual relationship. There are changes to life-styles. Some activities are given up. Energy is limited and time management & priorities change.
6] Partner Reactions to Illness. If both partners use avoidance of sex as a means of coping with worries, the couple may simply not resume sex until each is sure nothing adverse will happen. Each partner may use the illness as a face-saving device to retreat from lovemaking.
When sex does not resume after a serious illness, one should consider:
- One’s feelings about the illness causing the sexual avoidance
- A partner’s feelings about the illness causing the sexual avoidance
- If the partner is avoiding having sex because s/he intuitively understands his/her fear and choosing to wait until s/he can male love with more comfort
- If the partner is using the illness to avoid sex for reasons that have nothing to do with the illness per se
Factors that impede sexual recovery from physical illness
- Increasing age
- Poor quality of sexual relationship prior to the illness
- Poor quality of nonsexual relationship prior to the illness
- Lack of a partner
- Medical severity
- Poor disease acceptance
- Concurrent alcohol and substance abuse
