Подпись:Other conditions that affect sexual functioning are the respiratory illnesses, including chronic obstructive pulmonary disease (COPD), asthma, and tuberculosis. These dis­eases affect sexual functioning not only because they may make physical exertion difficult, but also because perceptual and motor skills can be impaired. The 20 million people who have COPD learn to take medicine before sexual activity, slow down their pace of lovemaking, and use positions that allow the partner with COPD to breathe comfortably.

Many other chronic illnesses call for special types of sexual counseling and under­standing. In order to understand the challenges that chronic illness poses to sexual func­tioning, we will now review a sample of such conditions and examine the types of sex­ual challenges they present.

Diabetes

Diabetes is caused by the inability of the pancreas to produce insulin, which is used to process blood sugar into energy, or by the inability of the body to use the insulin pro­duced. Diabetes may affect children (type I diabetes), who must then depend on insulin injections for the rest of their lives, or it may appear later (type II diabetes) and may then be controlled through diet or oral medication. Diabetes is a serious condition that can ultimately lead to blindness, renal failure, and other problems.

Diabetes is often used to demonstrate the effects of disease on sexuality because di­abetics tend to exhibit multiple and complex sexual difficulties. In fact, sexual problems (especially difficulty in getting an erection for men and vaginitis or yeast infections in women) may be one of the first signs of diabetes. A large number of men in the later stages of diabetes have penile prostheses implanted. Women with Type I diabetes, aside from some problems with vaginal lubrication, do not seem to have significantly more problems than unaffected women. However, women with Type II diabetes show loss of desire, difficulties in lubrication, less satisfaction in sex, and difficulty reaching orgasm (Schover & Jensen, 1988).

Differentiating between how much of a person’s sexual difficulty is due to underly­ing physiological problems and how much is due to psychological issues is often difficult. Depression, fear of erectile disorder, lack of sexual response, anxiety about the future, and the life changes that diabetes can bring all can dampen sexual desire. Sexual coun­seling is an important part of diabetes treatment. From a sexual standpoint, Viagra may be helpful for men with diabetes who are experiencing ED, enabling them to successfully engage in sexual intercourse again (Fink et al., 2002).