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How Caregivers Can Restore Intimacy With Their Partners

Whether sex is the first or last thing on a caregiving spouse's mind, there are strategies to preserve intimacy

By Diana B. Denholm, PhD, LMHC

Severe medical conditions can wreak havoc on a couple. When one partner suffers from the effects of a grave illness or catastrophic injury, and the other is thrust into the role of caregiver, reclaiming a satisfying sex life presents difficult challenges. But there are practical strategies that can help caregivers resolve conflicts and make their marriages or partnerships more compassionate, peaceful and loving, even if it turns out to be in the absence of sex.
In my private practice, I've worked with many couples on this deep and troubling issue, including the two I describe below. (I've changed their names.) Although the caregiver in both examples is female, the strategies I suggest apply to both genders.
When a Caregiver Wants to Have Sex But the Spouse Doesn’t
As the wife of a seriously ill husband, you may want to reclaim the loving relationship you had, but you don’t know how. Your husband may be impotent because of his illness or medications. He may have a seriously limited sex drive, or a diminished sense of himself as a man because of surgery or treatment-related hormonal changes. He may be in too much pain to even consider sex, or may feel he needs to conserve every ounce of his energy to confront his illness on a daily basis. Or he simply may be too depressed to have any interest.

(MORE: For Caregivers of Spouses With Dementia, a Redefinition of Marriage)

That’s where Susan and Sam, former high-school sweethearts, found themselves in their 60s. Sam was an attorney known for his sharp mind and sharp suits. But now he had terminal cancer, and even though he was physically able to do everything he could before, he chose to stay in bed, and he’d wear the same pair of pajamas for days. Sam didn’t talk much, and mostly snarled at Susan if she suggested they do anything together. In her first session with me, Susan related this story: One day, she awakened to a beautiful sunrise and thought, “Great! Sam and I can go hiking and have one of our romantic picnics beside the secluded creek."

But then she remembered they didn’t do that anymore.

Romance? Susan was lucky to get a civil word from her husband. Instead of hiking or picnicking, Susan often spent afternoons crying on her deck. We were able to discover, however, that the romance in her marriage didn’t have to be over, even though it might not be the same as before.

We started with a 24-question planning guide, a set of prompts to help a caregiver put his or her major (and minor) concerns down on paper. Susan's answers helped us clarify her issues and create a plan to address them. At this point, she didn't know how to approach Sam about anything, let alone sex. We discussed simple, non-threatening, non-demanding ways to begin a conversation with him. Susan and Sam needed to talk but it didn't have to start with her uttering the always-loaded phrase "We need to talk."
Susan and Sam were eventually able to talk about his self-image; their respective libidos; and her sexual needs. Susan told him she was prepared to lower her expectations and set goals that Sam could meet, if he would make the effort to meet them. These goals took the form of nonsexual encounters that could put some intimacy and maybe even romance back into their marriage. As a reasonable first step, she simply asked him to agree to set aside some time to talk about a book they both read. Through such small steps, civil conversation was restored, as the first step on their path back to intimacy.


(MORE: Should You Have an Affair When Your Partner Is Dying?)

Later, they agreed that one night a week, Susan would make a special meal and invite Sam to join her at the table, instead of eating in bed with a tray. When he joined her, they were able to reclaim some closeness. But just as important was Susan's response on the nights he didn't join her. Previously, she’d get angry at him for staying in bed, and sometimes would even yell at him, which only made connection more unlikely. Now she didn't fight his decision to not join her. By saying nothing, she created a more relaxed atmosphere in the house for both of them, and the opportunity for closeness to return.
When a Spouse Wants to Have Sex but the Caregiver Doesn’t
What if you don't want sex, yet your husband seeks even more intimacy and physical contact, despite his impaired physical condition? After all, what caregiver has the energy to have sex, in addition to all of her other duties? It can be difficult to contemplate having sex with someone you now spoon feed, or clean up after a visit to the bathroom, especially if his or her appearance has radically changed.
Frank and Fran, both in their 50s, have been married for 20 years, and now Frank is in the final stages of emphysema. Nevertheless, he wants sex and nags Fran about it constantly. But Fran finds the tubes hanging from his body, and his poor hygiene, to be a turnoff, to say nothing of the images in her mind of cleaning up after his accidents. What can she do?
Sex had become a major battlefield for the couple, and resentments from their arguments spilled into every area of their life. Fran was tired of the constant pressure. Frank was frustrated by the constant rejection. Yet it became clear that their opinions were not going to change. Their friendship, an essential element of their intimacy, was threatened. Using the same learned communication tools as Susan, Fran and Frank arrived at an understanding: To maintain physical connection in their marriage, Fran would make love to Frank once a week. She insisted, however, that he shower beforehand and that the room remain dark. As part of the compromise, they agreed not to debate their sex life again.

(MORE: How Caregiving Wives Can Handle the Challenge of In-Laws)

These compromises restored a measure of peace where there had been only anger and turmoil. The outcome was not ideal for Frank or Fran, but it was a way to return a level of intimacy to their marriage.
With an open mind and the right approach to communication, caregivers and their spouses can come to agreements on absolutely anything — even sex. Even if a spouse becomes seriously ill or injured, your marriage, and the love that is its foundation, do not have to disintegrate.

Diana B. Denholm, PhD, LMHC, a board-certified medical psychotherapist for more than 30 years, is the author of  The Caregiving Wife’s Handbook: Caring for Your Seriously Ill Husband, Caring for Yourself (Hunter House, 2012). For 11 years, she was the primary caregiver to her husband during a series of grave illnesses. Read More
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