1. Copyright Atomic Dog Publishing, 2004 Chapter Thirteen Illness, Disability, Drugs, and Sexuality

2. Copyright Atomic Dog Publishing, 2004 Illness, Disability, and the Myth of Asexuality Disability: Health condition that involves functional deficits in performing activities of daily living. There is little direct empirical evidence for belief that individuals with disease or disability are perceived as asexual—that is, as having no interest in sexual expression and no capacity for experiencing physical pleasure and intimacy.

3. Copyright Atomic Dog Publishing, 2004 Effects of Illness and Disability on Self-Concept and Body Image In general, persons with chronic illness or disability are vulnerable to developing a negative self-concept and body image, and viewing themselves as undesirable or inadequate romantic and sexual partners. Despite the challenges and obstacles, many ill and disabled individuals succeed in developing and maintaining a positive self-concept and body image.

4. Copyright Atomic Dog Publishing, 2004 Impaired Sensory – Motor Function and Sexuality - 1 The Spinal Cord and Sexual Response

5. Copyright Atomic Dog Publishing, 2004 Impaired Sensory – Motor Function and Sexuality - 2 Stroke Sudden disturbance in the blood supply to the brain caused by hemorrhage from rupture or blockage of a blood vessel Sexual dysfunctions may include declines in:  Sexual desire  Erectile function  Orgasmic ability  Vaginal lubrication  Coital frequency

6. Copyright Atomic Dog Publishing, 2004 Impaired Sensory – Motor Function and Sexuality - 3 Spinal Cord Injury Quadriplegia: Paralysis from the neck down Paraplegia: Paralysis of the lower half of the body Some form of sexual arousal can be achieved in most victims of spinal cord injury

7. Copyright Atomic Dog Publishing, 2004 Impaired Sensory – Motor Function and Sexuality - 3 Multiple Sclerosis (MS) A progressive disease that attacks the central nervous system. Sexual dysfunctions include:  Reduced genital sensation or pain  Vaginal dryness  Loss of libido  Erection problems  Ejaculation problems  Orgasmic problems

8. Copyright Atomic Dog Publishing, 2004 Impaired Sensory – Motor Function and Sexuality - 4 Cerebral Palsy (CP) Condition often caused by brain damage that occurs before or during birth or in infancy, resulting in muscular impairment and sometimes speech and learning disabilities.

9. Copyright Atomic Dog Publishing, 2004 Diabetes and Sexuality Diabetes Mellitus: Chronic disease in which the pancreas fails to produce sufficient insulin. In women, diabetes can result in lack of libido, diminished clitoral sensation, vaginal dryness and discomfort, and orgasmic dysfunction. Diabetic men may notice a progressive softening of the penis, eventually leading to the inability to perform vaginal penetration.

10. Copyright Atomic Dog Publishing, 2004 Impaired Cognitive Function and Sexuality - 1 Alzheimer’s Disease and Other Forms of Dementia Dementia Brain disorder involving multiple cognitive deficits, including memory impairment and at least one of the following:  Aphasia: Impaired communicative ability  Agnosia: Loss of auditory, sensory, or visual comprehension  Apraxia: The inability to perform coordinated movements

11. Copyright Atomic Dog Publishing, 2004 Impaired Cognitive Function and Sexuality - 2 Alzheimer’s disease: Progressive and degenerative brain disease progressing from mild memory loss, through significant cognitive impairment, to very serious confusion and the loss of ability to manage activities of daily living, such as dressing, eating, and bathing. Inappropriate sexual behavior may occur Partners face a variety of sexual problems

12. Copyright Atomic Dog Publishing, 2004 Impaired Cognitive Function and Sexuality - 3 Traumatic Brain Injury A closed head injury that results from an exterior force and creates a temporary or enduring impairment in brain functioning. Despite common belief, TBI results in decreased sexual frequency Mental Retardation/Intellectual Disability A condition which involves subaverage intellectual functioning and deficits in adaptive behavior  Sexual Consent Capacity  Sterilization and Mental Retardation  Sex Education for Individuals with Mental Retardation

13. Copyright Atomic Dog Publishing, 2004 Impaired Cognitive Function and Sexuality - 4 Mental Retardation/Intellectual Disability A condition which involves subaverage intellectual functioning and deficits in adaptive behavior. Aspects of sexual behavior:  Sexual Consent Capacity  Sterilization and Mental Retardation  Sex Education for Individuals with Mental Retardation

14. Copyright Atomic Dog Publishing, 2004 Mental Illness and Sexuality Mental Disorders Mental states characterized by mild to severe disturbances in thinking, mood, and/or behavior associated with distress and/or impaired functioning. Mental Illness and Sexual Dysfunction Mental illnesses and their treatments may contribute to sexual dysfunction Mental Illness and Barriers to Sexual Expression, Safer Sex, and Contraception A major barrier to the practice of safer sex among individuals with mental illness is lack of knowledge and information.

15. Copyright Atomic Dog Publishing, 2004 Effects of Pain and Fatigue on Sexuality Pain and Sexuality Most people with chronic pain have pain-related difficulty with sexual activity. Painful conditions can impair range of motion or make vigorous movement difficult during sexual activity. Fatigue and Sexuality Persons with fatigue feel exhausted, weak, and depleted of energy. Fatigue may result from the effects of an illness or disease on the various body organs.

16. Copyright Atomic Dog Publishing, 2004 Effects of Medical Treatment on Sexuality - 1 Effects of Surgery on Sexuality Surgery can have positive effects on sexuality when it alleviates a condition that interferes with sexual functioning.  Hysterectomy  Mastectomy and Lumpectomy  Radical Prostatectomy, Orchiectomy, and Penectomy  Ostomy Surgery

17. Copyright Atomic Dog Publishing, 2004 Effects of Medical Treatment on Sexuality - 2 Effects of Medication and Radiation on Sexuality Medication can improve sexual functioning by directly affecting sexual response or alleviating the health problem that underlies the sexual dysfunction.

18. Copyright Atomic Dog Publishing, 2004 Alcohol, Other Drugs, and Sexuality - 1 Table 18-1 Criteria for Substance Dependence and Abuse Substance DependenceSubstance Abuse Drug tolerance (more and more of the drug is needed to experience the effects) Persistent desire or failed efforts to reduce or control substance use Giving up important social, occupational or recreational activities because of substance use Continued substance use despite knowledge that such use contributes to a physical or psychological problem Failure to fulfill role obligations at work, school, or home due to substance use Substance use in situations that are hazardous (e.g., driving while impaired) Recurrent substance-related legal problems Continued substance use despite it’s negative effect on social or interpersonal relationships

19. Copyright Atomic Dog Publishing, 2004 Alcohol, Other Drugs, and Sexuality - 2 Alcohol and Sexuality Alcohol is a central nervous system depressant that physiologically suppresses sexual response and can interfere with:  Sexual arousal  Penile erection  Ability to achieve orgasm Other Recreational Drugs and Sexuality Recreational drugs are often used with the intention of enhancing sexual pleasure.

20. Copyright Atomic Dog Publishing, 2004 Alcohol, Other Drugs, and Sexuality - 3 Alcohol, Drugs, and Unsafe Sex Use of alcohol and other drugs is associated with having unprotected sex. In a national survey, nearly one quarter (23%) of sexually active teens and young adults (ages 15–24) reported having had unprotected sex because they were drinking alcohol or using drugs.

21. Copyright Atomic Dog Publishing, 2004 Illness, Disability, and Relationships - 1 Effects of Illness and Disability on Forming New Intimate Relationships People with disabilities may:  Begin dating and experiencing sexual interaction at a later age  Be restricted by poverty and unemployment  Experience social rejection  Fear that a nondisabled person wants to establish a relationship for the wrong reasons

22. Copyright Atomic Dog Publishing, 2004 Illness, Disability, and Relationships - 2 Effects of Illness and Disability on Couples Effects depend on:  The nature of the disability  The quality of the relationship before the disability occurred  The couple’s resources and coping abilities

23. Copyright Atomic Dog Publishing, 2004 Illness, Disability, and Relationships - 3 Personal Choices: Using Cognitive Restructuring to Cope with Illness or Disability Cognitive restructuring involves changing the way we think about something. For ill or disabled individuals and their partners, cognitive restructuring can be used to develop healthier, more positive ways to think about the illness or disability.

24. Copyright Atomic Dog Publishing, 2004 Addressing Sexual Concerns: Physician and Patient Barriers - 1 Physicians’ Barriers to Addressing Sexual Concerns with Patients Barriers to health-care providers include:  Discomfort in discussing sexuality  Lack of knowledge about the sexual consequences of an illness, disability, or treatment  Ignorance about treatments available for sexual problems

25. Copyright Atomic Dog Publishing, 2004 Addressing Sexual Concerns: Physician and Patient Barriers - 2 Patients’ Barriers to Addressing Sexual Concerns with Health-Care Providers Patients' barriers include:  Embarrassment in discussing sexual topics with health-care providers,  Lack of knowledge about treatments available for sexual problems,  Finding out that insurance may not cover treatment of sexual dysfunctions.