How Do You Deal With Intimacy When You Hurt Too Much?

And not only when you hurt too much, but when you are tired all the time, and your meds dull your libido.

A sex therapist I interviewed for my book (to be released in Jan 2011) about couples and illness said that not all intimacy has to be: "Insert penis in vagina and shake." Intimacy at its core is about giving and receiving physical pleasure, ideally accompanied by emotional closeness. This latter recipe can be achieved in many ways. Sexual touching can happen anywhere on the body.

But sometimes the well partner may just want intercourse. What then? And sometimes the ill partner may want intercourse, but is physically unable to engage. What then?

The path to a resolution will be different for each couple. Each couple's sexuality and emotionality is unique to them. But the path to getting to some resolution requires open and honest communication. No matter how hard it is to talk about such intimate matters.

If, at the end of the day, you still want to stand, or sit, or lay together - you have to tell each other what feels good and what doesn't. And you have to talk about what you miss and what you want, and how you might get it, together. And what about giving each other permission to get what you need outside the relationship? is that OK?

If you don't talk to each other about your intimacy needs, they will not go away. They can turn into an invisible barrier that can erode your sense of closeness in other areas.

I think this is one of the most difficult terrains for couples to navigate. What have been your experiences of dealing with the intimacy side of living with illness in your relationship?

Do You Play Around With Your Medications?

I have such an ambivalent relationship with my meds. They are my hero and my accuser.

They accuse me of still living with a chronic pain condition. Their little pink and yellow and sometimes blue fingers point at me and say, "You thought you escaped, that pain would be no more. But pain is just underneath the surface of the numbness we provide. Mess with us and you invite pain to step up."

And my meds are my hero. They protect me from my true nemesis -- pain. They are always there for me. And when I let them, they do their job, ceaselessly, heroically.

So why do I keep messing with them. I continually try to get them down to the next lower level, and then the next lower level. I cut them into halves and quarters. Then I scrape off molecules from the quarters until there's only a few nano-particles are left. The more I can pare away from my meds, the more healed I feel I am.

Not true. Maybe in some alternate universe, but not in ours. I always drop down a teeny bit too low and smack up against a relapse. And the relapse isn't reparable simply by going back up on meds by one step. The relapse soon becomes a cascade of pain that requires that I go way back up to the top of the medication mountain.

So I climb back up, take the highest level of meds, and am grateful that they work to take away the pain. But I carry my pick-ax with me. On the ready to chip away at the med mountain as soon as I stabilize.

Meanwhile, Richard is calling out words of encouragement to me to. "Don't worry, you'll get better."

Do you play these games with your medications? What are your reasons?

This Week's Grand Rounds

is up at the Health Business Blog. Have a read.

The Guilt of Illness

The sick partner feels guilty for being sick. For changing the game plan of the relationship. For not being able to do the things s/he used to, things ordinary couples get to do without a second thought. For having a hard day. For eating up savings that should have gone to the kids' college fund or retirement.

The well partner feels guilty for being well. For being in a different place than the ill partner. For being able to still socialize, do sports, even have some fun. For not being able to make the ill partner better. For feeling angry, afraid, and exhausted. For wishing this would all stop and get back to the way things used to be.

What's the benefit of carrying so much guilt? Not much.

Guilt doesn't act as a bridge, creating a conduit between two struggling people. Guilt can't repair health. Guilt doesn't bring laughter into the room.

Guilt turns off the lights and shuts the door.

Two guilt-ridden partners means two people hunkered down in their separate corners, hiding from the light in each others' eyes. Each person, alone, feeling bad over something they had no hand in making.

What's the way out of guilt?

Stand up, hold each other, and jointly say, "This sucks." Not, "I'm bad," or "You're bad." but rather: "The situation we are in is terrible. We are both so sad that this is changing the future we had planned. I'll be with you when you are hurting. I'll give you space when you need it."

Where do you feel guilt? How does it affect you? What do you do about it?

This Week's Grand Rounds Collection of Health Care Blog Posts

Check it out at Dr. Anonymous. Many diverse and interesting posts.