New Chronic Illness Podcast Episode: Physical Pleasure and Chronic Illness Interview with Sex Therapist Dr. Melvin Phillips
In this episode of Invisible Not Broken, we discussed reclaiming a sex life that works with chronic illness. The goal is to find out what is possible instead of what is achievable. Dr. Phillips informed the audience that sex is ultimately about pleasure not performance. Fatigue, one of the most common and most disabling symptoms of a chronic illness can lead to a decreased participation in sexual activity. People with various chronic illnesses may fear that the exertion of sexual activity may cause a progression of the illness. They may mistake the sedation experienced after climax to weakness, and so needlessly limit their sexual activity. The healthy partner of the person with a chronic illness may fear that sexual activity will worsen the severity of the symptoms and may avoid intimate physical contact. Decreased desire and arousal is associated with the cerebral plaques and also with depression. Cognitive changes (apathy and confusion) may have a profound effect on the quality of life, including sexual functioning. Here are his tips:
· When fatigue is a major complaint, individuals can plan sexual activity for morning when people with chronic illness generally have more energy. It is perfectly fine to plan sex! It does not have to be spontaneous!
· Couples also may alternate forms of sexual activity, such as oral sex and mutual masturbation. Remember, sex does not have to be about penetration…it is only one form of sex!
· For those with bladder incontinence can be managed by emptying the bladder immediately before or after sexual activity.
· For individuals with bowel incontinence, sexual activity can be planned so that it precedes intestinal stimulants such as coffee and meals.
· Decreased vaginal lubrication can be treated with water-soluble lubricants, and dysesthesias may be relieved with medication for nerve pain.
· Vaginal lubrication is controlled by multiple pathways in the brain and spinal cord, similar to the erectile response in men. Decreased vaginal lubrication can be addressed by using generous amounts of water-soluble lubricants, such as K-Y Jelly, Replens, or Astroglide. It is not advisable to use petroleum based jellies (e.g., Vaseline ) for vaginal lubrication due to the greatly increased risk of bacterial infection.
· Uncomfortable genital sensory disturbances, including burning, pain, or tingling, can sometimes be relieved with certain medications.I consult with medical providers almost daily in my practice about the medications my clients are prescribed. These are common medications I see prescribed.
· Decreased genital sensation can sometimes be overcome by more vigorous stimulation, either manually, orally, or with the use of a vibrator and other sex toys. Exploring alternative sexual touches, positions, and behaviors, while searching for those that are the most pleasurable, is often very helpful. Sexual activity is all about exploring and this can make it exciting. Several online sex shops such as Come As You Are and Good Vibrations are great.
· Masturbation with a partner observing or participating can provide important information about ways to enhance sexual interactions. Remember, sex is about pleasure, not performance.
· When it comes to chronic pain, there has been real evidence that endorphin release from orgasm can alleviate pain and may possibly help people manage chronic pain. This is because endorphins block pain while enhancing parts of our brain responsible for pleasure.
· Oxytocin, a bonding hormone that increases when we hug have orgasms, may also have pain killing effects, according to a report by researchers from the University of Alabama at Birmingham.
· When you are in pain, it affects you and your partner. You don’t want to be touched for fear that you will ache even more, your partner, afraid of causing you pain, may withdraw and feel isolated. Therefore, sexual communication is important.
Remember, pleasure is the measure!