Sex with a Chronic Condition: An Interview with Sex Therapist Lauren Dicair – Part 2

September is Sexual Health Awareness Month, and this is part 2 of 2 of our series, Sex with a Chronic Condition. Read part 1 here.

Are there any practices or exercises on what partners can do to regain lost intimacy?

"When intimacy has been lost, it’s often due to a loss of fulfilling one another’s fundamental, interpersonal needs. Our fundamental interpersonal needs are to feel significant, to connect, and to be understood. As time goes on in a relationship, it’s easy to slide into a routine of being around one another rather than being with one another, which can result in the death of intimacy.

These days, everyone has their faces buried in their cell phones, tablets, televisions, or other electronic devices. Simply turning these off or putting them out of arm’s reach and redirecting your focus on that other human next to you is a simple but especially important first step.

Now, it’s time to engage all of your 5 senses to experience each other: sight, sound, touch, taste, and smell. Some people may have 1 or more of these senses compromised due to an illness or disability. If so, using the senses that are available to you will be just fine."

What would you suggest for those who cannot physically have penetrative sex but want to create intimacy?

"Just simply experiencing each other through your senses alone is a powerful and necessary component of creating intimacy. It is so powerful, in fact, that I believe that from the moment you engage in sustained eye contact with your partner, before you’ve even engaged any of your other senses, before there’s even any genital stimulation, the 1 of you have already started making love, aka having sex.

Here is a grounding, intimacy-building exercise to try that involves all 5 senses. The only goal here is to build intimacy. If 1 or both of you become sexually aroused, great. But this is not a genital-focused or penetrative-sex-focused exercise:

Schedule a time with your/one of your partner(s) where the 2 of you will be able to dedicate at least an hour of sitting alone together with no distractions. You can either sit or lay down, facing each other. Next, you’ll want to meet each other’s gaze and maintain eye contact with each other. See how long that the 2 of you can keep silent while meeting each other’s gaze. This may eventually lead to laughing or talking, which is ok – just don’t avert your gaze.

Take turns telling each other what you notice about the other person’s eyes, such as their color and their shape. Then, pay attention to how it feels to have your partner look you in the eyes. Does it make you feel anxious? Loved? Insecure? Horny?"

Additional tips to build intimacy

"Tell your partner how it feels, and let them do the same with you with no judgmental responses. Listen not only to your partner’s words but also to the quality of their voice as they’re speaking. Is their voice deep? Throaty? High-pitched? Now, incorporate your sense of touch. Use your fingers to gently graze your partner’s hands or their cheek or their neck – any part of the body is ok so long as it is not the genitals.

Take notice of how their skin feels – is it smooth or rough? Warm or cool? Next, put your lips on the area that you were touching, gently using your tongue to re-discover the taste and texture of their skin. We all have our own personal scent – bury your nose in their skin – what is their scent like? Is it sweet? Musky? Floral?

Now you can both use your eyes, touch, taste, and smell senses to explore the rest of each other’s bodies.
If you decide to focus on each other’s genitals once you’ve gone through this exercise, oral sex and mutual masturbation are genital-focused activities that don’t have to involve penetration.

Don’t forget to continue to honestly communicate aloud what you are feeling within yourself and about your partner as you explore each other. What feels good? Where do you wish for them to linger? Where do you want them to touch lighter or harder? This is also a learning exercise – you are learning about how to fulfill your partner’s specific interpersonal needs are."

Are there positions for sex that seem to work better for those that have mobility issues, pain, or spasticity?

"In general, being in a semi-reclined position, a seated position, or being on the bottom require less respiratory and cardiac effort and leave less work for muscles and joints. Placing bed pillows under elbow and knee joints or surrounding oneself with a U-shaped body pillow can help ease pain.

If you are prescribed a PRN pain medication (PRN meaning that your physician has told you that you can take it whenever you have symptoms versus only on a set timetable), consider taking it at least 30 to 45 minutes (unless it’s a faster acting medicine) before you plan on engaging in sexual activity that will involve your affected body parts.

What positions may work 1 minute may become uncomfortable the next, so it’s important to maintain communication during your sexual experience to let your partners know when you need a change.

If you’re concerned about the possibility of experiencing emotional or physical discomfort during sexual activity, it’s a good idea to come up with safe words in advance that you can use with your partner(s) during sexual activity to convey whether you need to pause or stop an activity. You might want to consider using stoplight safe words:

• 'Red' for stop or I don’t like that
• 'Yellow' for slow down, be gentler, or I’m not totally feeling it but want to give it a little more time to try it out
• 'Green' for keep going or I really like this."

Where would you suggest people turn if they bring these problems or concerns to their doctor and their doctor is uncomfortable talking about the issues?

"It’s important when anyone is experiencing physical intimacy challenges that they first meet with their GP or PCP to rule out any underlying medical issues or prescription medicines that may be causing or exacerbating their physical intimacy challenges. Once the medical portion has been addressed, some people may find that their physician is not comfortable continuing the discussion around their intimacy concerns, particularly when the physician has not received specialized training around discussing sexual matters.

Aside from meeting with a sex therapist for private sessions, another possible way to obtain professional guidance and support is by joining a support group run by a sex therapist. This has the double advantage of providing access to a sex expert and a community of peers who 'get it.' For those on a budget, some professional-lead support groups can also cost less per session than private sessions. In the age of social media, there are also tons of free, virtual safe spaces like private, specialized Facebook groups where you can connect with, commiserate with, and ask for tips from others who are navigating similar challenges. A quick Google search for 'sex and chronic illness support' yields many resources. I recommend 1 website in particular that provides accurate and validating overviews and tips for sex with some (not all) specific chronic illnesses: Sex and chronic illness - Better Health Channel."