Having sex and living with a health condition

The impact of some types of medication on our sexual function is often badly-understood, poorly discussed and can be devastating for individuals and couples.  Some medications can affect your sex life by causing:

• vaginal dryness
• lowered libido
• anorgasmia (inability to achieve an orgasm)
• delayed orgasm
• difficulty achieving or maintaining an erection.

Speak to your GP if you are worried about the impact of your medication on your sex life. Side-effects of medications are very common, and your GP or healthcare specialist will work with you to find a balance. Don’t stop or change any medication without talking to your GP.

Obesity, an increasing problem generally as well as with age, can make having sex more challenging and can significantly impact sexual satisfaction.

Studies show that one third of people with obesity and two thirds of people with morbid obesity report sexual problems, including: little or no desire for sex, performance problems including erectile dysfunction, avoidance of sex, little or no enjoyment, mobility issues, or concerns about cardiovascular episodes or injury. Obesity can also reduce sperm count and contribute to problems with fertility, hormone production, and pregnancy.

People with obesity are entitled to good, healthy sex lives, and support is available.

Many obese people find that some positions are better than others; this article has some good suggestions on positions that work better for people with obesity- though of course, what feels right for you is most important.

There are also some great sex aids for people with obesity. There are specific wedges and pillows designed to support people with limited mobility during sex, and several sex toys exist to support reach and access. There is even furniture designed, including stools and swings, to support sex for people who need it. The best thing to do is talk to your partner and explore what is out there- you could be surprised!

It can feel scary to masturbate or have sex after a heart attack. You may feel less interested in sex or feel less able for a while. This could be due to being tired or anxious, the stress your body went through, or your medication. This is normal, and the feeling usually only lasts for a short time.

“How long should I wait…?”

Sex is a form of exercise. If you are wondering if you are ready to have sex or masturbate, here are some recommendations:

• You can climb two flights of stairs non-stop without pain or shortness of breath
• 2-4 weeks have passed since your heart attack (unless you have had surgery)
• 6-8 weeks have passed if you have had surgery
• Avoid having sex after a heavy meal – it can give you indigestion and lead to chest pain
• Don’t drink too much alcohol before having sex as it could make you lightheaded and may cause your heart beat to become irregular.
• If you’ve had surgery, wait until you’re healed (usually six to eight weeks).
• Find a comfortable position and don’t put any stress or pressure on your chest / breast-bone
• Take it slowly the first few times

Take your time to get back to having sex and don’t forget there are other ways to feel connected like kissing, touching or massage.

Please take time to talk through your worries or concerns with your partner, your GP or your cardiac rehabilitation team.

For more information, visit: BHF.org.uk/informationsupport/support/practical-support/sex-and-heart-conditions

COPD is a progressive respiratory illness that affects your breathing, causing shortness of breath, coughing, excess mucus production, fatigue, and restricted airflow from your lungs. All these things can impact your libido, your ability to achieve an orgasm, and your ability to achieve or maintain an erection if you have a penis.

Many people with COPD can and do have happy and fulfilling sex lives, either alone or with a partner, though changes are often needed to reduce complications.

Here are some basic tips for making the most of your intimate time together:

• be well rested before having sex or masturbating
• choose the time of day when you have more energy and when breathing is easiest
• avoid times when you've just eaten or had alcohol, or when it's hot or humid
• clear your lungs beforehand by using your bronchodilator medicine before you have sex
• try a side-by-side position
• consider using supplemental oxygen- if you need to wear oxygen while walking, you’ll probably need to wear it during sex, too
• let your partner know if you need them to take a more active role
• stop and rest if you have trouble breathing
• take your time, take it easy, and enjoy one another
• talk to your partner and stay open-minded

If possible, improving your overall fitness, quitting smoking, and reducing environmental irritants like dust will all likely help improve your COPD symptoms, and benefit your sex life, too!

Your doctor, nurse or physiotherapist may also be able to suggest ways to help manage breathlessness during sex.

For more information, visit: BLF.org.uk/support-for-you/sex-and-breathlessness

Diabetes can lead to sexual problems, particularly when blood sugar levels remain high for a long time. Many people with diabetes will never experience problems with sex or sexual function, particularly when their condition is well-managed. However, other people with diabetes are more likely to experience issues with their sexual health than people without diabetes, particularly when blood sugar levels are not well managed.

Complications of diabetes on your sex life can include:

• Fatigue, depression, or low self-esteem, leading to a lowered libido
• Anxiety, especially about having a hypo episode during sex
• Loss of sensation
• Lowered sex drive
• Vaginal dryness
• Urinary tract infections
• Thrush
• Erectile dysfunction

Managing diabetes is a balancing act, and it often takes trial and error to find out what works for you, and any partners you have or might have. Your clinician should have regular conversations with you about your sexual health and wellbeing; if they don’t, you should absolutely bring this up with them as a routine part of your management.

For more information on sex and diabetes, please visit: Diabetes.org.uk/guide-to-diabetes/life-with-diabetes/sex-and-diabetes

Prostate surgery is the removal of some or all of the prostate gland, and prostate surgery can significantly impact your sex life and relationships.  Ideally you should be able to ask questions about sex at any point - before, during or after your prostate surgery treatment. Talking about it before your treatment will mean you are more likely to know what to expect and can help you to consider what options there are to manage those effects.

“How long should I wait after surgery?”

Your sex life doesn’t have to be on hold for too long. Wait at least six to eight weeks after surgery before having sex or masturbating again, to avoid infection and tearing. Your clinician should provide specific advice about this to you. If they haven’t brought it up (they should!), please ask.

“I can’t get an erection!”

You may find you are having problems getting an erection following surgery. The nerves which give you an erection are close to the prostate and could be damaged when you have the surgery. If the nerves are intact you are likely to recover your erections, but it will take time, and it could be several months. If you are experiencing trouble getting an erection after 6-8 weeks, see your clinician.

You will also be able to attend a Penile Erectile Dysfunction Rehabilitation Programme run by your specialist team, or to be referred to a clinical expert in sexual problems or an erectile dysfunction (ED) – who are very used to talking about sex and any concerns.

“I don’t ejaculate”

If you have had what’s called a radical prostatectomy surgery, you will no longer ejaculate when you have an orgasm. The sensation will feel the same but your body won’t release any semen. Your clinician should explain this to you, but if you have any concerns or questions, don’t hesitate to ask.

If you have had surgery for an enlarged prostate, you may have something called retrograde ejaculation. This is where the semen travels backwards into your bladder when you orgasm, instead of coming out through your penis. This won’t hurt you! Your clinician should explain this to you, but if you have any concerns or questions, don’t hesitate to ask.

“I am still not sure…”

If you’re still not sure, talk to your clinician. We at SHIFT know that not everyone is used to talking about sex. Ideally your specialist team should ask questions about erections and sex life during your pre and post operative care- this is the golden standard, after all. But you might need to bring up the subject yourself, and you should not feel embarrassed or ashamed of doing so- you are absolutely entitled to a good, healthy sex life and your clinical team will support you to get there.

For more information, visit: Prostatecanceruk.org/prostate-information/living-with-prostate-cancer/sex-and-relationships

Like any type of surgery, after you have had a hysterectomy, it can take time for you to feel yourself again, both physically and emotionally. This can have an impact on how you feel about sex, whether it means that you have less interest in it, whether you are concerned about changes to your body or gender identity, or whether it has an impact on your mood or mental health.  

“How long do I wait?”

In general, most people will be advised to wait around six to eight weeks after having a hysterectomy to have sex or to masturbate again- all wounds need to have healed, and all surgery-related vaginal discharge needs to have stopped. This gives your body time to heal and for any bleeding or vaginal discharge to stop. Orgasm, whether by masturbation or with a partner, causes contractions in your pelvis and reproductive organs, where healing is taking place, and can therefore cause harm and pain if undertaken too soon after hysterectomy.

Hormonal changes

The type of hysterectomy you have will have different impacts on any hormonal changes you may experience. Your clinician should discuss these with you in detail prior to your surgery.

If you have had your ovaries removed as well as your uterus, this will trigger the menopause, whatever your age. It will also change hormone levels which can affect your libido, your ability to achieve orgasm, your ability to self-lubricate, your mood, or your ability to feel aroused. You should have an ongoing conversation with your clinical team to manage the impact of hormonal changes, and the impact those changes are having on your sex life should be an important part of those conversations.

Vaginal dryness, sensation, and orgasm

Having a hysterectomy does not mean that you won’t be able to have an orgasm, as your clitoris and labia will be unaffected. However, for some people, changes to their cervical region or nerve connections can cause reduced sensation or pleasure. If you experience this, experimenting via masturbation, talking to your partner(s), and seeking support from your healthcare provider could all help.

You might find that your vagina is less able to self-lubricate following a hysterectomy. If this happens, give yourself plenty of time to get aroused, and ensure you’re engaging in enough foreplay. Also, try using a lubricant such as KY Jelly. You can buy these over the counter at a pharmacy, or via many online stores. Be careful with flavoured lubricant, though- the sugars and chemicals in them can lead to an upset vagina, and infection!

Pleasure

Sex might feel different after a hysterectomy, especially shortly after surgery. There are a few things you can do to ensure you maximise your pleasure, either through masturbation or sex:

• Use plenty of lubricant
• Try masturbation first- you might be more comfortable listening to your body that way
• Don’t just think about penetration- try other things, too!
• Go slowly. You just had surgery, listen to your body.
• Talk to your partner about how you feel, before, during, and after. They may also be worried about hurting you after surgery.
• Try different positions. As you recover you may find different positions will be more comfortable as your stomach may still feel a little tender.

For more information, see: NHS.uk/conditions/hysterectomy/recovery/

One of the biggest factors that inhibits a healthy and fulfilling sex life throughout the aging process is performance anxiety. Slower response times, and more difficulty achieving or maintaining arousal, is common across people of all genders as they age.

Sometimes, there are physical factors such as obesity, menopause, medication side effects, or diabetes that might make arousal difficult. These can be addressed and supported by a good healthcare provider.

Other times, the anxiety over changes to your body can lead to a vicious cycle, whereby you worry that you won’t be able to perform, become tense and more anxious, and don’t enjoy what is happening- and therefore can’t perform. Good communication with your partner, if you have one, is key, as is feeling relaxed and comfortable about exploring sex as your body changes. Regular masturbation can be useful to understanding changes to your sexual needs and experiences, and a good couple’s counsellor can also support communication as needed.

Dementia is a cognitive disorder characterised by changes in and loss of memory, language, judgement, reasoning, emotional regulation, and other brain functions. Aging is the biggest risk factor for dementia, and as most types of dementia are progressive, it means that the symptoms of dementia tend to become more severe the longer someone lives with it.

Depending on the type of dementia, your sexual health can be affected in the following ways:

• Increased or decreased interest, and/or ability to perform
• Decreased in sexual inhibitions/losing your ‘filter’ and expressing your sexual self in inappropriate ways, times, and places
• Not recognising your partner and seeking sexual gratification elsewhere
• Hypersexuality (uncontrollable need for sexual stimulation)
• Lack of empathy.

However, people with dementia still need and deserve intimacy and comfort, and it’s difficult at times to separate that need from inappropriate sexual behaviours. Often, displays of sexuality that are seen as inappropriate are displays of unmet need. Good social and care support can help meet those needs (e.g. masturbation in private rather than public, disrobing in private or safe spaces, etc).

Some couples will discuss how they will manage their sexual relationship either in the early stages of dementia onset, or as a ‘just in case’ measure. Some will not. What is right for you, your relationship, and your partner will be different than what is right for someone else. We’d recommend that you seek specialised advice as support as issues arise for you, for example by visiting:

• Alzheimers Society
• The Wrinkle: Sex and seniors blog
• The Wrinkle Sex and dementia blog

For more information on dementia, including types and signs, please visit: Dementiauk.org

Everyone has the right to healthy, fulfilling, safe and consensual sex and relationships, and this is true for every person living with a disability - no matter how severe.

People with disabilities are often overlooked as having sexual needs, feelings, and desires, are often dependent on carers, can have little privacy, and might struggle to access or use STI testing and contraception. Physical disability can also decrease ability and make sex difficult without appropriate support or sex aids.

If your disability affects your sex life, or you lack confidence, you may feel worried about having sex.  Finding good support is key to helping you achieve and maintain a healthy, satisfying, and pleasurable sex life- either alone, or with a partner (or partners!).

There are several aids out there to help people with disabilities have sex, including:

• Intimate rider sex chair- for people in wheelchairs
• Vibrating sex wand- can be placed on a pillow for use by people with limited mobility, or who can’t hold a vibrator for very long
• Liberator positioning pillows and ramps
• Bondage tape- used for fetish, but also, to strap sex toys where they are needed (beds, pillows, wheelchairs, etc)
  • Can also be used to strap grips, etc. to sex toy handles that would otherwise be difficult to hold
• Spare part harness - used with a compatible dildo for penetrative vaginal or anal sex. Can be used by people without a penis, as well as by people unable to achieve or maintain an erection, whose partners enjoy penetrative sex
• Sex stools or sex swings- can improve mobility and movement if restricted
• Hot Octopuss, a hands-free masturbating device for people with a penis

If you have a disability and want further support, we recommend these sites:

• Sex and disability: the facts | Aruma Disability services. Putting you first.
• Sex and disability advice | Disability charity Scope UK
• Sex & Disability | Enhance the UK
• Intimate not Intimidated: It's Time to Talk about Sex and Disability
• Sex surrogate gives man with disability a ‘rocket-propelled’ sex life | New York Post