Chronic illness

Many individuals begin to experience the onset of
chronic illnesses during the fifth and sixth decades of
life. Diseases such as cardiac and circulatory problems,
diabetes, arthritis, osteoporosis, chronic obstructive
pulmonary disease, hypertension, neurological disorders,
and depression, among others, have a profound
impact on sexual functioning (Table 6.1).
1. Heart disease
The effects of cardiac illness on men have been
well researched. Few studies have addressed the
specific issues of women following a cardiac event
and their unique counseling needs. Women may
receive less counseling, including referral to
cardiac rehabilitation, than men do. Resumption
of sexual activity following a cardiac event may
elicit fear and anxiety. Women may choose to
avoid returning to their previous level of sexual
activity fearing a reinfarct or death. Symptoms
such as chest discomfort, shortness of breath, and
excessive sweating are deterrents to the
resumption of sexual activity in women.
a. Women can resume sex when climbing two
flights of stairs no longer causes anxiety or
chest pain. Education regarding the impact of
the sexual response cycle on cardiac function
is essential.
b. Explaining the number of metabolic equivalents
(METs) used during sex as compared with
common daily activities can help to reduce
anxiety. Patients must understand the need to
avoid heavy eating and drinking prior to sex to
reduce the potential stress on the heart. Patients
should be advised to discontinue sexual activity
if they become short of breath, experience chest
pain, or become too anxious, and to notify their
physician of their symptoms as soon as possible.
Reassurance and education can help to reduce
anxiety among women with cardiac disease.
2. Hypertension
Hypertension medications may affect the sexual
response cycle negatively (Table 6.2).
3. Diabetes
a. While impaired or decreased sexual functioning
is a complication of diabetes in men, the sexual
impact of diabetes on women is not well defined.
Early studies found that women with diabetes
often suffer significant orgasmic difficulty.10
Few more recent studies have investigated this
information. Results of subsequent research
have been inconclusive or contradictory.
b. Sexual dysfunction has been reported in 42%
of women with type 2 diabetes and in 18–27%
of women with type 1 diabetes.11 Women with more diabetic complications are more likely to
have sexual dysfunction.
c. Neuropathies alone have not been found to
contribute to sexual dysfunction in women
diabetics.
d. Many psychosocial problems that are
associated with diabetes can impact sexual
functioning.
e. Renal failure has been linked to several types
of sexual dysfunction in women. Anhedonia,
decreased vaginal lubrication, and anorgasmia
have been associated with women on
dialysis.12 Women with chronic renal failure
often have a hypoactive sexual desire disorder.
The source of this dysfunction may be
multifactorial, including chronic disease,
medications, and psychosocial issues.
4. Spinal-cord injuries
a. Spinal-cord injuries result in multiple types
of losses for the patient and her partner.
Self-esteem, perceptions of body image, social
roles, and feelings of dependence are all
affected. The degree of impairment dictates
the effect on sexual function. For example,
muscle spasticity may make penetration
difficult.
b. Therefore, an assessment of the patient’s
sensory capacity and mobility are important
in offering anticipatory guidance.
Recommendations may include encouraging
the patient to improve self-esteem and
self-image and to make advanced preparations
for sexual intimacy. The woman should tend
to bowel and bladder care before initiating sex
to avoid any accidents that would have
psychological consequences.
c. The timing of the sexual activity may be
important to avoid fatigue or spastic
responses.13 Sensate focus exercises may be
helpful to the patient and her partner.
Experimenting with different positions may
also be helpful.
5. Decreased mobility problems
a. Diseases that result in decreased mobility or
flexibility, such as multiple sclerosis, arthritis,
or connective tissue disorders, often lead to
sexual inactivity. Joint stiffness, decreased
flexibility, muscle spasms and increased tone,
pain and other symptoms affect a woman’s
ability to engage in sexual intimacy.
b. Multiple sclerosis has been associated with
decreased libido, delayed and decreased
lubrication, decreased orgasmic capacity, and
anorgasmia in many women. Fatigue,
spasticity, contractures, loss of manual
dexterity and incontinence may contribute to
sexual problems.14
c. The use of assistive devices, muscle relaxants,
and vibrators may help to alleviate the distress
and disability caused by contractures, muscle
weakness, and spasms.
d. Bowel and bladder training programs may be
recommended when incontinence is a problem.
e. For some patients, the use of corticosteroids
has produced improvement in sexual
functioning.
f. For women with arthritis, timing of sexual
activity to coincide with optimal physical mobility and pain relief may help. Specific
suggestions, such as positional changes
(side-by-side, woman on top, use of chairs, or
use of hot tubs) can aid the arthritic woman
maintain her sexual activity.
6. Scleroderma
a. Scleroderma can have negative effects on
sexual functioning. Women with scleroderma
and Sjogren’s syndrome have high rates of
sexual dysfunction.
b. Common problems include vaginal dryness,
dyspareunia, and decreased orgasmia. Other
changes such as joint pain, contractures,
and muscle weakness may interfere with a
woman’s sexuality.

Posted in: Health,Sexuality,Sexuality through the life-cycle