“That part of my life is over” said my lovely 68 year old patient as she sat at my consultation desk across from me at our first meeting. I had asked if she and her husband were sexually active, as part of our initial intake. When she answered she didn’t exactly seem unhappy — more like resigned — like that it was just a “given” that the answer to the question was “no”. Of course my automatic follow-up question was “Is that ok with both of you?” (Lesson #1 of evaluating sexual disorders= it’s only a problem if the patient thinks it’s a problem). Her answer was sad — “No it’s not ok! I love my husband and I want to, and I know he wants to. But we can’t. So we don’t. And then we don’t talk about it and we just live this way.” She suddenly seemed teary eyed at the prospect of actually letting it all out.
This is actually not an uncommon scenario — and not necessarily restricted to the over-65 age group. Truth is many couples for many different reasons lose that part of their relationship gradually and never address it. If it causes distress then it is something that should definitely be discussed in the doctor’s office — even if the doctor or health care provider doesn’t initiate the conversation.
With this particular patient (as with all others) it was important to get a history on the problem — what was the relationship like before? Physically? Emotionally? What prompted the decrease in sexual interest and activity? Was it a physical problem? A relationship issue? Was there pain? Illness? Just lack of interest? To use an old adage — which is more true in intimate and physical relationships than almost anywhere else — “if you don’t use it you lose it!” — meaning once the habit of NOT having sex becomes an established pattern, as time goes on, both physically and emotionally, it becomes more and more difficult to return to having that sexual relationship again.
In this case, as time went by, the patient noted that intercourse was beginning to get uncomfortable. They initially tried various positions and lubricants, and even used coconut oil, on someone’s recommendation but it did not seem to relieve the discomfort. She found that her bladder would get irritable after sex, and remain so for days, and sometimes she would just feel sore. This went on for awhile and she was reluctant and embarrassed to talk to anyone about it…