THE PHYSICAL CHANGES experienced by people who have MS can alter their view of themselves as sexual beings, as well as their perception of the way others view them. The psychological and cultural context in which physical changes occur can adversely affect self-image, mood, sexual and intimate desire, and the ease or difficulty with which people with MS communicate with their partners.
 |
| Tertiary Sexual Dysfunction In MS |
Self-image and body image
IN WESTERN SOCIETIES, women are particularly susceptible to having a negative body image. The media's depiction of women as unrealistically thin and oozing with sensuality is at odds with the reality of most women's personal experience. The extremely high prevalence of diagnosed eating disorders, the variety of commercially-packaged diet programs and cosmetic surgery centers, and the multi-billion-dollar cosmetics industry targeting women, all reflect the efforts of women to reconcile their sensual and sexual self-image with the unrealistic cultural feminine mystique. Women with MS may have difficulty enjoying their sensual and sexual nature because of the gap between their internalized cultural images of the "sensual woman" and their MS related physical changes.
Similar cultural pressures affect men. Internalized cultural images of men as potent, aggressive, and powerful are at odds with the illness experience. MS-associated changes in erectile capacity or employment can be associated with an internal sense of failure or defectiveness as the discrepancy between culturally induced self expectations and one's personal experience grows wide.
Changing roles
CHANGES IN FAMILY and societal roles secondary to disability can affect one's capacity for intimacy and sexuality. The person with MS who has difficulty fulfilling his or her designated work and household roles may no longer feel like an equal partner. The partner of a severely disabled individual may feel overburdened by additional care giving, household, and employment responsibilities. Their intimate relationship can be threatened by the growing tension that results from these feelings.
In addition, the care giving partner (either male or female) may have trouble switching from the nurturant role of caregiver to the more sensual role of lover. As a sexual partner of a woman (or man) with a disability, a man may begin to think of his partner as too fragile or easily injured, or as a "patient" who is ill and therefore unable to be sexually expressive. If it is practical or culturally acceptable, having nonfamily members perform care giving activities helps minimize this role conflict. When care giving must be performed by the sexual partner, separating care giving activities from times that are dedicated to romantic and sexual activities can minimize this conflict.
Accompanying these role changes may be an increasing sense of isolation in the relationship and less understanding of the partner's struggles and perspectives. The diminishing capacity to understand and work through these issues creates greater isolation and misunderstanding, leading to increasing resentments.
Cultural expectations regarding sexual behavior
THE RELIGIOUS, CULTURAL, and societal influences in our lives help shape our thoughts, views, and expectations about sexuality. One of the notions about sexuality that prevails in Western culture is a "goal-oriented" approach to sex. In this approach, the sexual activity is done with the goal of having penile-vaginal intercourse, ultimately leading to orgasm. Here, the sexual behaviors labeled as foreplay (e.g., erotic conversations, touching, kissing, and genital stimulation) are seen as steps that inevitably lead to intercourse rather than as physically and emotionally satisfying sexual activities in their own right. Hence, couples are not thought to be having "real" sex until they are engaging in coitus, and sex is typically not considered "successfully completed" until orgasm occurs.
This Western view of sexuality leads to spending a great deal of time and energy worrying about the MS-related barriers to intercourse and orgasm ("the goal") rather than seizing the opportunity to explore physically and emotionally satisfying alternatives to intercourse. The capacity to discover new and fulfilling ways to compensate for sexual limitations requires that couples be able to let go of preconceived notions of what sex should be and focus instead on openly communicating their sexual needs and pleasures without fear of ridicule or embarrassment. To find out more, you can check out Tertiary Sexual Dysfunction In MS.