Intimacy spans a wide spectrum. Sex is one form of intimacy. Emotional connection is another. How we may feel and express sexual connection and pleasure is contingent on where we are in life. When we encounter chronic or serious illness and disability, changes such as pain, losing your hair, living with an ostomy, or needing wound care can bring up personal feelings about your body and relationships. What feels intimate, pleasurable, or comforting may be changing, and it can take time to understand or discover what you want now. Courageously facing this aspect of illness and change will guide important quality-of-life conversations with yourself, your loved ones, and your medical team.
These four practices offer ways to explore your connection with yourself, talk with a partner about changing needs, and bring questions to your medical team.
Start with connection
Sex and intimacy is a connection between people. It is dynamic, and as roles change, the relationship also changes. Going from spouse to patient or from partner to caregiver revises the tenor of our relationships, and how we relate to each other sexually and intimately.
Everyone relates differently to their bodies. Some of us are gloriously embodied and accepting creatures. Others carry shame or negativity for whole lifetimes. Society hasn’t helped us on that front, and quite frankly—the medical field doesn’t always embrace direct, empathetic conversations about body image, vulnerability, and intimacy.
When your body undergoes radical or even slow changes, it is an opportunity to get curious about your connection with yourself. What have you always enjoyed in the realm of sex and sensuality? Within an honest answer to that question may lie an answer to what may fulfill sensual needs now. For some people, retaining a sex life may feel vital and urgent. For others, it ranks dead last on their list of needs.
Go gently. Give yourself time to take in what your body is going through—create room for healing alongside heartache.
Changing body, changing needs
Illness and treatment changes your body, your sex drive, and your energy. Acknowledging the adjustments to an altered body, a diagnosis is crucial, and provides reprieve—a little less pressure to maintain established rhythms of sex and intimacy. If you have a partner, express your needs and desires plainly.
Finding your way to non-sexual forms of intimacy may feel vulnerable or awkward, yet may feel beautiful and grounding in practice. That might mean touch with no expectation of sex, holding hands while watching a movie, or taking a walk outside. Let yourself express your desires and boundaries.
Throughout this process communication is paramount and big questions may need to be asked for the first time:
- How are you feeling about your sex life?
- What do you need?
- How can you be of service to your partner(s)?
In these moments, it is understandable to feel down, depressed, anxious, or even angry. This can further contribute to changes in sex drive, but maybe you need space to share your anxieties about these changes. These feelings, while challenging to disclose, are important to discuss openly so they do not ossify, and may open to other forms of affection and closeness.
If your partner has a stronger sex drive than you do, talking honestly can help you understand each other’s needs. Claim the space to say what needs to be said and discuss how to turn up for each other while staying true to what each of you wants.
Honor deep vulnerability
Giving someone access to our thoughts and bodies can be tender and fraught. Sometimes, it may be beautiful and transcendent, or it will also veer towards clunky and awkward. Expressing your vulnerability is an opportunity to open up new conversations and possibilities, and another way to convey intimacy.
When you are sick, nauseous, or scared, it can be hard to feel curious. During those times, set expectations aside and consider what might help you feel connected to your body. Could it be dancing in your kitchen, listening to music, taking a drive, writing outside in a park? Trying a spiral hands exercise? If you’re stumped, try and remember how you found comfort as a kid, and find your way back to the residue of that practice. You might find a trace of that impulse, in a form that feels possible for your body now.
Talk with clinicians
Doctors are not always great at talking about how sex and intimacy change when you’re sick because it’s usually not a formal part of their training. If your medical team does not broach the topics of sex and intimacy, we as patients will need to raise the conversation. This can be as basic as asking whether it’s safe to have sex, what sexual side effects a treatment may cause, or what might help with pain during sex. If it feels awkward, you might begin with, “I have something sensitive to discuss. Can I talk with you alone?”. These conversations are inherently personal and may cause unexpected feelings to arise, but this is a vital and important conversation to have: it’s your body and your time to ask about it.
Ultimately, the purpose of intimacy is connection, and a form of connection that can be deeply nourishing and comforting. You can explore what serves as a salve with room for your needs and desires to change. This doesn’t mean it requires physical intercourse to connect. For some people, physical intercourse is centrally important, yet, for others, it may be a relief to explore something new and unexpected. Exploring how you feel pleasure or soothed, whether by yourself or with a partner, can help to keep you connected and in touch with the world around you.
