Hi and welcome to my very first blog post. This blog will focus largely on the sexual side effects of life changing illness and injuries (and their treatments)and offer links to further information, ideas for intervention, and hope for sexual recovery. Your sex life is unlikely to be the same as before..it might even be..better!
I want to start with a theme that over-arches all life changing health events and that is depression. There has never been a better time to talk about depression and its impact on sexual expression, communication, behaviour and pleasure giving and taking, what with so much negativity whirling around – Covid 19, quarentine, isolation and bloomin’ politics! If you are starting from a place of illness, injury or disability, these issues are possibly magnified for you.
The effects on those of you who are already ill, being sheilded and/or awaiting treatments that have been delayed, may be deeply felt and could be destructive to relationships that are normally highly supportive. Sadly the sexual impact of additional depression, like many illnesses and medications are not discussed easily in our society in general – nor in health care.
The saddest thing of all is that it can become something of a downward spiral that gets darker and more tangled as you fall –
a)Disability and illness are already risk factors for depression.
b)Disability, illness and some treatments can affect sexual function, fertility and fun.
c)Depression can cause additional sexual side effects.
d)The medication for depression…often comes with sexual side effects too.
What a jumbled up mess!
But what kind of sexual side effects am I talking about?
I’m going to concentrate on sexual function here, accepting that there are many other things that are interconnected and no less important and likely playing a part in what you are experiencing. The thing is that I’m often asked about sexual function and what is ‘normal’ in my work as a sex therapist, so it is a good place to start. (My answer is that there is no ‘normal’, no standard, nothing to measure up to. Your sex life is unique).
The common sexual function side effects of depression are erectile dysfunction, delayed or entirely absent orgasm and low or no sexual interest (and little vaginal lubrication). These happen because the brain is a highly sensitive sex organ. I say that because sexual desire starts in the brain through brain chemicals called neurotransmitters which trigger more blood flow to the sex organs. The problem is, with depression, the brain circuits that communicate using these chemicals don’t function properly.
Many men and women with depression report a loss of sexual desire which can put extra strain on relationships (that are already challenged by a life changing diagnosis and the effort of adjustment). Often partners need close physical reassurance but cannot find it because the person who is depressed fears that sex is being sought and they are so, so not interested. This can feel very much like rejection for the partner and all warmth and intimate connection is at risk of being lost if they stop approaching for a cuddle because the rejection hurts. They may even become depressed themselves.
The good news is that there is help available to untangle all of this, if only you can talk about it to the right person.. find a professional who can work with you, keep you safe and find solutions that work for you. This is the same whether your life changing illness is prostate cancer, MS, spinal injury – or just about any other traumatic health problem, including menopause. There is always help. You may have to look for it yourself, you may even have to pay for it yourself…but there is help there*. If you are not in any state to seek it, please, please ask a friend to do it for you. Talk to your GP or specialist nurse, take your partner with you and let them do the talking – just don’t do nothing!
What will happen?
There are a number of things that might happen, depending on the depth of depression, the sexual side effects experienced, the impact of the illness or disability on sexual function and the desired sexual ‘goal’.
Perhaps you will be referred for a talking therapy to address your depression, or maybe you will be offered medication. If talking therapy is the way forward, ask about waiting times – they can be long, so perhaps linking with an online service such as at Mind.org.uk or through the website of your particular disease association (like the MS society or Ileostomy Association for instance) will help, while you wait. It could be that you seek a friend that you know has been depressed and who can listen.
If it is a prescription that is being handed to you, be sure to ask about any sexual side effects of the medication you are offered. You have my permission to embarrass the hell out of your doctor if they do not discuss any sexual side effects with you! If you then experience additional unwanted sexual side effects from anti-depressants, GO BACK to your doctor, there are others you can try, and there are extra things you can take to counteract these side effects. Your doctor cannot help you if you don’t make another appointment.
Maybe at some point, when your depression is better managed, should you wish to work on your sex life, you will be referred for NHS psycho-sexual therapy (PST) if that is available in your area. If you are referred for PST, stay curious, go along and hear what the therapist has to say. We don’t bite, you will not be asked to undress or do anything sexual in the therapy room, we only talk and guide, and you can ‘opt out’ at any time. If there is no NHS PST service in your area, try your local RELATE, or drop me an email on email@example.com if online therapy is for you. This approach is becoming the norm now due to Covid restrictions.
Don’t be brushed off with a referral back to your specialist or offered medication such as Viagra or Cialis to improve your erection, or lubricant for vaginal dryness – neither is likely to improve your libido or your depression! If your problem is depression, then it is your depression that needs addressing and your partner may need emotional support too!
And what else about your partner? All the while they are supporting you but getting little or no intimate contact…how can you stay connected and close? What are their needs? What are your assumptions? Try if you possibly can to talk about the sexual impact of your depression with them and understand what they would like to happen for the time being, until you get better. Perhaps that is just a cuddle before you sleep, with no expectation of sex – maybe it is a little physical contact such as hand holding and a kiss at bedtime. Maybe they are happy to let you ask for whatever you need, when you need it and be glad to oblige. You won’t know without talking.
It may be useful to know that not all sex starts with ‘desire’. It is possible to begin lovemaking by caressing and kissing and then allowing those sensations to drive what happens next – if it doesnt lead to intercourse, so what?! – You probably had a nice time anyway. Talk. You both have to be up for at least trying.
Another idea is to consider linking to Mind.org.uk who have great information and support online. Remember that the vast majority of people overcome their situation and are able to move forward to a happy life which includes sexual fulfillment once their emotional health is stabilized and adjustment is achieved. It is normal to be in turmoil after a traumatic health event and in these weird times. Seek help. You are not weak. You are normal.
It would be very wrong of me not to include advice for you if you are feeling desperatly low and unable to keep yourself safe. This is viewed as a mental health emergency and you must take action. Mind.org.ukstate:
If you feel like you might attempt suicide, or have seriously harmed yourself, you need urgent medical help. Please:
- call 999 for an ambulance
- go straight to A&E, if you can
- or call your local crisis team, if you have their number.
If you can’t do this by yourself, ask someone to help you.
Mental health emergencies are serious. You’re not wasting anyone’s time.
This post was triggered by a link I had with The Samaritans today, Their website is really useful too and they can be found at Samaritans.org
That’s it from me for today. I hope I have explained that if you are feeling sad, you are not the only person. You will get better with help. I don’t want to end on anything negative, because I really believe that you can and will recover. Just don’t do nothing.
With many good wishes.
*(Sometimes there are grants available or special rates for those in financial strife, you won’t know if you don’t look).