Chronic Sex

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This piece comes from one of my favorite people, Mariah Leach of From This Point. Forward. Mariah is one of my favorite people and, indeed, one of my favorite partners in crime.

For the past few years, I’ve been writing openly about the impact of chronic illness on intimacy and relationships – so I was excited when I was recently offered the opportunity to interview Dr. Logan Levkoff. A recognized expert on sexuality and relationships, you may have seen Logan on the reality show Married at First Sight. Logan is dedicated to perpetuating healthy and positive messages about sexuality and relationships, and she recognizes the added struggles a chronic illness can bring to the table.

Mariah: If one partner has a chronic illness, what can a couple do to try to address the diagnosis as a team? What if your partner is having a difficult time understanding or accepting the impact of your diagnosis?

Logan: I think it’s sort of funny – we share our bodies with our partner, but that doesn’t mean we feel able to easily talk about the feelings that go with that experience. None of these conversations are easy – they don’t come naturally – but we have to have them. “Communication” as an answer to this question is not the most novel idea, but there’s really no other way to do it. Your partner doesn’t understand what you are experiencing and vice versa, so we have to find ways to explain what we are experiencing. Listening is important too, as is considering your partner’s needs. Try turning the question around and asking your partner what they are experiencing, without making any assumptions.

Mariah: I think it can often be really difficult to consider your partner’s needs and experiences when you are really hurting or suffering yourself. What do you recommend if you are struggling to make room for your partner’s perspective?

Logan: It’s definitely a delicate balance between explaining your own needs and listening to your partner’s needs. If you mess up and end up in an argument instead of a conversation, you can always go back after the fact and say to your partner “I really wasn’t feeling well when we had that conversation, but that doesn’t mean what you are thinking is not important.” If you really struggle in this area, it may also be useful to have a third party, such as your healthcare provider, offer some information to your partner about how your chronic illness may impact intimacy. For example, after a woman gives birth their partner may not understand why they can’t be sexual, and a doctor can help explain the issue. A third party can also moderate the discussion, give information, and give your partner some idea of what to expect.

Mariah: That’s a good suggestion, but to get that sort of help from your doctor you have to bring up the issue in the first place. Do you have any advice for making it easier to talk to your doctor about this sensitive topic?

Logan: It really depends on the relationship you have with your doctor. If you’re uncomfortable, sometimes it can be easier to call the office in advance, tell them you’d like to talk about X subject, and ask them to make a note in the file to reserve the time during your next appointment. When you go in for your appointment, it may also help to have a list of questions. Even if you don’t really need a list it can serve as a psychological crutch to look down and read something off a piece of paper, instead of asking directly.

And you can always lead off with “I don’t know how to say this, but I need some guidance.” Nurses and nurse practitioners can be a good starting point too.

Mariah: So once you’ve gotten some advice from your doctor and figured out how to communicate better with your partner, what if you just don’t feel sexy? How can you learn to love your body in the face of chronic pain or in spite of the negative side effects from treatments?

Logan: We all have moments when we don’t feel our best, and it’s often because we have this idea that someone else sees us in a different way. There are times when we don’t give ourselves enough freedom to think about what really makes us feel good – sexy, fulfilled – beyond the role of being someone’s partner. As a starting place, ask yourself the question “when do I feel my best? What puts me in a space that I can let some of my worries go.”

Mariah: Do you have any advice on dealing with guilt over the impact your disease has on your partner’s life?

Logan: We often feel guilt because we feel like we are depriving our partner of something – and we tend to assume that we know how our partner is feeling about the issue. It’s about saying to your partner “I really want for us to have the most fulfilling intimate life possible. I’m sorry there are times we can’t get there – but what can we do together so we feel connected even when I’m not able to be physical with you?” We often avoid these types of conversations because it feels safer, but being vulnerable and owning it shows your partner that the issue is important to you. It may not be the exact journey you expected to be on, but it can still be fulfilling.

Mariah: What advice might you give to the “healthy” partner in a relationship facing chronic illness?

Logan: Honestly, I think these general thoughts apply to everyone. We often have this fairy tale idea of how relationships are supposed to look, act, evolve, etc. Get rid of that. Chronic illness or not, no one lives that life. Expectations don’t serve our purposes – for anyone. I’d also encourage the “healthy” partner to acknowledge that the situation may not be what they imagined, but that just means we have to change our definition of what fulfilling means. There are plenty of intimate things you can do to feel fulfilled – it doesn’t always have to be intercourse. Numbers and statistics and measuring seems to count, like we may see on the cover of a magazine, but the reality is that life isn’t supposed to be like that. The “healthy” partner could start by saying something like, “tell me how your pain makes you feel so I can understand where you are coming from and help you manage that.”

Mariah: Finding different ways to maintain intimacy despite pain is super important, but it can also be a challenge. Can you recommend any toys or props you think would be particularly useful for maintaining a healthy sex life while living with chronic pain?

Logan: I like to say “enhancements” rather than “toys or props,” because we are looking for something to help enhance the experience, not to replace any part of it. My advice would be less about particular products and more about things to look for. Realistically, texture can be an issue of you have sensitivity, so it may help to consider the size and weight, shape, and range of speed and pressure. Also volume, especially if you have small people in the house! Online research can be helpful – there are sites that have great reviews and people you can chat with. Or, if you have the ability, you can visit a store and feel the products yourself and ask questions. Keep in mind that what is good for one person isn’t necessarily good for another.

Mariah: Speaking of small people in the house, what advice do you have for women trying to balance chronic illness and an intimate relationship and motherhood?

Logan: Don’t expect it to be perfect and graceful all the time. Women can have and do it all – with the caveat being that we won’t do it all perfectly all of the time. It’s ok to admit that you have limitations – that doesn’t mean you don’t love your kids or partner. But you end up hurting yourself and feeling overextended if you don’t recognize your own limitations. Primary caregivers for small people also end up being touched and groped all day long, and when a partner comes home and touches you the brain doesn’t necessarily read it the way the touch was intended – it may seem like one more hand that wants something. But your partner, who may have had no physical affection all day, may see it as a rejection. We need to say “I love you, but I need you to know my brain is reading this as a demand.” This comes back to the importance of communicating our experiences to each other.

Mariah: Communication is certainly key to having a healthy intimate relationship despite chronic illness. I think you’re right that it’s important to remember that those conversations may not be easy – but they are necessary. Thanks so much for taking the time to chat about this subject!

You can find Dr. Logan Levkoff on Twitter, Facebook, Instagram, Huffington Post, and on her website. She is also partnering with Pfizer to talk about the emotional effects of living with arthritis – like how it affects sex and relationships! Visit Arthritis.com to learn more.