Women of any age can experience sexual difficulty but age and stage of life can predispose to particular problems.
Pregnancy and childbirth
Pregnancy and childbirth produce physical, emotional, and social changes in women’s lives and may also profoundly affect their partners, having a great influence on both general and sexual relationships. Whilst pregnant some women lose their libido and some men do not find their partner attractive. There may be fears relating to miscarriage early on and discomfort in the last trimester. After the trauma of childbirth, there may be additional physical or emotional problems. A woman may not like the changes in her body. Men who have watched their partner give birth may be overwhelmed by the changes that have taken place and the invasion of their partner’s “private areas” by others. Being a mother itself or having sex with someone who has become a mother may present a problem. There are the additional problems of tiredness and postnatal depression. On the other hand, there may be no problems at all.
In a study of 131 couples, 8 months following childbirth, 50% of first-time parents described their sex lives as “poor” or “not very good”. Twenty per cent said that they would like help for this. They also reported an associated increase in difficulties in their general relationship. Health visitors and doctors in child health clinics are well placed to screen for these problems before they become too entrenched.
Vaginal examination is not done routinely at the 6-week postnatal check. In my experience, many women do have fears that their body has not returned to normal and concerns about stitches being too tight or too loose. Although no medical examination should be done routinely, careful enquiry at this stage can determine which women have fears about their anatomy, and could help to identify which women would benefit from a genital examination. The doctor can gently show the woman that her vagina is well healed and encourage self-examination. Some patients are actually seeking permission from the professional to resume sexual activity. This is also an important time to discuss contraception, which can be a lead into enquiry about resumption of sexual activity. Some may be simply seeking reassurance that it is fine not to feel like sex when exhausted and bursting with milk and that this is a normal reaction.
Terminal illness and bereavement
It may not seem decent for the doctor or the patient to discuss sex when someone is dying or bereaved. Seriously ill people or their partners may feel guilty about the persistence of their sexual desire, which may be increasingly difficult to fulfil as they become more infirm. Doctors may be in a position to enhance these precious last times by giving permission to continue with intercourse, reassuring them that sex will not do any harm. Physical treatments for erectile dysfunction can be employed. Women, who have vaginal dryness following chemotherapy, for example, can be given practical advice. Analgesics can be used prior to love-making. Privacy also becomes a problem as the dying are hospitalized and this may be a reason for weekends at home.
In four cases of terminal care within the community, the main carer was the patient’s partner. Previous levels of physical intimacy account for differences in the ability or willingness to perform tasks for an invalid partner. At one extreme, a woman carer considered it a “liberty” that her husband should ask her to brush his hair, whilst at the other extreme, a man was able to make sexual innuendoes when his wife handled his catheter.
After the death of a loved one, the loss of the sexual relationship may be an additional blow that is hard to discuss. The memory of a previous partner often presents a barrier to a new sexual relationship, as there may be feelings of guilt, especially if the death was relatively recent. Resumption of intercourse after a long time lapse may present physical problems in both men and women, and they may find this particularly hard to discuss with their general practitioner.