Chronic illness and intimacy: six ways to improve your connectedness

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Photo for article on sex and chronic illness. Black and white photo of a naked woman hunched over. There are dots all over her body which seem to be coming from a light reflection.

Caption: For those couples wanting to continue sex with chronic illness, experimentation, good communication, and flexibility are fundamental. For those who decide that sex will no longer be a part of their relationship, a focus on other intimate aspects of the relationship can still foster closeness and caring. | Photo Credit: ©Porechenskaya / Adobe Stock

Chronic illness and intimacy

Many people with a chronic illness ask themselves: ‘What can I do when chronic illness affects my sex life?’ ‘Can chronic illness and intimacy co-exist?’ 

People with a chronic illness, including Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia, often find their illness affects their sex life, often with far-reaching consequences.

In a series of discussion groups looking at sex and chronic illness, and sex with chronic pain, people were asked how their illness affects their sex life. All of those who responded said that their chronic illness had reduced their sexual activity, or they had given up sex as a result of their illness. Most also described how they had adapted this part of their lives to the limits imposed by illness. As one person wrote, “yes, chronic illness affects my sex life … it is just another side effect of being ill.”

Many people also mentioned having a much lower level of sexual desire than before. Causes of their reduced libido included ongoing fatigue and pain, and the side effects of medications.

As one said, “I was unable to be interested when I was so tired, I could hardly stay awake and in so much pain that I could think of nothing else but how I could control it. This is how my chronic illness affects my sex life.”

Other causes of sexual problems included the effects of menopause, relationship strains, and the medical issues and/or impotence of their partner.

Many respondents in the sex and chronic illness focus groups told us that they used a variety of strategies to either adapt their sex life to their illness or to connect with their partner in other ways. Here are six strategies they told us are useful when a chronic illness affects their sex life:

"Intimacy is more than sex"

1. Talking about chronic illness and intimacy

Reduced sexual activity is a common source of strain in most relationships, but effective communication can help when it comes to chronic illness and intimacy. Several people reported that their relationship with their partner improved after they talked openly about their reduced interest in sex.

As one said, “I explained that I still loved him and felt the same (or more strongly) about him, but I just couldn’t show that through initiating sex…I have no desire for self-pleasure either. Explaining that sure made a difference to his acceptance of my state! This is how chronic illness affects my sex life.”

Another reported, “What helped my husband most was understanding that the lack of sex was nothing that was his fault, but just a manifestation of my illness.” Others reported that they benefited from open communication in bed about sex and chronic illness. One said, “I let him know if a certain position hurts, and we change positions.”

2. Explore alternative activities, in bed and out

Another pervasive theme about sex and chronic illness was focusing on alternatives to conventional sex, both in bed and out. One person wrote, “The times I am not up to having intercourse, he knows I am usually up for some cuddling and happy to satisfy him another way.”

Others wrote of alternatives to sexual intercourse, for those who think that appropriate. “When chronic illness affects my sex life, I tell myself that I don’t have to have intercourse to be sexually connected…You can be satisfied with manual stimulation and also oral sex.”

Others have found other ways to express their affection when chronic illness affects their sex life, through hugging, kissing, and holding hands, through words of appreciation and thoughtful acts, and through shared activities like going out for dinner together, watching a favorite TV program or giving one another a massage. When you have a chronic illness, intimacy needs to start outside the bedroom. And you need to remember that intimacy is more than sex.

One said, “When chronic illness affects my sex life, he rubs my back, and I rub his feet. We hug and share a kiss here and there…I make sure he knows how much I appreciate what he does for me.” Another wrote, “We still hug, kiss and say ‘I love you’ lots. I feel we have a solid and healthy relationship apart from the lack of sex.”

“You don't have to have intercourse to be sexually connected...You can be satisfied with manual stimulation and also oral sex.”

3. It is all in the planning when it comes to chronic illness and sexual intimacy

Another universal adaptation is planning for sex when one partner has a chronic illness. Several people mentioned that when chronic illness affects their sex life they take extra rest or reduce their activity level on days they anticipate having sex. And a number said they and their partners plan “sex dates.”

One said, “What my husband and I have learned is that we need to schedule a ‘date.’ I actually put it on my calendar.” Another said, “The ‘date’ planning has worked for me because I tend to do less of the things that I know will cause me residual pain.” For some respondents, sex and chronic illness are more enjoyable when planned in advance.

Another couple is increasing the frequency of sex by making a commitment to having sex once a week. The wife reported that sex is becoming less painful, and her husband “is much more cheerful and doing more around the house.” Painful penetration has also been reduced through prior planning.

4. Go ahead and experiment: be flexible

Given the often unpredictable course of many chronic illnesses, including ME/CFS and FM, it helps to be flexible about when sex occurs and what positions and activities are involved. One person said, “We’ve experimented with timing (morning is best), position (I seem to do best on my side), and lubricants.”

Others use observation as a basis for experimentation. One person wrote, “I noticed that in the summer, I had more desire and realized it had to do with the heat, so we started to shower together.”

5. Treating the pain and addressing hormone problems

Pain or the anticipation of pain can be a potent inhibitor of physical pleasure. To manage this pain, people reported treating it by using topical ointments, pain pills, massage, and heat. They also said that another way of getting around pain is by changing sexual positions. Several people also reported that their sex lives improved after treatment of pain and hormone problems.

Several also commented on how their interest in sex had improved with hormone treatment, either estrogen, testosterone, or both. One woman said that testing showed that both her estrogen and testosterone levels were low. Treatment of the latter “not only helped libido but my energy level as well.” Hormone problems can also affect men.

6. Put more emphasis on caring for your partner

Several people distinguished between intimacy and sex and said they and their partners focused on closeness and mutual caring. One wrote, “Sex is important in a relationship, but I don’t feel that it is the most important. I think all of the little everyday things that we do for each other and being supportive of each other is what really makes a marriage.”

Another said, “My husband and I have found we don’t need to express our affection sexually…For us, sex does not compare to the kind of fulfillment, which is a beautiful thing when shared between two people who are filled with warm, tender, loving feelings toward each other.” She wrote of expressing affection through problem-solving, sharing time together, touching, caressing, and cuddling.

For those couples wanting to continue sex when chronic illness affects their sex life, experimentation, good communication, and flexibility are fundamental. For those who decide that sex will no longer be a part of their relationship, a focus on other aspects of the relationship can still foster closeness and caring.

"No matter how a person's body changes because of a chronic illness, no-one should have to give up sex or intimacy."

Books on chronic illness and intimacy & sex and chronic illness

The ultimate guide to sex and disability

By Miriam Kaufman

The Ultimate Guide to Sex and Disability is the first complete sex guide for people who live with disabilities, pain, illness, or chronic conditions. Useful for absolutely everyone, regardless of age, gender, or sexual orientation, the book addresses a wide range of disabilities — from chronic fatigue, back pain, and asthma to spinal cord injury, hearing and visual impairment, multiple sclerosis, and more. Expertly written by a medical doctor, a sex educator, and a disability activist. 

Sex-Interrupted: Igniting intimacy while living with chronic illness

By Iris Zink and Jenny Palter

By the year 2030, as many as 171 million people in the U.S.- more than half of all Americans-will be living with at least one chronic medical condition. Chronic illness or disability can easily derail a person's sex life-but it doesn't have to be that way. Using kindness, honesty, and humor, Iris Zink, BSN, MSN, ANP, RN-BC, explores chronic illness and intimacy. She discussed the ways illness or disability can affect a sexual relationship and offers suggestions on how to regain intimacy. 

"Sex and chronic illness may pose challenges, but through open communication, exploration, and prioritizing care, we can forge a pathway to intimacy that transcends the limitations of our conditions."

Article by
Bruce Campbell PhD

Bruce Campbell, PhD, is the creator and first Executive Director of the ME/CFS and Fibromyalgia Self-Help Program. A recovered ME/CFS patient, he is a graduate of Stanford University and holds a PhD from the University of California.