Written by Dr David Delvin, GP and Christine Webber, psychotherapist
Growing numbers of people are finding their sex life suffers because they work too hard. Find out what you can do to redress the balance.
Working too hard can take its toll on your relationship.
Britain's long hours work culture means we are seeing an increasing number of people whose sex lives are going badly because of their jobs.
They say they are not making love as often as they used to and don't seem to have the energy for it either.
One high-powered exec told us: 'When I first moved in with my husband, we had sex almost every night. Now we only do it once a month. I think it's because both of us are exhausted.'
The effect of long hours on sex drive
Ebb and flow of desire
Less sex doesn't automatically point to a problem in the relationship.
Human desire tends to ebb and flow quite a bit.
Sometimes we feel really sexy and sometimes we don't.
Also, there is a natural tendency in relationships for sex to get less frequent as time goes by.
This is due to two things:
as the couple grow used to each other, the novelty of the relationship wears off
the desire for sex tends to decline with age, particularly for men.
A study published in the Journal of Sexual Medicine confirms that couples tend to have less sex as they get older, especially after the age of 50.
If you are tired, you are unlikely to have much strength left for sex - whether you are a man or a woman.
When a job is very stressful, the effect of that stress will be to diminish the amount of energy you have for sex.
You may be so stressed out, you don't even think of sex for quite long periods.
The above has always been true, but in recent years we would say long hours have become commonplace and this is having a damaging effect on a lot of people's sex lives.
We first noticed this among patients who work in the financial sector. Some of our clients start work at six in the morning, and carry on for more than 12 hours.
Often, they do not stop for lunch and many of them have a long commute at either end of the day.
So when we see a man or a woman who leaves home at 4.30am and gets back at 8.30pm, it's not surprising that they're likely to have trouble with their sex life.
Sexual difficulties caused by excessive work
No matter what your job, excessive work can cause the following sexual difficulties.
You will have less time for sex.
You will be tired so it may be difficult to summon up much interest.
You may find it more difficult to climax.
You will find it difficult to relax in bed.
If you're female, you may find it hard to produce adequate lubrication pre-intercourse.
If you're male, you may not be able to get erections easily.
Feelings of stress may make you less likely to give your partner sufficient romance and love play.
You will probably opt for doing the same things during sex.
Your partner may show disappointment or even anger towards you because of these work-induced symptoms.
Letting things continue as they are could lead to the breakdown of your relationship.
If work is affecting your love life, you need to do something about it fast. Doing nothing and just hoping things will sort themselves out is folly.
What changes can I make?
Short of giving up your job, there are no instant or magical solutions. But everyone can make small changes in their lives – no matter how busy they are.
These changes need to be ones that will bring some sort of balance into your lifestyle that does not exist currently. Such changes should help your health as well as your love life.
1. Be honest with your partner
The first thing you can do is to be honest with your partner.
We have had clients who have no desire for sex on weekdays. What they want during the week is a loving companion who will snuggle up to them and listen to what has happened in their day, but not demand sex.
If the busy person has never discussed this with their partner, it can cause a lot of upset and rowing because, understandably, the other person tends to feel rejected.
It may not be ideal to only have sex at the weekends or during holidays, but at least if both parties know this, there will be fewer unrealised expectations and fewer quarrels. In other words, the relationship should become more relaxed.
2. Give your partner some attention
It has to be said that honesty is not going to be enough to fix a rocky relationship, unless you pay your partner some real attention. He or she needs to feel affirmed and important – despite the paucity of sex.
3. Think about how you talk to your partner
It's easy to take workplace language into the home, but it can be abrupt and terse. Try not to bark out instructions to your beloved.
Use the journey home from the office to unwind and to get into a softer frame of mind. Instead of working on your laptop all the way, read a book or do a Sudoku puzzle.
You need to change gear from working mode to something a little more empathetic and human if you are to have a healthy romantic life at home.
4. Don't let work encroach on weekends and holidays
If you want to maintain your relationship, your partner will want to feel that you put him or her first at weekends and holidays. This means a complete change of pace.
Try not to bring work home or to keep checking your emails – and switch off your mobile phone.
5. Make sex special
When you do make love, try to wind down first so that you are in a more relaxed frame of mind. Partners do not want to feel that they're being used as a substitute for quick masturbation and all you care about is a swift climax.
Partners want to feel cared for and loved, so cuddle up together first or have a romantic meal. And then spend half an hour giving your loved one a massage, or have a bath or shower together.
6. Add variety in the bedroom
Try to vary your lovemaking. In our experience, very busy people tend to get into a set sexual pattern. They find a routine that works and is fast - and then use it every time.
This is boring and unimaginative. If you keep doing it, it's likely you'll both go off sex and this can spell doom for your relationship.
Lifestyle changes to reduce stress
You also need to make some lifestyle changes that will benefit your mental and physical health – and impact positively on your love life.
Eat breakfast
It is crazy to skip breakfast when it only takes three minutes in the microwave to make some porridge. This is a good way to start the day.
Oats give you a slow-release of energy and line your stomach before a tension-packed day. Or eat some muesli or another healthy cereal. If you can't face that, at least eat a couple of bananas.
Take a lunch break
You may say no-one in your office takes lunch, but why not be the exception? If you can get out of the workplace for half an hour and get some fresh air, you will feel more relaxed.
On days when you have to eat in the office, try ordering in salads, fruit and nuts. This is good fuel for your hard working body.
Drink more water
Make full use of the water cooler. People often get more tense and irritable when they are dehydrated. You will feel better if you drink water all day and cut down your coffee intake to a maximum of two or three cups a day.
Exercise more
Somehow you need to get some exercise. If you look carefully at your timetable, you should be able to find the odd half hour where you can fit in a workout or go for a swim.
If none of this is possible, get off the bus or train two stops early or park your car a few streets away and walk to work. At the office, take stairs instead of lifts between floors.
What if I don't have time to make these changes?
When you are busy and your career is going places, you probably feel you must put work first.
But unless you strive to bring some balance into your life - and you find the time to be loving and close to anyone who matters - you may find that your life begins to feel rather empty and meaningless, despite your healthy bank balance.
Further help
Specific sex problems may be disrupting your sex life that can only be resolved with specialist help. See the factsheets below for more information.
Erectile dysfunction (inability to get or maintain an erection).
Premature ejaculation (ejaculating too quickly to satisfy your partner).
Retarded ejaculation (male inability to climax).
Difficulties in climaxing (women).
Pain on intercourse.
Who to contact for sex therapy.
Friday, April 3, 2009
Who to contact for sex therapy
Written by Christine Webber, psychotherapist and Dr David Delvin, GP and psychosexual specialist
In 2009, more and more people are seeking help with their sex lives.
Whether sex and relationship problems are on the increase, or whether numbers have grown because of people's willingness to seek help, is unclear. What is clear is that if you have concerns regarding any area of your sex life, there are plenty of ways in which you can get assistance.
However, our research suggests that you may have to try pretty hard to get that help – particularly in areas of the country where therapists are rather thin on the ground.
Current NHS policy means there is very little money available for treatment of sex problems. So in most parts of the UK, you will probably have to pay for therapy or counselling.
We've put together a quick checklist of the best professionals and organisations to approach.
Your GP
For most problems, a good starting point is to visit your GP for a preliminary chat about your issues.
Of course it’s not always easy to speak about sex problems. In fact, it can be downright embarrassing. And unfortunately, it’s not only the patients who are embarrassed. Some doctors are not at all comfortable talking about sex difficulties. But it is important to speak frankly to your doctor.
If you find that your own GP isn’t very helpful, it might be worth asking to see one of the other doctors who work at the same surgery. Usually the medic who is responsible for family planning in the practice is a good bet as he or she will be used to talking about sex.
Most GPs allow 10 minutes per patient these days, but as talking about sexual problems can take a while, it might be a good idea to book a double appointment (usually 20 minutes), if this is permitted in your practice.
Your doctor may be able to offer you some immediate help. For instance, in recent years GPs have started prescribing erection drugs such as Cialis (tadalafil), Levitra (vardenafil) and Viagra (sildenafil), although the government places severe restrictions on who can receive them free of charge.
If your family practitioner can't help you, then he or she should discuss the viability of you getting free treatment on the NHS. Unfortunately, in large areas of the UK, no such free treatment is available. Nevertheless, your GP may know of private therapists in your region.
Family planning clinics
NHS family planning (FP) clinics used to be the main providers of psychosexual advice in the UK, particularly for women.
However, the current situation is that the clinics are mostly working under great pressure, so they tend to concentrate on their main job, which is providing contraception.
Many of the nurses and doctors do still have an interest in sexual problems, and will try to help you if time permits. They’re particularly good with the following difficulties:
vaginismus
low libido
poor technique
difficulty reaching orgasm
not being able to conceive.
FP clinics make no charge for giving help.
NHS hospitals
In some areas of the country there are psychosexual units at large hospitals - London and Sheffield are relatively well off in this respect.
There is invariably a waiting list, but people eventually get seen and helped. When you do get an appointment, it may be for some time well in the future. Please try to summon up the courage to attend your appointment. A lot of people get ‘cold feet’ and don’t turn up, which means a wasted appointment slot.
Treatment is free, but you will need to be referred by your GP.
Genitourinary medicine (GUM) clinics
GUM clinics treat sexually transmitted infections and can also help on all sorts of sexual issues.
They have good knowledge and lots of common sense, although the doctors are not generally highly trained in psychosexual issues because their forte is diagnosing and treating infections. In 2009, we have found that a number of clinics have doctors or nurses who offer psychosexual advice to women, but they will often specify that they do not treat erectile dysfunction (ED) or prescribe Viagra, Cialis and similar drugs.
There are concerns that waiting times for GUM clinics are growing, but it should be possible for you to see a doctor within two weeks to get some general advice. However, specialist psychotherapy and marriage guidance are definitely not provided.
All consultations are free. Your nearest GUM clinic is likely to be situated in your nearest big hospital. Ring that hospital for details of opening times. Or you can simply google ‘GUM’ – plus the name of your home town/city –and often nowadays a clinic near your home will then pop up.
NHS gynaecologists and urologists
The NHS should be able to help if a sex problem is essentially physical, for example a too wide vagina after childbirth or a bent penis.
Women are generally referred by their GPs to a gynaecologist and men to a urologist.
Some gynaecologists and urologists now provide psychosexual counselling services, and many urologists are prescribing erection-inducing drugs.
Treatment is free. Your GP should be able to advise you about who to go to and, most essentially, write you a referral letter.
Relate and Relationships Scotland
Relate is not just a relationship counselling agency.
A number of Relate counsellors have specific psychosexual training, mainly in the school of Masters and Johnson. So when you phone (0300 100 1234), make it clear that you are looking for sex therapy rather than guidance concerning relationship issues.
Relate sex counsellors are highly rated for doing an excellent job in treating various ‘technical’ bedroom problems such as:
premature ejaculation
lack of sex drive
inability to climax.
But they are not doctors, and therefore cannot examine you or prescribe medication.
Relate's fees are relatively modest and are means-based.
Relationships Scotland (until recently known as Relate Scotland) does similar good work to Relate, but north of the border. The number of your nearest clinic will be in your local phone book. The central number is 0845 1196088.
Institute of Psychosexual Medicine
The Institute of Psychosexual Medicine is an organisation of family planning doctors who have had special training in sex problems, particularly:
vaginismus
poor libido
difficulty in climaxing.
Some work in family planning clinics; others treat clients privately. Some of the latter will see a patient without a GP's referral – but not all will do this. Fees can be up to £ 150 an hour in the more expensive parts of large cities, so make sure you check beforehand.
Call the Institute on 0207 580 0631, or email them: admin@ipm.org.uk
British Association for Sexual and Relationship Therapy
The British Association for Sexual and Relationship Therapy consists mostly of non-medical personnel though some of its members are qualified doctors. All the association’s accredited members have had extensive training.
The best way to find out about a therapist in your area is to email info@basrt.org.uk
Therapists charge fees, which vary greatly in different parts of the country.
Always check what the costs will be before booking yourself in. Currently, you are likely to pay anything from around £45 to over £100.
Prices vary enormously according to the therapist’s experience and also to his or her location. Obviously, Harley Street and other central London areas are very expensive as the therapist is having to pay very high rents for a consulting room. If therapists work from home, clearly they don’t have rental costs and this tends to keep their fees down.
Sexual Dysfunction Association (SDA)
Formerly the Impotence Association, the Sexual Dysfunction Association is a national charity that tries to help both men and women find a suitable therapist or clinic for sex problems. It doesn't provide treatment or see patients, but it does have some good factsheets.
You can contact them on 0870 77 43571.
In 2009, more and more people are seeking help with their sex lives.
Whether sex and relationship problems are on the increase, or whether numbers have grown because of people's willingness to seek help, is unclear. What is clear is that if you have concerns regarding any area of your sex life, there are plenty of ways in which you can get assistance.
However, our research suggests that you may have to try pretty hard to get that help – particularly in areas of the country where therapists are rather thin on the ground.
Current NHS policy means there is very little money available for treatment of sex problems. So in most parts of the UK, you will probably have to pay for therapy or counselling.
We've put together a quick checklist of the best professionals and organisations to approach.
Your GP
For most problems, a good starting point is to visit your GP for a preliminary chat about your issues.
Of course it’s not always easy to speak about sex problems. In fact, it can be downright embarrassing. And unfortunately, it’s not only the patients who are embarrassed. Some doctors are not at all comfortable talking about sex difficulties. But it is important to speak frankly to your doctor.
If you find that your own GP isn’t very helpful, it might be worth asking to see one of the other doctors who work at the same surgery. Usually the medic who is responsible for family planning in the practice is a good bet as he or she will be used to talking about sex.
Most GPs allow 10 minutes per patient these days, but as talking about sexual problems can take a while, it might be a good idea to book a double appointment (usually 20 minutes), if this is permitted in your practice.
Your doctor may be able to offer you some immediate help. For instance, in recent years GPs have started prescribing erection drugs such as Cialis (tadalafil), Levitra (vardenafil) and Viagra (sildenafil), although the government places severe restrictions on who can receive them free of charge.
If your family practitioner can't help you, then he or she should discuss the viability of you getting free treatment on the NHS. Unfortunately, in large areas of the UK, no such free treatment is available. Nevertheless, your GP may know of private therapists in your region.
Family planning clinics
NHS family planning (FP) clinics used to be the main providers of psychosexual advice in the UK, particularly for women.
However, the current situation is that the clinics are mostly working under great pressure, so they tend to concentrate on their main job, which is providing contraception.
Many of the nurses and doctors do still have an interest in sexual problems, and will try to help you if time permits. They’re particularly good with the following difficulties:
vaginismus
low libido
poor technique
difficulty reaching orgasm
not being able to conceive.
FP clinics make no charge for giving help.
NHS hospitals
In some areas of the country there are psychosexual units at large hospitals - London and Sheffield are relatively well off in this respect.
There is invariably a waiting list, but people eventually get seen and helped. When you do get an appointment, it may be for some time well in the future. Please try to summon up the courage to attend your appointment. A lot of people get ‘cold feet’ and don’t turn up, which means a wasted appointment slot.
Treatment is free, but you will need to be referred by your GP.
Genitourinary medicine (GUM) clinics
GUM clinics treat sexually transmitted infections and can also help on all sorts of sexual issues.
They have good knowledge and lots of common sense, although the doctors are not generally highly trained in psychosexual issues because their forte is diagnosing and treating infections. In 2009, we have found that a number of clinics have doctors or nurses who offer psychosexual advice to women, but they will often specify that they do not treat erectile dysfunction (ED) or prescribe Viagra, Cialis and similar drugs.
There are concerns that waiting times for GUM clinics are growing, but it should be possible for you to see a doctor within two weeks to get some general advice. However, specialist psychotherapy and marriage guidance are definitely not provided.
All consultations are free. Your nearest GUM clinic is likely to be situated in your nearest big hospital. Ring that hospital for details of opening times. Or you can simply google ‘GUM’ – plus the name of your home town/city –and often nowadays a clinic near your home will then pop up.
NHS gynaecologists and urologists
The NHS should be able to help if a sex problem is essentially physical, for example a too wide vagina after childbirth or a bent penis.
Women are generally referred by their GPs to a gynaecologist and men to a urologist.
Some gynaecologists and urologists now provide psychosexual counselling services, and many urologists are prescribing erection-inducing drugs.
Treatment is free. Your GP should be able to advise you about who to go to and, most essentially, write you a referral letter.
Relate and Relationships Scotland
Relate is not just a relationship counselling agency.
A number of Relate counsellors have specific psychosexual training, mainly in the school of Masters and Johnson. So when you phone (0300 100 1234), make it clear that you are looking for sex therapy rather than guidance concerning relationship issues.
Relate sex counsellors are highly rated for doing an excellent job in treating various ‘technical’ bedroom problems such as:
premature ejaculation
lack of sex drive
inability to climax.
But they are not doctors, and therefore cannot examine you or prescribe medication.
Relate's fees are relatively modest and are means-based.
Relationships Scotland (until recently known as Relate Scotland) does similar good work to Relate, but north of the border. The number of your nearest clinic will be in your local phone book. The central number is 0845 1196088.
Institute of Psychosexual Medicine
The Institute of Psychosexual Medicine is an organisation of family planning doctors who have had special training in sex problems, particularly:
vaginismus
poor libido
difficulty in climaxing.
Some work in family planning clinics; others treat clients privately. Some of the latter will see a patient without a GP's referral – but not all will do this. Fees can be up to £ 150 an hour in the more expensive parts of large cities, so make sure you check beforehand.
Call the Institute on 0207 580 0631, or email them: admin@ipm.org.uk
British Association for Sexual and Relationship Therapy
The British Association for Sexual and Relationship Therapy consists mostly of non-medical personnel though some of its members are qualified doctors. All the association’s accredited members have had extensive training.
The best way to find out about a therapist in your area is to email info@basrt.org.uk
Therapists charge fees, which vary greatly in different parts of the country.
Always check what the costs will be before booking yourself in. Currently, you are likely to pay anything from around £45 to over £100.
Prices vary enormously according to the therapist’s experience and also to his or her location. Obviously, Harley Street and other central London areas are very expensive as the therapist is having to pay very high rents for a consulting room. If therapists work from home, clearly they don’t have rental costs and this tends to keep their fees down.
Sexual Dysfunction Association (SDA)
Formerly the Impotence Association, the Sexual Dysfunction Association is a national charity that tries to help both men and women find a suitable therapist or clinic for sex problems. It doesn't provide treatment or see patients, but it does have some good factsheets.
You can contact them on 0870 77 43571.
Sex, heart disease and physical disability
Reviewed by Dr Neal Uren, consultant cardiologist and Dr David Delvin, GP and sex and relationships expert
There are a many medical conditions and disabilities that make it difficult to enjoy a normal sex life.
For example, sexual intercourse may be difficult for people with any of the following conditions:
paralysis (following a stroke or a spinal injury)
severe arthritis
heart failure
severe respiratory problems (such as chronic bronchitis or emphysema)
kidney (renal) failure.
Numerically, the problem which most often affects people’s sex lives is heart disease.
Heart attacks and heart failure (cardiac insufficiency) are common, and can easily make patients feel frightened about re-starting sexual intercourse.
Unfortunately, a lot of people are embarrassed about discussing such issues. So a disabled person may find it hard to talk about his or her sexual problem or to ask for any kind of help. A reluctance to discuss things often makes the problem worse.
So do try and talk matters over with your partner and (if necessary) your doctor.
Heart disease
A patient's sex life may suffer following a heart attack or other form of heart disease, even after recovery. The patient or their spouse may be afraid that the physical strain of sexual intercourse will provoke serious heart problems.
In fact, the exertion of sexual intercourse does not usually exceed that of climbing four floors of stairs at an easy pace, provided people take things easily.
If the patient can climb four floors without breathing difficulties, significant palpitations or any much chest pain (angina), they should be able to have sex as well. Having sex may even restore their faith in their health.
After the shock of heart disease, and the natural fear of losing each other, a couple may find that their relationship is made stronger by resuming their sex life. Anyone who has had a heart attack and is concerned about having sex should ask their doctor for guidance.
Based on a text by Dr Erik Fangel Poulsen, specialist
There are a many medical conditions and disabilities that make it difficult to enjoy a normal sex life.
For example, sexual intercourse may be difficult for people with any of the following conditions:
paralysis (following a stroke or a spinal injury)
severe arthritis
heart failure
severe respiratory problems (such as chronic bronchitis or emphysema)
kidney (renal) failure.
Numerically, the problem which most often affects people’s sex lives is heart disease.
Heart attacks and heart failure (cardiac insufficiency) are common, and can easily make patients feel frightened about re-starting sexual intercourse.
Unfortunately, a lot of people are embarrassed about discussing such issues. So a disabled person may find it hard to talk about his or her sexual problem or to ask for any kind of help. A reluctance to discuss things often makes the problem worse.
So do try and talk matters over with your partner and (if necessary) your doctor.
Heart disease
A patient's sex life may suffer following a heart attack or other form of heart disease, even after recovery. The patient or their spouse may be afraid that the physical strain of sexual intercourse will provoke serious heart problems.
In fact, the exertion of sexual intercourse does not usually exceed that of climbing four floors of stairs at an easy pace, provided people take things easily.
If the patient can climb four floors without breathing difficulties, significant palpitations or any much chest pain (angina), they should be able to have sex as well. Having sex may even restore their faith in their health.
After the shock of heart disease, and the natural fear of losing each other, a couple may find that their relationship is made stronger by resuming their sex life. Anyone who has had a heart attack and is concerned about having sex should ask their doctor for guidance.
Based on a text by Dr Erik Fangel Poulsen, specialist
Sex and neurological disorders
Written by Dr David Delvin, GP and family planning specialist
What is a neurological disorder?
A neurological disorder is a disease or injury of the nervous system – which is the ‘communications network’ of the body. Common neurological disorders include strokes, multiple sclerosis (MS), Parkinson’s disease and spinal injuries – mainly caused by road accidents. Head injuries are also common, and may interfere with sexual function.
It is important to realise that the vast majority of sexual problems are not caused by any kind of neurological disease.
However, nerve disorders which can cause sexual difficulties include all the above conditions.
Strokes
Strokes (cerebrovascular accidents or CVAs) are tremendously common, and affect well over 100,000 people each year in the UK.
Many of them make a good recovery. Quite a few CVA survivors do want to continue with their sex lives – particularly men.
With the help of a cooperative and loving partner, it is often possible to continue with a reasonable amount of sexual activity, though lack of mobility may be a problem. Some couples successfully get round this with the use of vibrators.
Multiple sclerosis (MS)
Free treatment
MS is one of the few disorders which entitle the patient, under the NHS, to free treatment with drugs for erection problems.
Many men and women who have multiple sclerosis (MS) do manage to maintain a rewarding sex life. However, some patients do have difficulty in achieving orgasm. Men may sometimes have problems in getting an erection.
Fortunately, the recently developed ‘erection helping’ drugs have proved a great boon to many male MS sufferers.
Viagra (sildenafil) works in about half of these patients. If it is not successful, then it’s well worth trying its newer successors: Cialis (tadalafil) and Levitra (vardenafil).
If these drugs fail, there is also the possibility of penile injections, or of using a vacuum pump.
Parkinson’s disease
Parkinson's disease is extremely common, and has become more so as people have started to live longer.
It causes trembling and incordination in various parts of the body. The difficulty in coordination may cause problems with intercourse, and sometimes with erection.
Fortunately, the oral treatments for erectile dysfunction (ED) can help these patients, and they are not contraindicated in men with Parkinson's disease. Under the NHS regulations, these drugs are available free if you have Parkinson’s disease.
Spinal injuries
Serious spinal injuries – most commonly sustained in traffic, riding or aircraft accidents – are likely to cause paralysis and loss of sensation in regions of the body below the level of the damage to the spinal cord.
Unfortunately, sexual function is very often affected. Men may lose the ability to get an erection – and obviously this may make it very difficult for them to have children.
However, many people with spinal injuries do manage to have a fairly active sex life – particularly if they have a considerate, loving and inventive partner.
Furthermore, the new drugs to treat ED will help many men who have sustained spinal trauma. NHS rules allow free prescription of these drugs if you have a spinal cord injury.
If the man wants to father children, this may sometimes be possible using recently developed methods of obtaining sperm, such as electro-ejaculation – in which an electric stimulus is applied to the prostate area, via the rectum.
The cost of this treatment is considerable, but if you were injured in an accident through no fault of your own, your compensation payment may cover it.
At a conference we attended in 2008, it was stated that a cheaper alternative to electrotherapy is the use of a male specially-designed vibrator, operating at a particular frequency.
Useful organisations
Organisations which can provide further information that may help your sex life include:
The Stroke Association: helpline: 0845 3033100.
Multiple Sclerosis Society: helpline: 0808 800 8000.
Parkinson's Disease Society: helpline: 0808 800 0303.
Spinal Injuries Association: helpline: 0800 980 0501.
Outsiders Sex and Disability helpline: telephone: 0707 499 3527.
What is a neurological disorder?
A neurological disorder is a disease or injury of the nervous system – which is the ‘communications network’ of the body. Common neurological disorders include strokes, multiple sclerosis (MS), Parkinson’s disease and spinal injuries – mainly caused by road accidents. Head injuries are also common, and may interfere with sexual function.
It is important to realise that the vast majority of sexual problems are not caused by any kind of neurological disease.
However, nerve disorders which can cause sexual difficulties include all the above conditions.
Strokes
Strokes (cerebrovascular accidents or CVAs) are tremendously common, and affect well over 100,000 people each year in the UK.
Many of them make a good recovery. Quite a few CVA survivors do want to continue with their sex lives – particularly men.
With the help of a cooperative and loving partner, it is often possible to continue with a reasonable amount of sexual activity, though lack of mobility may be a problem. Some couples successfully get round this with the use of vibrators.
Multiple sclerosis (MS)
Free treatment
MS is one of the few disorders which entitle the patient, under the NHS, to free treatment with drugs for erection problems.
Many men and women who have multiple sclerosis (MS) do manage to maintain a rewarding sex life. However, some patients do have difficulty in achieving orgasm. Men may sometimes have problems in getting an erection.
Fortunately, the recently developed ‘erection helping’ drugs have proved a great boon to many male MS sufferers.
Viagra (sildenafil) works in about half of these patients. If it is not successful, then it’s well worth trying its newer successors: Cialis (tadalafil) and Levitra (vardenafil).
If these drugs fail, there is also the possibility of penile injections, or of using a vacuum pump.
Parkinson’s disease
Parkinson's disease is extremely common, and has become more so as people have started to live longer.
It causes trembling and incordination in various parts of the body. The difficulty in coordination may cause problems with intercourse, and sometimes with erection.
Fortunately, the oral treatments for erectile dysfunction (ED) can help these patients, and they are not contraindicated in men with Parkinson's disease. Under the NHS regulations, these drugs are available free if you have Parkinson’s disease.
Spinal injuries
Serious spinal injuries – most commonly sustained in traffic, riding or aircraft accidents – are likely to cause paralysis and loss of sensation in regions of the body below the level of the damage to the spinal cord.
Unfortunately, sexual function is very often affected. Men may lose the ability to get an erection – and obviously this may make it very difficult for them to have children.
However, many people with spinal injuries do manage to have a fairly active sex life – particularly if they have a considerate, loving and inventive partner.
Furthermore, the new drugs to treat ED will help many men who have sustained spinal trauma. NHS rules allow free prescription of these drugs if you have a spinal cord injury.
If the man wants to father children, this may sometimes be possible using recently developed methods of obtaining sperm, such as electro-ejaculation – in which an electric stimulus is applied to the prostate area, via the rectum.
The cost of this treatment is considerable, but if you were injured in an accident through no fault of your own, your compensation payment may cover it.
At a conference we attended in 2008, it was stated that a cheaper alternative to electrotherapy is the use of a male specially-designed vibrator, operating at a particular frequency.
Useful organisations
Organisations which can provide further information that may help your sex life include:
The Stroke Association: helpline: 0845 3033100.
Multiple Sclerosis Society: helpline: 0808 800 8000.
Parkinson's Disease Society: helpline: 0808 800 0303.
Spinal Injuries Association: helpline: 0800 980 0501.
Outsiders Sex and Disability helpline: telephone: 0707 499 3527.
Sex and diabetes
Reviewed by Dr David Delvin, GP and psychosexual specialist, Christine Webber, Psychotherapist and Dr Dan Rutherford, GP
If diabetes causes sexual problems, talk to your GP.
Twenty-five per cent of all women with diabetes and about 50 per cent of men will experience some kind of sexual problems or loss of sexual desire as a result of their condition.
What problems does diabetes cause?
In men
Long-term diabetes can cause damage to the nervous system, which is involved in the complex process of erection.
This means men with diabetes may suffer from erectile dysfunction (ED) and be unable to get or maintain an erection. As many as a third of men with diabetes eventually experience ED.
Some men only discover they have diabetes when they seek treatment for their erectile dysfunction.
Once diabetes has been regulated through diet, pills or insulin injections, sexual problems often disappear and the ability to get an erection is restored.
In women
A number of women with diabetes may suffer from recurring vaginitis (inflammation of the vagina), which is usually due to yeast (thrush) infection. This makes sex painful. You may suffer itching or burning sensations, and a white discharge.
Women with diabetes may also get recurring cystitis.
There is also some suggestion that women with diabetes have problems with arousal, and just as the penis fails to become erect in the man, the clitoris in a woman may not respond to stimulation in the normal way.
Can you make your sex life work when you have diabetes?
If you feel diabetes is causing problems with your sex life, talk to your doctor.
While no-one relishes talking about sexual problems with a doctor, these issues can only be addressed if you seek help.
Your GP will try to find out whether sexual problems are caused by defects in the nervous or circulatory system as a result of the diabetes, or whether they are of a more psychological nature. Often this distinction is difficult to make.
In any case, when sexual dysfunction begins to happen on a regular basis it tends to get worse unless it is properly treated, so the psychological element inevitably builds up.
An increasing number of men who have diabetes and ED are being helped by medicines such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).
If tests confirm that your nervous system hasn't been damaged by diabetes, and there are no associated circulatory problems, there's no reason why your sex life shouldn't recover.
Sometimes a little help and support from your partner and doctor is all that's needed.
What can be done about sexual problems that are not caused by diabetes?
This is a sensitive issue, but help is available.
Generally the most useful first port of call is your family doctor, who can refer you (and your partner) to a psychosexual therapist – or relationship counsellor if this is more appropriate.
Try not to dwell on the fact diabetes can cause sexual problems – just because it can, doesn't mean it will.
And if you do experience difficulties, be reassured that nowadays there is a lot of help available:
Diabetes UK
Relate
British Association for Sexual and Relationship Therapy.
Based on a text by Dr Erik Fangel Poulson, Specialist
Sex and cancer
Reviewed by Christine Webber, psychotherapist and lifecoach and Dr David Delvin, GP and family planning specialist
Does cancer cause sexual problems?
Yes, very frequently. You see, it is always a shock for people to be told that they have cancer or any other serious illness. Their lives are suddenly dominated by medical examinations and treatment – and quite naturally all of their attention is focused on the disease.
In this frightening situation, it's not unusual for sex to take a back seat for a time. But after a while, when the patient has gathered enough strength to look forward and to take an interest in good health and a normal life once again, he or she will almost certainly rediscover an interest in sex. But it may be difficult to resume sexual relations - particularly if you are tired or in pain.
Does cancer cause problems in a relationship?
In most relationships, serious illness can result in anxiety and uncertainty. Furthermore, the patient may be afraid that sex could cause physical injuries.
Even after patients recover, they may worry that having sex will cause the illness to break out again. People may also have irrational fears that the illness may be contagious or sexually transmitted.
These kinds of thoughts and misconceptions can make a relationship come to a standstill. It's vital for couples in this situation to talk to each other - and to a doctor - to dispel any fears or uncertainties.
They may also benefit greatly from being referred to a medical expert specialising in psychosexual medicine, or from getting some counselling with a sex or relationship therapist.
Can it be dangerous to have sex when you have cancer?
Unless the cancer affects the genital area, there is usually no reason why the patient should not have sex.
It is a good idea for cancer patients to discuss with their doctor whether or not they can have sex. If possible, this question should be raised early in the illness before any potential operation or complicated medical treatment such as chemotherapy has begun.
Unfortunately, it has to be said that – even today – not all doctors are comfortable talking about this subject. Sometimes a nurse, or a counsellor, is a better person to chat to.
It is extremely important that patients are kept well informed about their illness and its immediate consequences in the short term and in the long term.
They will want to know what impact it will have on every aspect of their life – including their sex life. For instance, people need to know whether the treatment will have any effect on their sexual function or fertility.
Are the patient's sexual problems caused by factors other than cancer?
If a patient experiences difficulties with sex after cancer or any other serious disease, it may help if they ask themselves the following questions: 'Are my sexual problems a result of the disease itself or are they caused by other things in my relationship?'
If a person is not sure that he or she is capable of functioning sexually it might help to try to achieve orgasm by masturbation. If this ‘works', then that is a sign that the basic mechanics of the sexual apparatus are functioning properly.
If sexual difficulties arise, it is essential that you ask a GP or specialist whether the problem is due to:
the cancer
the treatment of the cancer
other factors such as psychological causes.
What can be done if cancer has led to a physical disability that affects the performance of the sex organs?
Remember that loss of sensation does not mean loss of feelings. If the illness has resulted in a male patient becoming impotent he should bear in mind that there are many highly effective treatments for impotence these days.
But he should also realise that he can still be loving towards a partner and help him or her have orgasms by methods other than intercourse. It is very possible for people to have sexual relationships even if the function of their genitals has been lost.
Any cancer patient – male or female – who has sex or relationship problems will also probably benefit from being involved in one or other of the excellent cancer patients' support groups. It is very useful to chat to other people who are going through similar problems to your own. This communication will help you feel less hopeless and less isolated.
Based on a text by Dr Erik Fangel Poulson, specialist
Does cancer cause sexual problems?
Yes, very frequently. You see, it is always a shock for people to be told that they have cancer or any other serious illness. Their lives are suddenly dominated by medical examinations and treatment – and quite naturally all of their attention is focused on the disease.
In this frightening situation, it's not unusual for sex to take a back seat for a time. But after a while, when the patient has gathered enough strength to look forward and to take an interest in good health and a normal life once again, he or she will almost certainly rediscover an interest in sex. But it may be difficult to resume sexual relations - particularly if you are tired or in pain.
Does cancer cause problems in a relationship?
In most relationships, serious illness can result in anxiety and uncertainty. Furthermore, the patient may be afraid that sex could cause physical injuries.
Even after patients recover, they may worry that having sex will cause the illness to break out again. People may also have irrational fears that the illness may be contagious or sexually transmitted.
These kinds of thoughts and misconceptions can make a relationship come to a standstill. It's vital for couples in this situation to talk to each other - and to a doctor - to dispel any fears or uncertainties.
They may also benefit greatly from being referred to a medical expert specialising in psychosexual medicine, or from getting some counselling with a sex or relationship therapist.
Can it be dangerous to have sex when you have cancer?
Unless the cancer affects the genital area, there is usually no reason why the patient should not have sex.
It is a good idea for cancer patients to discuss with their doctor whether or not they can have sex. If possible, this question should be raised early in the illness before any potential operation or complicated medical treatment such as chemotherapy has begun.
Unfortunately, it has to be said that – even today – not all doctors are comfortable talking about this subject. Sometimes a nurse, or a counsellor, is a better person to chat to.
It is extremely important that patients are kept well informed about their illness and its immediate consequences in the short term and in the long term.
They will want to know what impact it will have on every aspect of their life – including their sex life. For instance, people need to know whether the treatment will have any effect on their sexual function or fertility.
Are the patient's sexual problems caused by factors other than cancer?
If a patient experiences difficulties with sex after cancer or any other serious disease, it may help if they ask themselves the following questions: 'Are my sexual problems a result of the disease itself or are they caused by other things in my relationship?'
If a person is not sure that he or she is capable of functioning sexually it might help to try to achieve orgasm by masturbation. If this ‘works', then that is a sign that the basic mechanics of the sexual apparatus are functioning properly.
If sexual difficulties arise, it is essential that you ask a GP or specialist whether the problem is due to:
the cancer
the treatment of the cancer
other factors such as psychological causes.
What can be done if cancer has led to a physical disability that affects the performance of the sex organs?
Remember that loss of sensation does not mean loss of feelings. If the illness has resulted in a male patient becoming impotent he should bear in mind that there are many highly effective treatments for impotence these days.
But he should also realise that he can still be loving towards a partner and help him or her have orgasms by methods other than intercourse. It is very possible for people to have sexual relationships even if the function of their genitals has been lost.
Any cancer patient – male or female – who has sex or relationship problems will also probably benefit from being involved in one or other of the excellent cancer patients' support groups. It is very useful to chat to other people who are going through similar problems to your own. This communication will help you feel less hopeless and less isolated.
Based on a text by Dr Erik Fangel Poulson, specialist
Sex and alcohol
Written by Dr David Delvin, GP and family planning specialist
Alcohol affects people’s sex lives in many ways. We can divide its effects into ‘bad’ and ‘good.’
Good effects of alcohol
Small amounts of alcohol oil the social wheels and reduce shyness – thereby making it easier for people to meet up.
Similarly, a little wine or a cocktail will often make a person feel romantic – or perhaps less ‘uptight’ about sex.
Also, a very small ‘dose’ of alcohol can extend the time which a nervous young man takes before he climaxes – thus combating any slight tendency to come too soon or experience mild premature ejaculation (PE). However, alcohol is not a treatment for this condition.
Bad effects of alcohol
Unfortunately, the list of ‘bad’ effects of alcohol is much longer! Here they are:
Alcohol makes people far more likely to have unwise sex with the wrong person – and therefore to get pregnant, to catch infections, and to embark on affairs that cause marriage break-ups. In fact, booze is the main reason why in 2005, there is a massive demand for the ‘morning-after pill’ on Saturday, Sunday and Monday mornings.
Alcohol makes people fuddled, so that they don’t take proper contraceptive precautions.
Alcohol is bad for the unborn baby – so it should only be taken very sparingly in pregnancy. During 2008, there have been conflicting reports about how safe it is for pregnant women. Some authorities feel that during pregnancy it should be avoided totally. At present we don’t know whether alcohol taken on the night of conception could be bad for the baby.
Alcohol is a major cause of impotence (erectile dysfunction). A lot of younger males don’t realise this, because they think that booze boosts ‘horniness'. But as Shakespeare says in the Scottish play: ‘It increases the desire, but it takes away the performance.’
A lot of men who are hooked on alcohol develop permanent ‘Brewer’s droop’ – and often loss of interest in sex as well.
We do not yet know if excessive alcohol use can cause female sexual problems, but on the basis of probabilities it does seem likely that some cases of diminished libido are due to excessive alcohol consumption.
If you have problems with excessive alcohol use or think you may be suffering from alcoholism, we suggest you contact Alcoholics Anonymous.
Alcohol affects people’s sex lives in many ways. We can divide its effects into ‘bad’ and ‘good.’
Good effects of alcohol
Small amounts of alcohol oil the social wheels and reduce shyness – thereby making it easier for people to meet up.
Similarly, a little wine or a cocktail will often make a person feel romantic – or perhaps less ‘uptight’ about sex.
Also, a very small ‘dose’ of alcohol can extend the time which a nervous young man takes before he climaxes – thus combating any slight tendency to come too soon or experience mild premature ejaculation (PE). However, alcohol is not a treatment for this condition.
Bad effects of alcohol
Unfortunately, the list of ‘bad’ effects of alcohol is much longer! Here they are:
Alcohol makes people far more likely to have unwise sex with the wrong person – and therefore to get pregnant, to catch infections, and to embark on affairs that cause marriage break-ups. In fact, booze is the main reason why in 2005, there is a massive demand for the ‘morning-after pill’ on Saturday, Sunday and Monday mornings.
Alcohol makes people fuddled, so that they don’t take proper contraceptive precautions.
Alcohol is bad for the unborn baby – so it should only be taken very sparingly in pregnancy. During 2008, there have been conflicting reports about how safe it is for pregnant women. Some authorities feel that during pregnancy it should be avoided totally. At present we don’t know whether alcohol taken on the night of conception could be bad for the baby.
Alcohol is a major cause of impotence (erectile dysfunction). A lot of younger males don’t realise this, because they think that booze boosts ‘horniness'. But as Shakespeare says in the Scottish play: ‘It increases the desire, but it takes away the performance.’
A lot of men who are hooked on alcohol develop permanent ‘Brewer’s droop’ – and often loss of interest in sex as well.
We do not yet know if excessive alcohol use can cause female sexual problems, but on the basis of probabilities it does seem likely that some cases of diminished libido are due to excessive alcohol consumption.
If you have problems with excessive alcohol use or think you may be suffering from alcoholism, we suggest you contact Alcoholics Anonymous.
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