When health changes your sex life, intimacy doesn’t have to disappear

(Aging Untold) — Health changes don’t just affect the body — they can reshape confidence, connection and communication between partners.

The Aging Untold experts tackle the questions many couples are afraid to ask out loud: When is it safe to resume sex? What if it isn’t? And what should you ask your doctor?

Start with what’s changing — and why

Sam Cradduck, a gerontologist, said the first step is figuring out what’s behind the change.

“What’s changing it and why is it changing?” Cradduck said.

Cradduck noted that competency and consent are the first things to consider.

“Is it a matter of competency and consent? And if it is, then it’s off the table,” Cradduck said. “I’m not talking about lucidity. I’m saying if somebody cannot consent, then sex is off the table at that point. It’s not consensual.”

Cradduck added that for physical issues, like erectile dysfunction, a doctor can often help.

“Seeing a doctor can absolutely take care of it, and take care of things that are before, that are coming after,” Cradduck said. “There’s a lot of reasons to change, and there’s a lot of things that happen. We know with women, we have our own issues as we’re post-menopausal.”

Cradduck encouraged couples not to let embarrassment stop the conversation.

“Don’t be embarrassed by it, and say, ‘Hey, this isn’t working,’ or ‘This is hurting,’ or ‘This is something I want to participate in, but I’m not in the mood to,’” Cradduck said.

Intimacy and sexuality aren’t the same thing

Dr. Rhea Rogers, a board-certified physician, said one of the biggest misconceptions couples carry is treating intimacy and sexuality as interchangeable.

“I think one of the biggest misconceptions is that intimacy and sexuality are the same — and they’re not,” Rogers said. “Intimacy is that connection, and sexuality is an expression of that connection.”

Rogers said the best time to talk about these changes is before a health crisis hits.

“I think the best time for people to have these kinds of discussions is before a crisis,” Rogers said. “These are things we need to be talking about when we’re younger, because we know we’re going to age. We know there’s going to be a trajectory for different chronic conditions that may interfere. Perhaps if we start to take the time to discuss it early, we have a better understanding, the communication.”

When you’re exhausted from caregiving, intimacy can look different

Aging expert Amy O’Rourke said intimacy is ultimately about feeling seen.

“To me, intimacy is feeling seen and understood and loved,” she said. “So when I think about that, I think talking is so important, and really honest conversations.”

O’Rourke acknowledged that caregiving fatigue can get in the way of a partner’s desire for sex.

“If you’re the caregiver and you’re taking care of somebody, you’re going to be tired a lot,” she said. “Maybe the other person wants to have sex, and maybe you’re just so exhausted you just can’t do it.”

Her suggestion: bring back date night.

“Go back to that,” O’Rourke said. “Set aside some time, just the two of you, no caregiving job in front of you, and talk. And maybe intimacy for you guys is just going to be holding hands. Maybe it’s going to be watching a TV show with your arms wrapped around each other. Maybe it’s going to be just a little bit of cuddling at night. So you can replace a few things until maybe you get back to possibly having sex again.”

A husband’s question: dementia, desire and what’s OK

Cradduck shared a story from a husband who called her with what he described as an awkward question. His wife had dementia, and he said she wanted to have sex.

“He said, ‘This is going to be an awkward conversation,’” Cradduck said. “I said, ‘Shoot it, I’m good.’”

Cradduck said the couple had a decades-long love story — high school sweethearts who found each other again later in life, only for her to later be diagnosed with dementia.

“He said, ‘She wants to have sex,’” Cradduck said. “And I said, ‘Do you want to have sex with her?’ And he said, ‘Well, of course I do. But is it OK?’ And I’m like, ‘Absolutely, it’s OK. She wants to.’”

Cradduck said the husband handled all of his wife’s care tasks — bathing her, helping her use the toilet — and she offered him a practical way to separate his roles.

“I did tell him, if you want that separation between your caregiving and your intimate life, wear gloves when you’re caregiving so that touch is clinical, and then touch her with your bare hand when you’re her husband,” Cradduck said. “That helped him, because he was having trouble himself moving from ‘I’m the caregiver’ to ‘I’m the husband.’ It gave him that separation.”

Understanding consent when cognitive decline is involved

Rogers said cognitive decline adds complexity to questions of consent.

“Do you guys see a difference when you bring cognitive decline into it for the person? That can be a whole different avenue to explore, because now you’re looking at that consent. When do they know, and how do you even broach that?” Rogers said.

Cradduck explained that consent and lucidity are not the same thing.

“If she’s not able to consent, if she’s not able to agree to what’s happening, or if she’s uncomfortable in those actions, then that’s not consent,” Cradduck said. “If she is not a willing participant, that’s not consent. And lucidity and consent are not the same thing. You can have moments of cognitive impairment and still be consensual in this relationship.”

Cradduck added that cognitive impairment can also lower inhibitions, which can change how a person expresses desire.

“Sometimes cognitive impairment also takes away some inhibitions,” Cradduck said. “So some people become more amorous.”

Rogers noted that consent for someone with dementia can shift moment to moment.

“I’ve seen people with dementia, and they change. They might outburst, ‘Don’t touch me,’ and then everything is fine,” Rogers said. “You have to be consenting at the time of whatever that emotion is.”

Cradduck added that you have to respect it if the consent gets removed in the midst of things.

O’Rourke also recalled a moment from working as a nursing home administrator, when a caregiver ran down the hall to report that a couple living together was about to be intimate.

“They’re about to do it. What do we do?” O’Rourke recalled the caregiver asking. “And I said, ‘You shut the door.’”