Many of us will confront chronic illness in ourselves or our partners at some point in our lives. The illness may impair the nerves, hormones, or blood flow essential to sexual functioning. Some medications and side effects of treatments for the illness can also negatively affect sexual interest and response. Any accompanying pain and fatigue can

Sexual Difficulties and Solutions

At a Glance

■ TABLE 14.4 Sexual Effects of Some Abused and Illicit Drugs

Drug

Effects

Alcohol

Chronic alcohol abuse causes hormonal alterations (reduces size of testes and suppresses hormonal func­tion) and permanently damages the circulatory and nervous systems.

Marijuana

reduces testosterone levels in men and decreases sexual desire in both sexes.

Tobacco

adversely affects small blood vessels in the penis and decreases the frequency and duration of erections (Mannino et al., 1994).

Cocaine

Causes erectile disorder and inhibits orgasm in both sexes.

Amphetamines

High doses and chronic use result in inhibition of orgasm and decrease in erection and lubrication.

Barbiturates

Cause decreased desire, erectile disorders, and delayed orgasm.

SOURCE: Finger et al. (1997).

distract from erotic thoughts and sensations or limit specific sexual activities (Schover, 2000). For example, erectile dysfunction is often associated with diabetes, high blood pressure, and cardiovascular problems. In fact, when men are unable to experience erections, health-care practitioners often see the sexual problem as a predictor of these serious medical problems, particularly cardiovascular disease. In contrast, research indicates that men who experience erections but have difficulty maintaining them are more likely to have a psychological cause behind the problem (Corona et al., 2006).

The following paragraphs describe the sexual effects of specific illnesses.

Diabetes Diabetes is a disease of the endocrine system that results when the pancreas fails to secrete adequate amounts of insulin or when cells in the body are insulin resis­tant. Nerve damage and circulatory problems from diabetes cause about 50% of diabetic men to have a reduction in or loss of capacity for erection. Some diabetic men experi­ence retrograde ejaculation (ejaculating into the bladder). Heavy alcohol use and poor blood sugar control increase the chances of erectile problems in diabetic men. Women with diabetes are likely to have problems with sexual desire, lubrication, and orgasm (Diabetes Care, 2009; Wessells et al., 2011).

Cancer Cancer and its treatments can be particularly devastating to sexuality because they can impair hormonal, vascular, and neurological functions necessary for normal sex­ual interest and response. Chemotherapy and radiation therapy can cause hair loss, skin changes, nausea, fatigue, and permanent hormonal changes—all of which can negatively affect sexual feelings (Hill et al., 2011; Incrocci, 2006). Some cancer surgeries result in per­manent scars, loss of body parts, or an ostomy (a surgically created opening for evacuation of body wastes after removal of the colon or bladder)—all of which can result in a negative body image (Hill et al., 2011; Ogden & Lindridge, 2008). Pain from the cancer or its treat­ments can also greatly interfere with sexual interest and arousal (Fleming & Pace, 2001).

Although all forms of cancer can affect sexual functioning, cancers of the repro­ductive organs often have the worst impact. For example, men who have had prostate cancer often experience the absence or significant reduction of ejaculation and are 10 to 15 times more likely to experience sexual problems because of treatment (Glina, 2006; Harvard Health Publications, 2006).

Multiple Sclerosis Multiple sclerosis (MS) is a neurological disease of the brain and spinal cord in which damage occurs to the myelin sheath that covers nerve fibers. Vision, sensation, and voluntary movement are affected. Studies have found that most MS patients experience changes in their sexual functioning and that at least half have sexual

CHAPTER 14

problems. A person with MS can experience either a reduction in or a loss of sexual interest, genital sensation, arousal, or orgasm; he or she can also experience uncomfort­able hypersensitivity to genital stimulation (Smeltzer & Kelley, 1997).

Strokes Strokes, or cerebrovascular accidents, occur when brain tissue is destroyed as a result of either blockage of the blood supply to the brain or hemorrhage (breakage of a vessel, causing internal bleeding). Strokes often result in limited mobility, altered or lost sensation, impairment of verbal communication, and depression. Stroke survivors frequently report a decline in their frequency of sexual interest, arousal, and activity (Giaquinto et al., 2003; Rees et al., 2007).