Conjugal Conundrum (Part 1) by Dr. Sue Townsend
As I’m on the road speaking to women’s groups, men’s groups and groups of married couples, I get a lot of questions about sex and intimacy that relate to my research but aren’t directly addressed. Since I’m not a counselor, I don’t necessarily know the answers to some of these specialized questions. So I went looking for answers from a group of recognized experts I highly respect. This article is one of a series. –Shaunti
Sherry is an attractive 35 year old who, in a past life, was quite active. A common occurrence for Sherry was a 5 mile run around her neighborhood. All that changed when Sherry was hit by a car on one of her runs. Thankfully, she wasn’t killed but there were permanent injuries with no means of repair and now chronic pain is her constant companion. Sherry loves her husband very much and prior to the accident she and her husband enjoyed a mutually fulfilling sexual relationship. She understands how important sexual intimacy is for him but, since the accident, her chronic pain makes intimacy more complicated. He doesn’t want to be “serviced” or to have sex when Sherry is in pain but he continues to complain that he is unsatisfied with the amount of sex they are having. Sherry is in a conundrum…how does she provide her husband with the amount of sex he finds satisfying, while not in pain since he says he doesn’t want to have sex when she is in pain but yet she is in pain to varying degrees 24/7? She also finds that being in pain decreases her desire for sex. Sherry feels like she is in a no-win situation and wonders if there is anything within her control to improve the situation.
Differences between a husband’s and wife’s sexual desire are very common and complex. So many issues can negatively impact sexual desire, from injury and illness, to fatigue, to being overwhelmed, to depression, to poor communication, hormone problems, body image issues, etc. Relationships are generally very important to women and they need to feel safe in the relationship prior to being receptive to their partner’s advances.
When a woman is faced with an injury, disability or illness it is important to become the CEO of her own body and educate herself regarding the disease she is faced with—to include what are the state-of-the-art treatments; who is doing the state-of-the-art- treatment; what her risk factors are; and what lifestyle changes she can make to facilitate wellness. I encourage women to obtain second and if necessary third opinions regarding their diagnosis and treatment options. Also it is important for her to understand what works for her body and what does not work. It is important to use reputable resources such as government agencies [National Institute of Health; Center for Disease Control, National Cancer Institute], regional medical centers [Mayo Clinic; Johns Hopkins; Duke University] and national disease specific agencies [American Cancer Society]. Information is POWER. Lifestyle changes such as attending to a nutritional diet and exercise can be extremely helpful in preventing further problems and restoring function [including sexual function].
One major issue facing those with a chronic disease is physical deconditioning. It can help to work with a Physical Therapist or Exercise Physiologist to help her understand current strengths and weaknesses and to develop a plan to address these. Core strengthening exercises such as Pilates; Stretching exercises such as Yoga; aerobic exercise such as a walking program; balance exercises; and weight training can be helpful in reconditioning and promoting health [includes sexual health].
Couples may find it necessary to modify how and when they make love. Initially it is helpful to discuss with one’s spouse his expectations, what has worked, what is not working and to problem solve new ways of connecting sexually. It is important to redefine lovemaking as more than sexual intercourse and orgasm. It is also important to stay in touch with one’s spouse throughout the day. Passionate kissing, love pats, endearing looks and connecting communication are very helpful. Chronic illnesses sometimes make it necessary to find solutions to new issues such as fluctuating energy levels and elevated pain levels. During these times, cuddling with no expectation that it will progress to intercourse, can be an alternate way to connect. The skin is our largest sense organ and touch continues to be an important way to say to one’s partner, “I love you”.
Scheduling time together can be helpful in alleviating miscommunication. For example, saying “I would like to make love when my energy is the highest and my pain level is low—How about we make love Sunday afternoon?” Either the husband or wife can ask to have the time changed [for example: if pain levels spike or energy levels are too low]. Good communication continues to be important. Simply repeating what you think you heard from your spouse can do wonders in clarifying the actual message. For example: “I heard you say that you would like to make love Sunday afternoon, did I understand you correctly?”
Many couples play ‘read my mind’—For example, a woman can think her man wants to have sex when that might not be his message. His message may be “I like feeling close to you” and “I feel closest to you when we make love…I miss not being able to hold you.” It is helpful to schedule time together on a regular basis. Decide together how frequently you want to be together and then plan ahead by scheduling specific times to be together. Make sure that the time is protected from all distractions [such as email, texts, phone calls, family members, pets, etc.]. If needed, take pain medication one half hour to one hour prior to your “interlude.” A warm bath can also help. Decide who is going to set up your romantic encounter and plan together on what is going to occur. Of course, unpredictable issues can arise so, either the man or woman can ask to have the time rescheduled [make sure a new time is actually selected!]
Another common issue is the lack of foreplay. Foreplay of course includes sexual touch but it also includes the wonderful things that happen during the day such as a phone call to check on how the partner is feeling, to preparing a special dinner, to redecorating the bedroom, to the special look that says “I find you desirable.” Other types of foreplay include cuddling on the couch while watching a favorite TV program, showering together, holding hands, and passionate kissing [these are just as much a part of foreplay as active genital touch]. It is important to focus on the moment and not focus on what may or may not be the next step. Additionally, remember to schedule time together to talk, to touch, and if both desire, to make love.
Read Part II of this blog for additional recommendations and click here to download a PDF with condition-specific guidance. In the future, we will be posting an article addressing this issue with suggestions for the husband.
Dr. Susan Townsend has been licensed since 1991 and has been in private practice in Knoxville since 1996. With a Doctorate in Counseling from The College of William and Mary in Williamsburg, Virginia and a Certificate in Sex Therapy from the Institute for Sexual Wholeness at Richmont Graduate University in Atlanta, Georgia, she is licensed by the State of Tennessee as a Professional Counselor and as a Mental Health Provider and certified by the American Board of Christian Sex Therapists.
This content is for informational purposes only and is not designed to offer medical or psychological advice or counsel. Since individual needs vary, please contact your qualified medical provider prior to implementing any aspect of this article.