This isn't quite as hard a subject as it might be, because, to a degree, sometimes a large degree, illness and medication will combine to make the issue of physical intimacy a moot point. They can make sex uncomfortable, or impossible.
But not always, and that's what we're here to talk about today. Rest assured, though - we won't talk about the mechanics. You're reading this, you should already know that stuff.
To begin with, the physical relationship you had before the illness hit is going to determine what happens in the last months or years of life. If the relationship was good and mutually satisfying, that can continue, and should, for as long as possible.
If sex was awkward or nonexistent when your spouse was healthy, there may be a temptation to try to overcome the problems "while there's time".
It's in many ways a laudable goal; the physical part of a marriage is important, and making an attempt to heal the hurts - including emotional and spiritual differences - can be a vital part of the process, for both caregiver and soon-to-be-dead-dude-or-dame.
It can also be a nightmare, if it goes wrong, and has the potential to introduce a huge amount of tension into an already charged situation.
Sexual problems in a marriage are usually indicative of deeper issues, and terminal illness is not a magic wand of good feeling and compassion that will sweep them away. If you want to work at the "make it better while there's time" option, I strongly urge the involvement of a counselor, because the reality of a limited horizon puts on the pressure like you wouldn't believe - pressure to be compassionate, pressure to br gracious, and pressure to perform.
Aside from being an important part of marriage, sex is for many (probably most) people symbolically life-affirming, both in its procreative purpose, and in the physical and emotional lift it can give.
But when someone's dying, there are some specific factors to consider.
First, there's the ewwww! quotient. While most terminal illnesses are definitely not contagious, we all have that little seed of doubt...that "what if?" Education (and a talk with your spouse's doctor) should lay this to rest, but it's best to admit its potential presence. If fear causes reticence, your partner will surely feel it, and the experience will be tinged with or ruined by that barrier.
There is also the possibility that illness and/or medication can cause bad breath, body odor, weigh gain or loss, skin dryness or discoloration, hair loss...the list goes on, but you have to be aware of this, and have some sort of idea how you're going to deal with it without making your mate feel rejected, and gross.
Next, what if he/ she dies 'during'? It happens. Not often, but again, a talk with the doctor is essential. There are jokes about men feeling like, well, it would e a good way to die...but that's mainly fiction. No one wants to die of anything, and the thought of having sex knowing it might be fatal - and having the feeling that the prospect is real rather than macho posturing - will tend to cool a man's interest.
Then there are performance issues. We usually think of impotence and erectile dysfunction, but even more basic, there can be loss of libido in both men and women...but this loss of libido can be accompanied by emotionally-driven desire.
Here' it's important for you, the caregiver, that this may not be just a desire for physical release - it may be a desire for you, heightened by the sense of impending loss.
Tough stuff, eh? Not what you imagined in the first blush of awakened emotions and hormones.
So...what to do?
- Christians have it sort of easy; the Apostle Paul was quite clear that abstaining from sex for reasons other than limited times of worship, or illness that prevents it, is wrong. You are supposed to try to be available. In the real world, that means that you, the caregiver, should ideally try to overlook the problems that you're able to overlook. You've got to know what the limit is, but you are enjoined to try.
- I'm uncomfortable, as a man, in giving the above advice to women, because so many women have felt used by an insensitive husband, and all too often Paul's words were used to coerce, not to grow companionship. If that describes you, or describes a significant portion of you married life, counseling is vital. You're called to mutual sharing in marriage, but not to the martyrdom of your heart. You don't have to destroy your feeling of self-worth, just because your husband's now dying. Death may be tragedy, but it's not entitlement.
- Be patient; physical changes can make sexual activity much slower, and can curtail it unexpectedly...your mate may ask to stop from fatigue or pain, or may just fall asleep. Don't be offended. It's not about you, and it's likely to be embarrassing to him or her.
- Be flexible in timing, if you can. There is the possibility that this time, when your husband asks...it may be the last time he's able. This is personal; it happened to me.
- Be adaptable in the mechanics. What worked before may not work now. The important thing is that the experience is mutually satisfying, yes, but also that you, as the caregiving spouse (emphasis added) may have to be the guiding light and hand, and no, I'm not trying to be funny. This is the real world.
- Pay more attention to atmosphere, and use things like scented candles and scented massage oils. A pleasantly wholistic experience may go a long way toward enhancing performance and enjoyment, and offsetting performance 'problems' in men. Men have some pretty mushy emotions, sometimes. These may well come to the fore now.
- Never criticize, because a fragile ego comes with terminal illness (and many medications). If sex was lousy and boring, and your husband asks how it was or you...lie. Honesty, here, will gain nothing, and can knock out a prop to an interest in life.
- If you need to talk to a counselor about your feelings, feelings that you can't share with your mate, do it. This is not the time to bottle it up. Just be sure that your counselor is trained, and is of the same sex.
What can you add? What have I missed?