Health and the Sexual Female 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

Research indicates that one in two adults have at least one chronic health condition and one fourth of these adults will have limitations in their daily activities [that includes the sexual realm].  Current research is being conducted by Dr. Archibald Hart, Dr. Catherine Hart Weber, and Debra Taylor that will directly address some of these percentages [sexinchristianamerica.com].  People with chronic illnesses often have numerous questions, fears and impairments regarding their sexual function. These questions, fears and impairments can result in disruption of sexuality, depression and anxiety, decreased self-esteem, decreased sexual esteem, noncompliance with medical treatment and relationship disturbance [source—Finger article].  Although chronic disease and disabilities may disrupt/permanently alter sexuality, it does not change the fact that we are sexual beings.

According to the Center for Disease Control [CDC] the six most prominent chronic illnesses impacting Americans are heart disease, cancer, diabetes, arthritis, obesity, and respiratory diseases.   Common concerns include disruption in a woman’s body image, negative sexual image, negative perception of her abilities, lack of knowledge of the specific illness, lack of knowledge of sexual physiology, lack of knowledge of how the illness and/or its treatment impacts sexuality, and lack of knowledge of helpful sexual techniques.  Additionally, treatment and symptoms may be unpleasant, and the woman may lack support.   As an illness lingers, the woman may experience a significant decrease in her physical conditioning, which can result in the concerns stated above to become more pronounced.  Many chronic diseases can have a direct negative impact on a woman’s sexuality [such as the pain and stiffness from arthritis,  physical limitations imposed by heart disease] as well as indirect impact through  prescribed treatments such as medications that blunt sexual desire, surgeries that remove body parts, chemotherapy that cause severe fatigue, etc.

Common emotional responses include shock and disbelief [“I can’t believe this is happening to me”]; anger [“I am angry at my doctor for not sending me sooner to a specialist”]; depression [“I feel really sad about being sick”]; followed by resolution and acceptance [“It really is OK”].  Soon after the diagnosis it may seem the diagnosis is present everywhere–It is the first thought in the morning and that last thought prior to going to sleep.   When first diagnosed, it may be difficult to focus on anything but the diagnosis and possible treatment—at this point there can be considerable uncertainty and fear [of the unknown, dying, etc.].   Initially, sexual functioning may not be thought about, however, at some point she will begin to think about her sexuality.

Some women struggle with feelings of unattractiveness and it is important to recognize that this is an important and common reaction.  Let’s face it, struggling with body image and feeling unattractive is not limited to having a chronic illness.  Prior to the development of a chronic illness, a woman may lament having a bad hair day or feeling “too fat”, “too bloated”, etc.  After a chronic illness diagnosis, it becomes apparent that the past negative body image was in fact not the problem once thought.  A bad hair day seems minor compared to dealing with the many side effects of chemotherapy.It can help to list one’s positive attributes and focus on these rather than things that cannot be changed.    Attractive, well-fitting clothing including bras and underwear can help.  One of the positive things about a mastectomy [besides the obvious one of being cancer free] is that most insurances pay for 6 new bras a year.  [And there are some very pretty bras now!]  Hair loss from chemotherapy can be similarly dealt with by wearing a pretty scarf, head piece or wig.  Remember that most hair loss is temporary—the hair will grow back several months after treatment is finished.  It is helpful to put a different frame around the issue by saying to oneself things such as “for a while I won’t have to shave my legs or underarms or wax my eyebrows.”  Some find it helpful to make jokes about their circumstances—For example, calling their remaining breast a nickname, etc.

The American Cancer Society [ACS] has several programs that bring women together to discuss response to treatment– “Look Good, Feel Better”and “I Can Cope” are two examples. It can help to talk to others who are further along the path, possibly a “Reach to Recovery” volunteer or an ACS Support group.  The ACS also has donated wigs, bra forms, etc. that help a woman transition through these early phases of treatment.

Many medications prescribed for many chronic illnesses can negatively impact sexual desire, sexual arousal and orgasm. Touch sensations may be diminished.   It is important to discuss any sexual side effects with your doctor.  DO NOT stop the medication without talking to your doctor.  Most medications have side effects that need to be balanced with the positive effects of the medication.  The physician may be able to change the medication to reduce side effects.  Remember that lifestyle changes such as eliminating risk factors, a healthy diet, stopping smoking, stopping alcohol intake, and exercise can improve function and may decrease one’s need for medication.

Some women being treated for breast cancer experience an aversion to being touched. The fact that a woman is aware of her aversion to being touched is an important step in being an overcomer.   It is important to understand this is a common response and has many possible causes.  Breast cancer treatments are meant to be toxic to the cancer cells but also have widespread systemic physical, relational, sexual, and psychological effects.  It takes time to heal from the treatments and adjust to a new normal.  Talking to one’s spouse, minister, mentor, physician, etc. can be helpful.   Additionally, it is also helpful to talk to others who have experienced similar issues.  The American Cancer Society [ACS] has free programs that help women discuss their feelings and concerns.  Call the local or national American Cancer Society [1-800-ACS-2345] to find support groups.   Oncologists often have information regarding local support groups.    The ACS has an excellent booklet Sexuality for the Woman with Cancer which can be downloaded from www.cancer.org or obtained from a local ACS office.

The important thing to remember is there is help available in dealing with the unwelcome side-effects of chronic illness and their treatments. I encourage you to be proactive and learn from those who have gone before you.

The articles referenced below were used in the preparation of this blog and are not necessarily reflective of either Dr. Townsend’s beliefs or that of this website.

Bruner, D. W. & Calvano, T. (2007).  The sexual impact of cancer and cancer treatment in men.  Nursing Clinics of North America.  42.  553-580.

Barton-Burke, M. & Gustason, C.J. (2007).  Sexuality in women with cancer.  Nursing Clinics of North America.  42.  532-554.

Esmail, S., Esmail, Y, & Munro, B. (2001). Sexuality and disability: the role of the health care professionals in providing options and alternatives for couples. Sexuality and Disability, 19, 267-282.

Finger, B., (2006).  Sexuality and chronic Illness. Paper presented at the 2006 AAPA Conference.

Goodell, T.T. (2007).  Sexuality in chronic lung disease.  Nursing Clinics of North America.  42.  631-638.

Grandjean, C. & Moran, B. (2007).  The impact of diabetes mellitus on female sexual well-being.  Nursing Clinics of North America.  42.  581-592.

Hardin, S.R. (2007).  Cardiac disease and Sexuality:  Implications for research and practice.  Nursing Clinics of North America.  42.  593-603.

Kaufman, M., Silverberg, C. & Odette, F. (2007).  The ultimate guide to sex and disability.  San Francisco:  Cleis Press, Inc.

Katz, Anne (2007.)  Breaking the silence of cancer and sexuality. Pittsburg, PA: Oncology Nursing Society Publishing.

Kroll, K., & Klein, E. L. (1992). Enabling romance.  Horsham, PA:  No limits  Communications.

Newman, A.M. (2007).  Arthritis and sexuality.  Nursing Clinics of North America.  42.  621-630.

Roseau, D., Childerston, J., & Childerston, C. (2004).  A celebration of sex after fifty.  Nashville, Tennessee: Thomas Nelson Publishers.

Sanders, S., Pedro, L.W., O’Carroll Bantum, E., & Galbraith, M.E. (2008).  Couples surviving prostate cancer:  Long-term intimacy needs and concerns following treatment.  Clinical Journal of Oncology Nursing. 10, 503-508.

Steinke, E. [2005].  Intimacy needs and chronic illness.  Journal of Gerontological Nursing.

Wilmoth, M.C. (2007).  Sexuality: a critical component of quality of life in chronic disease.  Nursing Clinics of North America. 42, 507-514.

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.