Medical disorders and sex problems

Robert W. Griffith, MD
June 15, 2000 (Reviewed: December 10, 2002)

Introduction

We have outlined some of the causes of sexual problems in men and women in earlier articles ( Sex Problems in Women and Sex Problems in Men). In some cases, the cause is a fairly common chronic medical condition that has a distressing effect on sexual relations. In this summary, we consider some of the more likely diseases, their possible effects, and approaches to treatment.

Physical disability

Disabilities may impose physical, emotional, and social barriers to sexual intercourse, but if a sympathetic, understanding, partner can be found, most of these barriers can be overcome. Finding the right partner is the chief difficulty (as it is for persons without disabilities!). Nurses and sex therapists can advise and help people with disabilities overcome the physical problems involved with sexual intercourse, and provide the needed "coaching" for both partners to achieve a gratifying outcome.

Arthritis

Arthritis causes pain and disability that can interfere with sexual performance, leading to dissatisfaction and, often, depression. Sometimes the medication taken for arthritis is responsible. The affected couple should try to have sex at a time of the day when pain and stiffness are least, and the sufferer has taken an effective painkiller an hour earlier. Trying different positions can be helpful - your family physician can put you in touch with a sex therapist, who will give practical advice.

Chronic obstructive pulmonary disease (COPD)

Shortness of breath interferes with all physical activity, including sex, so that COPD sufferers may have difficulty with the act. In addition, there is lack of desire (in both sexes), and erectile dysfunction (ED) in men is fairly common. Diabetes may occur in the same patient, which complicates matters. Treatment of COPD (including stopping smoking!) will help, and ED in men with COPD often responds to sildenafil (Viagra). A training program to improve breathlessness on exertion is important. Different sexual positions should be tried to reduce the effort involved by the patient, and the physician may prescribe inhalation of oxygen.

Diabetes mellitus

Diabetic men may have complications involving the small blood vessels or the nerves, both of which can lead to ED. Progression of both these types of complications can be checked by very tight blood glucose control; this involves frequent blood monitoring and adjustment of treatment doses. One rare problem seen in diabetic men is the pelvic steal syndrome, in which an erection is lost as soon as the man enters his partner - blood shifts by gravity away from the pelvis. In such cases, changing position can help; for instance, the man lies on his side or back.

Vaginal infections are quite common in women with diabetes, and can produce pain or discomfort on intercourse. Treatment by a gynecologist and sympathetic understanding by her partner should restore good sexual function.

After a heart attack (myocardial infarction, or MI)

The patient should spend 2-3 months recuperating before resuming any tiring exercise at home, and this includes sexual activity. A good rehabilitation program (including graded exercise under supervision) and reassurance by a physician is most important - having sex need not be more strenuous than climbing a flight of stairs. The fear of bringing on another attack may produce impotence; so can the use of medications to treat depression, which is fairly common after a heart attack. Sexual satisfaction should be restored so as to be the same as before the attack.

Patients with coronary artery disease who have undergone coronary bypass surgery should take similar steps, although the period of abstinence may be shortened, or masturbation can be used in place of more strenuous sexual activity.

Heart failure

Both the condition itself and the medications used to treat it may cause sexual difficulties. However, a cardiologist should be able to give reassurance that sex is a safe activity for heart failure patients. A supervised, graduated exercise program can improve things a lot.

Stroke

Most stroke patients, and their spouses, have disturbed sexual activity - lessened frequency of sex, ED, ability to orgasm, and sexual satisfaction. Emotional factors are chiefly responsible, although physical difficulty due to paralysis may play a role. Its important that the spouse can provide support and encouragement, and that the couple are prepared to try out new positions for sex. If necessary, they should seek sex counseling.

High blood pressure

Increased blood pressure can cause changes in the blood vessels, causing ED. However, this is also a side effect of various medications used in treatment, although it's rare with the newer classes of blood pressure drugs. Viagra is effective in treating ED of this type, and may be used at the same time as blood pressure medication (but not if the patient is taking treatment for angina pectoris); it must be prescribed by a physician.

Kidney disease

Chronic kidney failure produces sexual problems in both men and women. Treatment, however, including dialysis and correction of anemia, will help considerably. The main factor is uremia, which is associated with autonomic neuropathy. However, a successful kidney transplant is the most effective way to restore normal sexual function.

Chronic prostatitis

Prostatic enlargement is not normally accompanied by impaired sexual function. Prostatitis, or inflammation of the gland, which is due to infection, will prevent intercourse because it is painful. It's best to consult a urologist for treatment. Antibiotics, warm sitz baths, special exercises and massage of the gland should reduce pain and permit intercourse.

Parkinson's disease

People with Parkinson's disease know that it can upset sexual performance, partly due to decreased bodily agility and flexibility. The medications taken can interfere reduce sexual interest and performance, although very rarely some can cause an increase in sexual desire. Depression is common in people with Parkinson's, and it too can decrease sexual energy. Viagra may be helpful in men with ED, and can normally be used in combination with Parkinson drugs. As a practical step, sex should be planned for times when medications are likely to be at peak effect, and symptoms are at a minimum. Once again, support from the spouse is most important.

Multiple sclerosis

Most persons with multiple sclerosis report sexual difficulties. Treatment should aim at improving overall disability. The sex problems can be treated in the same way as they are in otherwise healthy people (see the articles mentioned in the first paragraph, above).

Other sources of help

Many chronic medical conditions have their own patient organizations, and most of these have sites on the Internet; patients can often obtain information and encouragement in dealing with their sexual problems by visiting these sites. Here are some of them:

Physical disabilities
Chronic obstructive pulmonary disease (COPD)
Heart attack and heart failure
Stroke
Kidney disease
Parkinson's Disease Foundation
Multiple sclerosis

Source

• Sexuality in Old Age, in Brocklehurst's Textbook of Geriatric Medicine and Gerontology RN. Butler, MI. Lewis, Churchill Livingston, NY. 5th edition, 1998, vol. 103, pp. 1439--1444

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.