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Sexual dysfunction

 

 
 
 
Intimacy & sexual activity



Intimacy & sexual activity
When a condition is first diagnosed, there are so many things to work through that sex is often low on the list of concerns. Eventually, the urge to return to intimacy and a sexual life is likely to be important for most people - of all ages.

Then the questions begin. Is it possible? Is it safe? Am I being selfish even considering it? Will he or she still find me attractive? Can I be a good lover? Will my erection last? Can I have an orgasm? What if I lose bladder control during sex? How can I have sex when Iím always tired? Will my partner continue to love me? How do I get interested in sex when I am dealing with everything else?
Keeping channels of communication open and discovering appropriate avenues for sexual expression can have significant benefits to your overall feelings of happiness and wellbeing. If you are having problems, do ask your doctor or condition-specific support organisation for advice or more information.

Stroke

A common worry for people after stroke is whether sexual activity will cause another stroke. The concern here is blood pressure. We all experience a sudden rise in blood pressure as excitement increases, but if it is already high this can cause problems.

Check with your doctor. It also helps to make having sex more effortless, and your partner may need to take a more active part. A partner with high blood pressure is also likely to be on tablets to control it. These may affect the ability to have intercourse. If this is a problem, talk to your doctor. There are tablets that do not have this side effect.

How chronic conditions affect sexual activity

Difficulties often arise as chronic neurological conditions progress, such as:

physical changes
cognitive changes
fatigue
incontinence
emotional responses
personality changes
self-esteem and self-image
physical changes
For example, symptoms such as paralysis, weakness, spasticity, poor balance, muscle wasting or pain may require couples to adjust their positioning or types of sexual activity.

Cognitive changes

Brain damage can affect cognitive (thinking) abilities that have an impact on a personís sex life. For example, emotional instability (often part of ABI) and poor communication due to speech dificulites can be distruptive.

Fatigue

Fatigue can have a significant impact but if you know it is most likely to occur, you can plan time together around it. Medications can also increase or decrease tiredness or change muscle function, which you may need to take into account as well.

Incontinence

The fear of bladder or bowel accidents makes some people uneasy but there are ways to minimise the likelihood: go to the toilet immediately before love-making, adopt postitions that minimise the chance of reflex emptying of the bladder and having towels and a sense of humour on hand, just in case.

Emotional responses

Depression, anxiety and stress occur either as a result of changes in the brain or in reaction to brain injury and can also reduce sexual desire. If depression is an issue, treatment can make a huge difference. Talk to your doctor. Strategies for reducing stress can also help.

Personality change

When brain injury affects aspects of someoneís personality, it can feel like you are living with a stranger. Occasionally, demanding or inappropriate sexual advances are an issue. A neuropyschologist can help with strategies that minimise difficult new behaviours.

Selt-esteem and self-image

Sexual response is also tied up with our self-image and self-esteem. Both depend on our ability to accept ourselves and to not be influenced negatively by the perceptions of others, but both are challenges when someone becomes chronically ill. Self-image can take a battering when a personís physical appearance changes. Selt-esteem can falter if the person is less physically able to engage in sexual activites. If these are serious issues for you, consider seeing a sex counsellor or joining a support group. Your doctor or condition-specific group can help with referrals.

The well partner

Well partners often experience guilt, frustration, resentment, anger, exhaustion, depression or a combination of these states. Itís hard to switch from the role of carer to the role of lover.

Some carer-partners play down their own concerns for fear of seeming selfish or complaining to a loved one whose ego may already be fragile. All elements can generate anxiety and dampen interest and pleasure in sex. It is important for carers to identify their needs, so donít be afraid or feel selfish when asking for help. If youíre not well, you canít care for your partner either.