Sexuality and Chronic Health Conditions
Brooke Faught and Cheryl A. Glass
Lifestyle and genetics play a role in the aging process of each individual. Medical intervention for age-related ailments varies widely across different patient populations. With advancing medical technology and research, humans are living longer; with that, a larger proportion of the life span is spent with chronic health ailments and conditions. Medications, surgeries, and other medical interventions can further complicate sexuality in the aging population.
A.Cancers:
1.In the United States, the five leading cancer sites in women by prevalence are breast, lung, colon/rectum, uterine, and thyroid. In men, the five leading cancers occur in the prostate, lung, colon/rectum, bladder, and melanoma of the skin.
2.Many treatments for cancer can have a significant impact on sexual functioning in both men and women. These effects can persist throughout the remainder of the individual’s life.
3.The psychological burden of a potential lifethreatening condition impacts every facet of life, including sexuality and intimacy. This is relevant for both the patient as well as his or her partner.
4.Although there has been a tremendous amount of research in the area of nerve-sparing surgeries for prostate cancer, urologic and sexual side effects remain a significant concern. Common side effects of radical prostatectomy include orgasmic dysfunction, urinary incontinence (UI) during sexual activity, penile sensory changes, penile shortening, and penile deformity.
5.Among women following mastectomy, significantly more report problems with sexual desire, arousal, the ability to achieve an orgasm, and intensity of the orgasm.
6.Both prostate and breast cancer treatment regimens frequently involve endocrine therapy that suppresses or eliminates circulating estrogen and/or testosterone:
a.Although these individuals may have already a decline in hormone levels depending upon age at initiation of suppressive treatment, the abrupt shift can prove quite detrimental to overall quality of life.
b.With androgen deprivation therapy for prostate cancer, men frequently experience symptoms similar to women in menopause, including hot flashes, cognitive dysfunction, and sexual complaints such as erectile dysfunction, orgasmic difficulty, and loss of sexual desire.
c.In women, aromatase inhibitor-treated breast cancer patients report more sexual complaints than tamoxifen-treated patients and controls. Although only 31% of tamoxifen-treated patients reported painful intercourse, 57% of aromatase-inhibitor-treated patients reported the same. Aromatase inhibitor-treated patients also reported a 74% incidence of insufficient lubrication.
B.Diabetes:
1.Diabetes mellitus (DM) is on the rise in the United States. In men with recently diagnosed type 2 DM, there is a high prevalence of sexual dysfunction. In this population, erectile dysfunction (ED) was classified as either mild, mild-moderate, moderate, or severe, with a cumulative prevalence of nearly 67%. More than 21% described their ED as severe.
2.Additional sexual comorbidities include premature ejaculation, delayed ejaculation, and hypoactive sexual desire. Considering the progressive nature of diabetes, early diagnosis, counseling, and management can aid in preservation of sexual functioning.
3.Sexual dysfunction is more prevalent in women with all types of diabetes, although more so in those with type 2 DM. In women with diagnosed DM, nearly one in four experience sexual dysfunction, although degree of severity varies based on type of diabetes, diabetic complications, hemoglobin A1C value, and presence of depression.
4.Low Female Sexual Function Index (FSFI) values correlate with high body mass index (BMI). This is of note with type 2 DM patients given the comorbidity of obesity.
5.Among studies of sexual functioning in both men and women with DM, patients consistently have a higher prevalence of depression, which further negatively impacts sexual functioning.
6. 
See Section III: Patient Teaching Guide Diabetes.
C.Sleep apnea:
1.Sleep apnea is a chronic breathing disorder that disrupts sleep. In addition to the physical impact on the individual, partners are often bothered by the sound of heavy breathing and loud snoring. Because of this, sleep dynamics may change and result in the couple sleeping in separate beds and/or rooms.
2.Approximately 60% of men with diagnosed obstructive sleep apnea (OSA) have concomitant erectile dysfunction. Although the use of continuous positive airway pressure (CPAP) is effective at managing OSA, only about 29% of men report improvement in erectile dysfunction. Use of phosphodiesterase 5 inhibitors (PDE-5i) has been helpful in this patient population, even when CPAP is not included in the treatment regimen.
3.There is limited understanding of sexual health in women with OSA, although multiple studies have shown an increase in sexual dysfunction concurrent with OSA. Some evidence suggests that sexual dysfunction correlates with OSA in obese women only if nocturnal hypoxia is present. Other than this, severity of OSA has not consistently been linked with degree of female sexual distress (FDS).
4.Refer to Chapter 12 for further detailed information on OSA.
D.Cardiovascular disease:
1.After a cardiac event, patients are frequently left with uncertainty of their ability to resume sexual activity. Although patients turn to their healthcare professionals for guidance, most medical providers do not address the topic of sexuality after a cardiovascular event, specifically myocardial infarctions (MIs).
2.Many individuals with a history of cardiovascular event(s) are fearful of resuming regular physical activity, including sexual activity, due to fear of recurrence or even death:
a.A study intended to observe changes in blood pressure (BP) and heart rate during sexual activity showed that these measurements increase just slightly for a short time and recover their baseline level soon after sexual activity for healthy adults.
b.Given this knowledge, many medical providers are comfortable allowing patients to resume some form of sexual activity within a reasonable amount of time following a cardiovascular event. This decision needs to be made on a case by case basis.
3.Although cholesterol-lowering medications can benefit erectile function in men with concomitant ED and hypercholesterolemia, many of the medications used to treat and manage cardiovascular health conditions can have a negative effect on sexuality.
4.There has been some data to suggest a correlation with HMG-CoA-reductase-inhibitor medications, otherwise known as statins, and low libido in men. Gender-specific research regarding the effect of statins on the sexual health of women is lacking.
5.Hypertension in women can lead to sexual dysfunction in the areas of libido, arousal, and orgasm more so than men. Whereas beta blockers are known to produce sexual side effects, treatment with alternative medications and lifestyle modifications can potentially reduce sexual dysfunction in this population.
6.Refer to Chapter 13 for further detailed information on cardiovascular conditions.
E.Dementia/Alzheimer’s disease:
1.Sexuality can be significantly impacted by dementia and Alzheimer’s. The most commonly reported sexual dysfunction is disinterest due to apathy and blunted affect. Spouses can develop disinterest and poor sexual functioning in response to worsening of partner’s cognitive decline.
2.In severe cases, hypersexual tendencies occur as a manifestation of disinhibition in patients
with dementia and Alzheimer’s. Examples of this include sexual comments, public exposure masturbation, and unwarranted sexual proposals.
3.Refer to Chapter 23 for further detailed information on dementia/Alzheimer’s.