Chronic illness and sexual functioning

American Family Physician, Jan 15, 2003, by Margaret R.H. Nusbaum, Carol Hamilton, Patricia Lenahan

Sexual functioning is a complex process that depends on the neurologic, vascular, and endocrine systems, and is influenced by numerous psychosocial factors, including family and religious background, the sexual partner, and individual factors such as self-concept and self-esteem. Sexuality can be altered by aging, life experiences (e.g., abuse), and various illnesses and their treatments.

Sexuality has received little scholarly attention, and professional training in sexual health is limited. Although the available literature demonstrates the importance of sexuality to patients, (1-6) physicians often do not introduce the subject during clinical encounters (4) or address sexual concerns in patients who have chronic diseases. (7) Because of the complexity of these illnesses and their treatments, as well as time constraints, inquiry about sexual functioning may be neglected. Without physician prompting, patients are reluctant to bring up sexual concerns. (2,8)

Patients who have chronic illness often have difficulties with sexual functioning. (7,9) With an understanding of the impact that chronic illness can have on sexual functioning and the use of basic management strategies, family physicians can readily screen for and manage sexual dysfunction, thereby enhancing quality of life for their patients.

Chronic Illness and Sexual Health

ISSUES FOR PATIENTS

Although the physical demands of sexual activity are high, (10,11) few, if any, chronic illnesses require restriction of sexual activity. However, couples may have to alter their sexual activity to accommodate physiologic or mechanical limitations.

Patients with chronic illness may become disinterested in sex or may become sexually inactive because of misconceptions about their ability to have sex or the safety of having sexual relations, or because of body-image concerns or grief related to the diagnosis of their disease. (12) Depression, fatigue, pain, stress, and anxiety may further contribute to sexual dysfunction. These problems may affect the willingness of patients or their partners to engage in sexual or other intimate relations. However, touch and physical intimacy are extremely important for severely debilitated or terminally ill patients. (7)

SEXUAL RESPONSE CYCLE AND CHRONIC ILLNESS

A knowledge of the sexual response cycle--desire, arousal, plateau, orgasm, and resolution--is important to understanding the impact that chronic illness can have on sexual functioning (Table 1). (10,11,13)

Desire is influenced by neurotransmitters, androgens, and the sensory system. It is also influenced by psychosocial factors such as self-esteem, body image, and the relationship with the sexual partner. Any illness or treatment that affects these factors can have a negative impact on a patient's interest in initiating or being receptive to sexual activity.

Arousal and plateau require intact vascular and parasympathetic nervous systems. Orgasm requires an intact sympathetic nervous system, and its intensity is affected by muscle tone.