Ill Partner

Severe medical and psychiatric illness can alter partner-related sexual desire. Case Study

Tanya and Phillip (not their real names) were each 27 years old and married for the first time for 3 years. They did not have children, did not smoke or use street drugs, and neither had had major health problems in the past. They described themselves as Christian and although they did not have intercourse before marriage, they "could not keep their hands off each other" during that time and enthusiastically engaged in a variety ofsexual activities. Their sexual experiences in the early years of their marriage were uncomplicated and highly pleasurable to both. In the second year of their marriage Tanya developed an episode of mania. When they were initially referred (because of lack of sexual desire on Phillip's part), she had been taking maintenance medication for the previous 12 months.

When Phillip was seen alone (they were initially seen together), he professed his continuing love for Tanya but at the same time said that she was not the same person whom he married. He hoped that their active and pleasurable sexual experiences would return and was puzzled by his own diminished sexual desire. He found himself thinking about sexual matters and fantasizing about old girlfriends. He had masturbated regularly before he and Tanya met but not through their courtship and early part of their marriage. He had begun masturbating again in recent months and contrary to his expectations, the frequency had not diminished. He had no idea why his sexual desire for Tanya had seemingly disappeared.

Although little exists in the literature on the sexual impact on partners when one of them becomes ill, the syndrome of diminished sexual interest in the well partner is familiar to sexuality professionals who work with the physically ill in rehabilitation centers (B. Lawrie, personal communication, 2004). The change seems much more evident in men than women, perhaps because men are generally perceived as perpetually sexually interested and ready in a way that is ordinarily unaffected by environmental circumstances. The very fact that men are so influenced by severe illness in a partner suggests that this general perception is exaggerated. In the context of Levine's tripartite definition of sexual desire, men in this instance lose the "motive" to engage in sexual activity with their partner (even though the drive may continue to exist) (2).

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