Health-Related Sex Issues

oldercouple.bedroomHealth-Related Sex Issues

Sometimes sexual problems can be a result of a physical condition. Natural processes such as aging and menopause often bring changes in sexual feelings and our body’s ability to respond to sexual stimulation. Disease and disability as well as surgery and other medical treatments can also affect sexual functioning, as can dealing with a diagnosis of a sexually transmitted disease (STI) or fertility problems.

Often, sexual problems due to physical conditions are complicated by other factors such as stress over sexual performance, loss of self-confidence or relationship issues. These can make it challenging to return to one’s previous sex life or adapt one’s style of lovemaking to the changes the physical condition has brought on. Meanwhile, doctors often don’t have the time or expertise to assist their patients in their sexual recovery process.

Your sex life doesn’t have to be over when aging or medical problems occur. Your needs for physical intimacy and closeness have not changed and sexual health is an important component to well-being for everyone.

As your therapist, we will explore your needs and concerns, and identify ways you can overcome the barriers to remaining sexually active.

Here are some of the health-related reasons why clients seek my services.

Sexual issues due to aging

Normal aging brings physical changes that can affect our ability to have and enjoy sex. As we age, our body’s ability to respond to sexual stimulation slows down and this can bring the following changes.

For men:

  • Your erections are more difficult to achieve or they’re not as rigid as before.
  • It takes you longer to ejaculate and your orgasms may also feel less intense and pleasurable than before.
  • You now have to wait longer between erections, whether you ejaculate or not.
  • You may feel confused about your body and have lost confidence in your sexual abilities.

For women:

  • You may feel less interested in sex, especially since you reached menopause.
  • You may be experiencing difficulties lubricating during sex and this may make sex painful at times.
  • You might have also noticed that it’s become more difficult for you to reach orgasm.
  • As you notice changes in you physical appearance due to age, you may also feel differently about how you look and this is affecting your ability to focus on sexual sensations and enjoy sex.

Sexual Issues due to illness

Serious illness can take a toll not only on physical and emotional well-being but on your sexual health too. Diseases affecting directly or indirectly your sexual feelings or functioning can disrupt you and your partner’s sex life. Sex therapy can help you get through the difficult period and return to the sex life you once enjoyed.

Below are some health problems that can cause sexual dysfunction.

  • Diabetes can cause erectile dysfunction or ejaculatory problems (retrograde ejaculation) in some men.
  • Arthritis can make physical contact or certain sexual positions painful.
  • Heart disease, high blood pressure or atherosclerosis affects blood flow and can lead to problems with erection.
  • Incontinence due to aging affects more women than men and may make them avoid sex for fear of leaking urine and being embarassed.
  • Conditions affecting the penis such as Peyronie’s disease or phimosis may cause pain during erection and make intercourse difficult.

Sexual issues due to physical disabilities

People with physical disabilities are sexual beings with sexual thoughts and feelings like anyone else.

Depending on the nature of your disability, your sexuality may be affected by: lack of sensation, muscle fatigue, inability to achieve or maintain and erection, inability or difficulty ejaculating, lack of vaginal lubrication, urinary or bowel incontinence, body image issues due to deformity or amputation and more. Other considerations such as being in a wheel chair or catheter use can also complicate sex.

Meanwhile, assumptions about people living with disabilities as being non-sexual combined with stereotypical images of sexual activity shown in popular media can make it challenging for people with disabilities to feel comfortable talking about their concerns and get the help they need to be sexually active.

As your therapist, I will treat you like any other client who is looking to improve their sex life by offering you and your partner the support and guidance you need as you explore different ways to enjoy intimacy.

Sexual problems due to medical treatments

Sometimes, what restores global health will negatively impact sexual health. While sex might not be your first concern after having lifesaving medical treatments, the desire to return to a normal lifestyle which includes sexual intimacy will most likely resurface as you recover.

Some of you may experience difficulties in becoming sexually active again after medical procedures or treatments due to changes in sexual functioning. For others, it’s the psychological and emotional side effects of treatments that are making it hard to enjoy physical intimacy again. And partners might also be worried about how to express their love physically after treatment.

Sex therapy can help you overcome the barriers to your wanting and enjoying sexual intimacy again once you’ve recovered from treatments and are ready to become sexually active again.

Here are examples of how some medical treatments can impact sexuality.

Breast cancer treatments

Changes in appearance due to surgery (mastectomy) can affect a woman’s feelings of attractiveness and cause worry about becoming sexually active again. Also, chemotherapy can change hormone levels and negatively affect sex drive and functioning (vaginal lubrication).

Prostate cancer treatments

Prostatectomy, radiation, brachytherapy and hormone treatments can cause sexual side effects such as erectile dysfunction or decreased sex drive.

Treatments of gynecological diseases

An oophorectomy (surgical removal of one or both ovaries) as treatment for diseases like ovarian cancer or endometriosis, or to prevent certain cancers, can cause decreased sex drive and difficulties with sexual arousal and lubrication.

Treatments for diseases of the digestive or urinary systems

Some will experience sexual problems after ostomy surgery (colostomy, ileostomy, urostomy). Fear and worry about attractiveness, pouch leakage or performance may make it difficult to want and enjoy sex again.

Sexual functioning affected by medication

In addition to the sexual impact of medical treatments and procedures, certain medications can affect sexual desire and functioning. For example, some medications for depression, high blood pressure or cardiac disease are known to have sexual side effects.

While some medications decrease sex drive, others may increase the level of stimulation that is required for you to feel aroused (erection or vaginal lubrication) or to reach orgasm.

In some cases, your doctor may be able to reduce the dosage or change your medication to one that has less sexual side effects. If not, you may need to adapt your lovemaking in order to remain sexual functional and satisfied.

Sometimes, the problem persists after you’ve stopped taking the medication. Having had repeated experiences of “sexual failure” while on the medication may have created performance anxiety.

In either case, sex therapy can help you address these issues and continue to enjoy sex despite your taking medication.

Sexual issues due to gynecological issues

Medical conditions affecting the vulva or vagina that cause pain and discomfort during sex will likely affect sexual desire and functioning. Some conditions are unfortunately chronic and recurrent. Unless properly managed, these conditions can generate feelings of hopelessness and frustration in the women and couples living with them.

An approach combining sex therapy and pain management will help you identify factors contributing to sexual pain and develop coping skills to manage pain and adapt lovemaking to stay sexually active and fulfilled.

Here are some of the gynecological conditions I help women and couples deal with.

Provoked vestibulodynia (formally known as vulvar vestibulitis)

The vestibule is the area where the vulva meets the vagina. Women who suffer from this condition experience a hypersensitivity to light touch to the vestibule which can make penetrative sex painful.

Lichen sclerosus

A disease that affects the genital skin of women (and rarely of men) that may eventually cause scarring or atrophy of the vulva or vaginal entrance making it difficult or painful to have sex.

Endometriosis

This condition occurs when tissue from the lining of the uterus grows outside of the uterus on other organs such as the ovaries, the bladder or the fallopian tubes. Chronic pelvic pain is often a symptom of endometriosis which can make sex uncomfortable and painful.

Issues surrounding the use of sex-aiding products

Sex aiding products such as erection enhancing drugs (Viagra, Cialis, Levitra), penile injections and suppositories or mechanical aids such as vacuum pump devices, rings and vibrating devices can take some getting used to. Learning how to integrate these drugs or devices into lovemaking can be challenging.

Some hate having to plan for sex and find using them makes sex feels mechanical or unnatural. The use of erection-aiding products can also make sexual partners feel left out or undesirable.

Meanwhile, such products might fix the physical aspect of the sexual issue but won’t address the potential harm that’s been done to the individual or couple who has been struggling with sexual dysfunction.

Sex therapy can help you recover from the effects sexual dysfunction has had on you and your sexual relationship and find ways to incorporate the product into your sex life so that lovemaking is still feels natural and sexy.

Problems related to sexually transmitted infections (STIs)

Receiving diagnosis of an STI is upsetting for most people and can bring up a whole range of emotions. But learning that you have a STI that is incurable such as genital herpes or HIV (human immunodeficiency virus) can turn your life upside down.

Although being infected with HSV (herpes simplex virus) and HIV do not in any way carry the same health risks (HIV being life-threatening if not treated while genital herpes is not), persons getting either diagnosis often share some of the same feelings and concerns regarding dating and sex.

At first, knowing that you have HSV or HIV may make you feel sexually undesirable and depressed as you imagine having to give up sex and relationships forever. The idea of having to tell potential partners about your diagnosis can be daunting so it’s normal want to put off dating or sex for a while as you come to terms with your diagnosis.

Fortunately, once the emotional turmoil settles down, most people want to get on with their lives, including their sex and love life.

You may feel uncomfortable talking about your feelings and concerns with people you know, but it’s best you not go through this alone.

As your therapist, I can help you overcome these feelings and find ways to cope with questions such as when and how to tell new partners you have HSV/HIV and how to practice safe sex.

Sex Issues due to infertility

Couples dealing with infertility will often experience changes in various aspects of their sex life that can lead to issues or conflicts surrounding sex.

After a while, structuring sex around ovulation can lack spontaneity and feel unsexy. Lovemaking can end up feeling more like a chore than a pleasurable activity, and this can lead to decreased sex drive and sexual dissatisfaction.

Having sex on demand can also put a lot of pressure on a couple’s sexual relationship and lead to sexual dysfunctions such as absence of vaginal lubrication and orgasm in women or difficulties getting an erection and reaching ejaculation in men.

On an emotional level, the dehumanizing and invasive process of fertility testing and procedures, as well as the distress associated to repeated failures at conceiving, can easily change how couples feel about their bodies and sex. Having sex can come to mean failure and generate feelings of sadness, hopelessness and frustration. It’s also not uncommon for couples to keep experiencing sexual problems long after fertility treatments are over.

If you find that infertility is damaging your sexual relationship and you’re experiencing difficulties communicating with your partner, sex therapy can help you get through this difficult period and ensure that lovemaking remains the source or pleasure and connection it’s always been.

Mylène D’Astous, M.A., CCC


Clinical Sexologist and Psychotherapist

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