The Caregiver's Handbook

Caring for a loved one—and yourself

What About Sex?

You want it, they don’t. They want it, you don’t.

Frustrated and embittered men and women frequently pose that question – or launch it angrily at their partner. Just what do you do when you want sex and your partner doesn’t, or you want sex but your partner simply can’t participate, or they want sex and you don’t? After reading my article, “Who Cares for the Caregivers”, one woman queried, “What about sex…if your partner is too sick to participate, but demands that you still be completely faithful?” Fortunately, whether your loved one is healthy or not, there are practical strategies for resolving these dilemmas and making your life and relationships more peaceful, loving and satisfying.

Intimacy vs. sex

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Your sex life may have deteriorated so much that you’d be delighted to reestablish any form of intimacy, but don’t know how. Or, like our enquirer, you desire intercourse irrespective of your loved one’s abilities or wishes. But, how do you even broach this sensitive topic?

You want sex but your loved one can’t or won’t participate.

Your loved one may have lost function or sex drive due to illness, hormonal changes, anger or depression. Or they may fear a repeated medical incident. Whether caused by illness, a lost job or financial crisis, your loved one’s sense of self may have taken a hit, destroying your sex life in the process.

That’s what Alice found with Albert. Now in their 50s, terrific sex was always important to them. But Albert suffered a heart attack and was angry, depressed and feared a second attack. So he chose to stay in bed--wearing the same pajamas for days. He didn’t want to talk, and mostly snarled at Alice if she suggested he do anything. Romance?! Alice was lucky to hear a civil word from him. Fortunately, Alice learned that the romance and her marriage did not have to be over if she used the collaborative communication tools discussed below.

Avoid being adversarial. Their relationship had deteriorated so drastically that they had to start with very simple steps on their path to intimacy. Alice began by identifying and clarifying her concerns. Rather than faulting Albert for his lack of interest in her, his poor hygiene or how he wasn’t a complete husband any longer, what bothered her most was that she missed Albert; so would share that with him. Not knowing how to approach him about anything these days, she learned simple ways to begin a conversation. Rather than starting with “WE NEED TO TALK!”, she used the more effective approach of “Honey, I’d like to talk…”, or “Honey, I’m concerned about…”.

Now using these and other techniques she learned in my book, she and Albert agreed that one night a week she would make a favorite meal. When he joined her, they reclaimed some intimacy. When he didn’t, she said nothing instead of screaming at him as she had before. Now there was a more relaxed atmosphere in the house for both of them. Through simple agreements such as these, they created ways to put intimacy and romance back into their marriage, opening the door for passionate sex to return.

When necessary, agree to disagree. Alice learned that some people agree to disagree when they reach an impasse. This replaces discord with peace, yet still leaves options. Of course, there is one-person sex in many forms which can be done either privately or in the presence of a loved one. Affairs are another alternative. If you wish to have an affair, think long and hard before deciding to broach this with your loved one. If you decide to, collaborative communication provides the best likelihood of a good outcome. Some spouses give permission, while others are vehemently opposed, ill or not. Most likely the spouses who give permission offer that as an option, rather than the desiring partner/caregiver requesting it. Pros and cons of affairs are explored in my article, “Affairs are Self Indulgent”.

Your loved one wants sex, you don’t.

You may not want sex, yet your loved one now requires even more--no matter what their physical or psychological condition. They may have faced their mortality, don’t want to miss a moment of living, or want to prove they’ve still “got it”. As a caregiver, you think “Who has the energy to have sex on top of my other duties!” And how can you think of having sex with someone you now spoon feed, or clean after a visit to the bathroom–someone who looks bad and smells bad? Besides, since you probably have avoided self-care in order to care for your spouse, it’s been a long time since you pampered yourself in order to feel sexy.

Married in their 20s, Paulo and Patricia are now forty-five. Patricia had a stroke which left her right arm limp, unable to move easily in bed, and unable to perform personal self care. Nevertheless, she wants to be satisfied and nags Paulo about it daily. Paulo has many work obligations, and has to take care of cooking, cleaning and Patricia’s special needs when he gets home. Paulo finds Patricia’s limp arm, the resulting poor hygiene, emergency clean ups, and her demanding attitude a turnoff. A shift from caregiver to lover is almost impossible. What can he do?

Make agreements that work for you. Men tend to be visual and arousal can’t occur if they are turned off by what they see. Women are physically able to work around being turned off a little more easily. In either case, collaborative communication is the answer.

Using the same learned communication tools as Alice, Paulo and Patricia arrived at very specific agreements. Sex had been a major battlefield, and bad feelings from their arguments spilled into every area of their life. They each had their opinion, and those would not change--ever. So, in order to reclaim the friendship part of their relationship, they reached an understanding that sex would not be discussed again. But in order to satisfy Patricia’s needs, Paulo conceded to once a week – if Patricia had an aide clean her that day. This created peace and calmness where once there had been dissension and turmoil. So, even though the outcome was not ideal, they found hope for reclaiming some intimacy in their marriage.

Of course intimacy can exist in many forms from lying next to your love, holding hands, just looking into each other’s eyes or active sex. Whatever is appropriate for, and acceptable to you, sets the standard. Whatever that may be, collaborative communication will provide the hope, and the key, to keeping your marriage, and ensuring that the love you shared will not disintegrate.

Diana B. Denholm, Ph.D., L.M.H.C., is a medical psychotherapist and the author of The Caregiving Wife's Handbook.

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