epublishing store: Intro

Sexual Health eBook Volume2
Chapter 14

Chronic Conditions and Disability, Annette F. Owens & Mitchell S. Tepper

Every year, millions of people around the world are either born with a disabling condition, confront a life-threatening illness that has lasting sequelae, or acquire a disability and survive. A physical and emotional roller coaster of treatment and coping often follows. Often, the most difficult adjustment involves sexual activities. An important first step back to a rewarding sexual relationship involves communicating openly and directly with partners, doctors, and other health care professionals. This is not always easy, however. People often have trouble discussing sexual issues (Partnership for Women’s Health, 1999) or simply feel lucky to be alive and therefore as if they do not have the right to “complain” about changes in sexual functioning.

The treatment of an acute medical condition usually involves little attention to the patient’s sexual functioning, unless it is the primary concern (e.g., sexually transmitted infections, including HIV/AIDS, and gynecological or reproductive disorders). In life-threatening conditions, sexual concerns usually are ascribed low or no priority at all. However, if a medical condition develops into a chronic one, the impact on sexuality gains importance.

Take, for instance, sexuality issues in women with breast cancer or in men with prostate cancer. During the initial stages of cancer treatment the sole focus is on survival. However, once the cancer survivor has completed treatment, possibly having undergone mastectomy, reconstructive surgeries, or prostatectomy, adjustment to this new situation often involves dealing with how sexuality is affected (see chapter 12, volume 4). The patient may have to adjust to a changed cosmetic appearance and lower energy levels and may be physically and emotionally drained from chemotherapy or radiation therapy, leaving little room for sexual activity; yet the need for closeness and intimacy may be stronger than ever.

Another example is an individual who has acquired a spinal cord injury (SCI). Life has taken a sudden and complete turn, and it often takes months and even years to adjust to the new situation (Tepper, Whipple, Richards, & Komisaruk, 2001). Many of these individuals are in their reproductive phases of life, and questions such as, How will I be able to attract a partner? and Will I still be able to have children? arise. Other common questions include the following: Can I still have sex? Will I still respond the same? What is the point of still having sex if I cannot feel anything? Can I still please my partner? Will my partner be able to please me? Tepper concluded that the ability to experience pleasure and orgasm in a person with an acquired SCI is the culmination of a long-term process of sexual self-discovery that is reflective of sexual discovery within the larger sexual culture (learning as you go, without any formal sources of sexuality education and many sources of misinformation) and includes reestablishing a sexual relationship with oneself and others in the context of a changed body, changed life, and changed interpersonal relationships (Tepper, 2001b).

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