In 1977, we graduated the first patients from our outpatient pulmonary rehabilitation program, the second such outpatient program in the world. Very little information about rehabilitation was available in those early days, so I turned to the only pulmonary experts I knew, my patients. What they taught me was responsible for much of the success of that early program.
One of these first patients challenged me one day asking, “Do you know what it is like, to be so short of breath, that you don’t kiss your husband anymore, afraid that the kiss will suck away the small amount of air you are gasping for?” That question shocked me into awareness of how little I knew, and how much I still needed to learn.
Yes, respiratory diseases can complicate a sex life. It is important, however, to avoid judging your level of masculinity or femininity merely by your physical ability to perform vigorous lovemaking. Sexuality remains even when ways of expressing it may change. Unfortunately, when a man starts losing his ability to do the heavy chores, or feels in other ways he is aging, he may also start losing self-confidence in his masculinity. When a woman starts to cough or wheeze with shortness of breath, she too may feel she has lost her sexual attractiveness. Remember, satisfactory lovemaking is often more dependent on attitude than on the results of breathing tests!
With the help and advice of our patients, we offer some suggestions that we hope will be of help. With communication, preparation, and loving care, many couples are able to find new and exciting ways to enjoy intimacy, even with a respiratory handicap.
Start by Communicating
Communication is the foundation of any good relationship. It will be hard to overcome sexual problems if you are not able to speak about them with your partner. It may be uncomfortable, but consider it the first step to finding a real solution to any problems you might have.
After a heart attack, many patients have concerns about when they again can have sexual relations with their partner. “If you can walk up two flights of stairs or walk briskly for two blocks you can probably handle sex”, I have read in some brochures and heard some doctors reassure their respiratory as well as their cardiac patients. That is not reassuring for those who get fatigued and short of breath (SOB) just walking briskly around the house! Good sex needn’t require expending lots of energy! Remember that the energy requirements for sexual activities aren’t that different from the energy requirements for doing other things you manage.
There is no doubt, however, that improving your fitness, with the advice of your physician, will help. If at all uncertain about starting an exercise program on your own, a referral to your local hospital’s pulmonary rehabilitation program is one good answer. I’ve observed that even patients who come to their first class in a wheelchair, by the end of the six-week program are able to slowly walk an hour a day, as well as perform other forms of activity again, judging by some sly hints and grins.
If your physician can’t recommend a local pulmonary rehabilitation, take a look at livebetter.org to help find a program near you. There are other resources on the PERF website too, which can help you find a program or give you some inspiration to start exercising.
If your fatigue and shortness of breath are not of much concern, try starting your own program of slowly walking, perhaps with your partner. First, refer back to Basics on our website or check out Starting an Exercise Program for some tips that will vary according to your level of fitness.
Of course, those with COPD might become fatigued during sexual activities, just as they might with other exercises! To make sure neither your, nor your partner’s efforts fail, plan sexual encounters for a time of day when the partner with breathing problems feels the best. Plan on enjoying intimacy when rested and have the most energy. Avoid sex immediately after a heavy meal, as well as avoiding that second glass of wine. In excess, alcohol can impair sexual function as much as COPD, so why take a chance?
Even a slightly flirtatious attempt not used before might add a dash of excitement. You and your partner could try a few new signs to indicate you’d like to “turn in and turn on” such as perhaps whispering something suggestive in the ear or lightly kissing, or sliding fingers of the hand across the cheek or the nape of the neck as you pass by? Make inviting sexual relations an erotic game, not a chore!
Agree to slow down, or take little “breathers” if sex becomes too strenuous. Encouraging the partner without COPD, or other breathing problems, to take a more active role might be enjoyable for both partners to try.
Rid Your Bedroom of Irritants that Harm Your Breathing
Breathing problems can be aggravated by dust, mold, pet dander, smoke, fragrances, etc. Do all you can to rid the bedroom of these irritants. This is not the time for ladies to use their favorite perfume.
Dust, vacuum, and wash the bedding regularly. Consider using a HEPA air filter. Watch out for smelly cleaning products — especially chlorine bleach — as some odors can trigger symptoms.
Scented deodorants, shampoo, and perfumes can pose a problem, so try switching to unscented products. If excessive mucus secretions cause trouble, keep a box of tissues at the bedside.
You probably have found that a cool breeze on the face can help ease the shortness of breath that people with COPD and other breathing problems often experience. That breeze can come from an open window, a small fan (some are battery operated) or a simple electric fan. Keeping the bedroom cool helps prevent a buildup of body heat which can add to breathlessness.
Take Your Medication Before Sexual Activity
Short-acting bronchodilators used before exercise can help prevent coughing, and wheezing as well as shortness of breath, so use them about 15 minutes before sexual activities, but also keeping your inhaler next to the bed in case of a sudden flare-up of symptoms.
If excess sputum is a problem, try clearing mucus beforehand by using controlled coughing or trying postural drainage a half hour before sex is anticipated.
If the man is experiencing erectile dysfunction, speak with your doctor about the appropriate use of Viagra or a similar drug. Some studies suggest that the drug may not only enhance sexual performance but also ease breathing restrictions. However, remember that Viagra is contraindicated for some conditions so be sure to discuss its use with your physician first!
Consider Using Supplemental Oxygen
If you or your partner have used supplemental oxygen for other activities, ask your doctor about using it during sexual activity. Using extended tubing to the oxygen makes it easier to move around.
If the partner with COPD doesn’t use supplemental oxygen, but wonders if it would help during sex, you can find out with the help of an oximeter, a simple device the partner with COPD puts on the fingertip. If the readout indicates that oxygen saturation falls below 88% with activity, using supplemental oxygen during sexual activity could prove very helpful, just as it would with other exercise.
I once got a doctor to order “oxygen for activities in the bedroom”. It must have helped because the patient gave me a bottle of scotch (which I don’t drink) along with a wonderful note of thanks several days after first trying the oxygen. Don’t be afraid to ask your doctor, pulmonary nurse, or respiratory therapist for help in documenting desaturation of oxygen levels with exercise in order to be eligible for Medicare or insurance reimbursement.
Many physicians now prefer to keep a patient’s oxygen levels around 93% saturation with exercise. If your saturation doesn’t quite go down to the 88% (which is the level needed for insurance to reimburse it), you still can obtain oxygen if your doctor agrees and provides a prescription but you will need to pay for it yourself. A small cylinder, at this time, may cost about $35 but other costs probably would be added. Remember that a doctor’s prescription is legally required because oxygen is considered a medication.
Don’t Be Afraid to Experiment
Try different sexual positions to find which ones work best for you and your partner. In general, positions that put pressure on the chest of the partner with COPD are more troublesome than side-by-side (face-to-face and front-to-back) or seated positions if you have severe respiratory breathing problems. Back in the old days, when we were still using slides, I was delighted to obtain a slide program on sexual positions to show during my first class on sexuality. Several patients were rather uncomfortable about this whole thing and I guess I was too. I filled the carousel and started showing the slides. For about 30 seconds all of us stared silently, with gaping open mouths, as the showing of “recommended positions” flowed by. I had put all the slides in — upside down! The room burst into laughter as even the most reserved in the group almost fell off their chairs, doubled over laughing. They all demanded that I repeat this upside down slide program as is for all future classes. Someday check out similar programs still available on the web and you will see why.
Take a Break
If at any point during sexual relations the partner with breathing problems starts to feel breathless, he/she should feel free to slow down or even pause to rest — though there’s no need to stop giving and receiving gentle caresses during the lull in action.
Keep in mind that it’s normal for anyone to experience some shortness of breath during sex. Remember that shortness of breath during sexual activities is no more dangerous than the shortness of breath you have often experienced doing everyday activities.
Remember Your Goal
“Good sex” isn’t just about giving and receiving an orgasm. It’s about lovemaking and intimacy that by itself can be satisfying. The goal for both the patients with breathing problems and their partners, should be to have the most intimate experience that can be managed. Sometimes that means reaching orgasm, but sometimes not.
Always remember that intimacy and sexuality are not limited to intercourse. They can also be shown by candlelight dinners, extra attention to grooming, a thoughtful compliment, a shy smile or an unexpected hug. Try it and see.
Sometimes, simply lying together and cuddling are all that someone with an exacerbation of their breathing problems can manage at that particular time — and that may be enough to satisfy both partners as they continue the adventure of finding new ways to explore and to enjoy their sexuality.
This short blog, of course, cannot cover all the questions, answers or concerns you might have. We welcome your comments and suggestions for us, but also for those who read this blog in the future, so please feel free to add them to the comment section.
With best wishes for your success,
Mary Burns, RN BS