Harvard Women's Health Watch

Don’t accept a diminished sex life as a “side effect” of illness

Living with a chronic condition or as a survivor of cancer or a heart attack needn't take a toll on intimate relationships.

diminished sex life
Strategically timing when you take pain medication can make sex more comfortable.
Image: Jack Hollingsworth/Thinkstock

Sexual satisfaction is an important part of well-being, yet women who have been successfully treated for cancer or are living with chronic conditions often accept a diminished sex life as a trade-off for being alive. "Women with cancer go through surgery, chemotherapy, and radiation in order to be alive, but once they're through treatment they may not feel as though they are really living to the fullest," says Dr. Sharon Bober, a psychologist at Harvard-affiliated Dana-Farber Cancer Institute. Women with cardiovascular disease, diabetes, and arthritis may also feel that their health issues have eroded their intimate relationships.

Sexual problems aren't topics people are comfortable discussing, Dr. Bober says. Moreover, doctors and other providers may not bring up such issues because they lack a plan for addressing them. While counseling can be helpful, not everyone needs a consultation from an expert. The websites of several organizations, including the American Cancer Society (www.cancer.org ), the American College of Rheumatology (www.rheumatology.org ), the American Diabetes Association (www.diabetes.org ), and the American Heart Association (www.heart.org), have good information on sexual health.

Common issues

The sexual issues associated with chronic illness are often difficult to tease apart from those related to menopause and aging because both tend to occur in middle age and later. The factors that contribute to a loss of interest in sex or decline of intimacy between partners might include flagging libido or pain during intercourse, The following may also contribute to loss of intimacy:

Fatigue. It's natural to tire more easily when you are in pain or healing. Set aside time with your partner when your energy is likely to be at its peak.

Altered self-image. Illness can change the way you see yourself in terms of your physical appearance, your sexuality, and your wholeness as a person. Support groups and psychotherapy can help you develop a more accepting attitude toward yourself.

Lack of communication. Women have to be their own advocates with their health care providers and their partners. Work with your health care team to find medications and physical therapy and with your partner to explore new approaches that can make lovemaking easier. If your partner is also having difficulty adapting, you may want to explore couples therapy. "Be willing to say, 'It's not the way it used to be. It's really bothering me, and I'd like to work on a way to make things better,'" Dr. Bober says.

Tips for specific issues

If you have one of the following conditions, these suggestions may help:

If you're a cancer survivor. Cytotoxic (cell-killing) chemotherapy for a host of cancers and hormonal therapies for breast, ovarian, and uterine cancers can result in a sudden drop in estrogen levels that exacerbates the classic symptoms of menopause, including vaginal dryness and loss of tone and elasticity in pelvic floor tissues. "There is help for all these symptoms, particularly to improve vaginal health," Dr. Bober says. Although vaginal estrogen creams may not be advised for some cancer survivors, longer-lasting moisturizing gels containing polycarbophil (Replens) and a hyaluronic acid derivative (Hyalo Gyn) are effective in replacing natural vaginal secretions, while water-based lubricants like Astroglide and K-Y Jelly can ease penetration. If sex is still painful, pelvic floor therapy, which often involves gentle stretching exercises, can renew vaginal elasticity and increase vaginal capacity.

If you have cardiovascular disease. If you've had a heart attack or stroke, it's important to talk to your doctor about when it's safe to resume sexual activity. It's also essential to enroll in—and complete—a cardiovascular rehabilitation program. Although some forms of systemic hormone therapy can increase the risk of heart attack and stroke, vaginal estrogen creams are generally safe for women with cardiovascular disease.

If you have diabetes. High blood glucose levels make women with diabetes more susceptible to vaginal yeast infections and can heighten menopausal symptoms such as vaginal dryness, mood changes, fatigue and hot flashes. Talk to your health care team about ways to control your blood sugar.

If you have arthritis. Taking pain medication about 30 minutes before sex can help you get the greatest relief from joint pain. A warm shower or bath or using a warm pack, heating pad, or electric blanket can also help ease stiffness. Try using pillows or blankets to cushion your joints during sex.