Sexuality with Chronic Conditions

When intimacy changes

Chronic conditions can noticeably change sexuality and intimacy. Many people notice, for example, that touch feels different, that desire appears less frequently or less reliably, or that pain and fatigue influence sexuality more strongly than before.

Often, this creates a double experience: on the one hand, there is a desire for closeness and connection. On the other hand, there may be uncertainty, physical symptoms, or the fear that sexuality could become exhausting or no longer “work” in the way it used to.

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These reactions are understandable. They do not mean that something is “wrong.” Rather, they reflect natural changes in how a body responds after illness and ongoing strain.

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Sexuality does not have to disappear as a result. It can change – in its timing, its form, and in what feels possible. Often, the focus shifts toward finding new conditions under which intimacy can feel safe and coherent again.

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In sex therapy, the aim can be to better understand these changes, reconnect with your body in a new way, and develop an approach to intimacy that feels guided by safety and orientation rather than pressure.

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Why sexuality can change

Physical factors

Chronic conditions can affect sexuality on several levels: pain, inflammation, fatigue, reduced mobility, or limited stamina. Sometimes it is not desire that is missing, but physical capacity in the moment.

Medication or medical treatments can also play a role – for example by affecting arousal, lubrication, erection, or orgasm. If you notice that symptoms may be linked to medication or have appeared newly, a medical evaluation is recommended. This can be relieving and provide clarity.

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Emotional & relational factors

Beyond the body, the relational level is often central: shame, grief about what used to feel easier, fear of pain or rejection. In relationships, additional uncertainty may arise: Who initiates? Am I allowed to bring this up? Am I currently more “partner” or more “care receiver”?

Often, communication becomes more limited – out of consideration, exhaustion, or because words are missing. This silence, however, can create distance even when closeness is still present.

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How I can support you

Depending on your situation, it can be helpful to:

• better understand bodily limits (e.g. early signals of overload, pain thresholds, good time windows)

• practice pacing: shaping closeness so it does not become “too much”

• find language to express wishes, pauses, and uncertainty without blame

• gently rebuild touch: starting small, clarifying what feels okay (and what doesn’t)

• clarify roles in relationships when illness or caregiving takes up a lot of space

• work with shame, body image, grief, or fear so that more ease becomes possible

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If touch or sexuality has become difficult due to distressing experiences (including medical ones), we proceed especially carefully. The first step may simply be to regain a sense of what currently feels okay – and what does not.

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Limitations

I do not provide medical treatment or diagnoses. Sex therapy can offer psychological and relational support alongside medical care.

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Please seek medical evaluation for new, severe, or unclear symptoms, especially:

• new or increasing pain (including during sex), bleeding, or severe dryness

• suspected medication side effects or interactions

• significant physical changes after surgery, chemotherapy, radiotherapy, or hormonal treatments

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If you are in acute crisis or feel unsafe, please seek immediate professional support (emergency services or crisis services in your area).

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Structure & process

Free initial consultation

I offer a free initial consultation (approx. 20 minutes). You can describe your situation in your own time, and we explore whether and how I can support you – without pressure.

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I mainly work online. Appointments in Berlin are possible by arrangement.

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• Duration: 50 minutes

• Frequency: usually weekly or biweekly, depending on energy and daily life

• Confidentiality: full confidentiality; GDPR-compliant data protection

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If desired, collaboration with medical providers can be included – always with your consent.

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What is realistic

Chronic conditions do not disappear through therapy. What often can change is the way you live with them: less pressure, more clarity, better communication – and more room for closeness in the way it is possible today.

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Some people return to sexuality that is slower and more intentional than before, but no less meaningful. Others discover forms of intimacy that feel less demanding than “having to function.”

Together, we explore what fits your life – step by step.

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If you wish, you are welcome to schedule a free initial consultation.

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References​​

Carter, J., Lacchetti, C., Andersen, B. L., et al. (2018). Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation. Journal of Oncology Practice, 14(4), 247–269. https://doi.org/10.1200/JOP.2017.028134. PMID: 29227723.

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European Medicines Agency (EMA). (2019). PRAC recommendations on signals adopted at the 13–16 May 2019 PRAC meeting: SSRIs/SNRIs and long-lasting sexual dysfunction. (Product information wording extract).

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Hazan, C., & Shaver, P. R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. https://doi.org/10.1037/0022-3514.52.3.511. PMID: 3572722.

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Landolt, S. A., Weitkamp, K., Roth, M., Sisson, N. M., & Bodenmann, G. (2023). Dyadic coping and mental health in couples: A systematic review. Clinical Psychology Review, 106, 102344. https://doi.org/10.1016/j.cpr.2023.102344. PMID: 37866090.

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Leemans, C., et al. (2025). Sexual dysfunction in patients with chronic non-genital diseases: A systematic review. International Journal of Environmental Research and Public Health, 22(2), 157. https://doi.org/10.3390/ijerph22020157. PMID: 40003383.

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Ma, H., Yang, Y., Li, Y., Cariola, L., & Gillanders, D. (2025). Effectiveness of psychological interventions in improving relationship functioning among couples coping with prostate cancer: A systematic review and meta-analysis. Psycho-Oncology, 34(1), e70080. https://doi.org/10.1002/pon.70080. PMID: 39804293.

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Massé-Pfister, M., Rosen, N. O., Bigras, N., Girouard, A., Perrier-Léonard, D., & Bergeron, S. (2025). Cross-sectional and prospective associations between self-compassion and sexual distress in couples coping with sexual interest/arousal disorder. The Journal of Sexual Medicine, 22(3), 404–415. https://doi.org/10.1093/jsxmed/qdaf007. PMID: 39916375.

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Samami, E., Shahhosseini, Z., Khani, S., & Elyasi, F. (2023). Pain-focused psychological interventions in women with endometriosis: A systematic review. Neuropsychopharmacology Reports, 43(4), 426–438. https://doi.org/10.1002/npr2.12348. PMID: 37366616.

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Tarchi, L., et al. (2023). Selective serotonin reuptake inhibitors, post-treatment sexual dysfunction and risk of persistent effects: A systematic review. Pharmacoepidemiology and Drug Safety. PMID: 37294623.

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World Health Organization. (n.d.). Sexual health / Defining sexual health. WHO.

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FAQ​

Do I need a diagnosis for sex therapy to be useful?

No. What matters is whether you are experiencing changes that feel distressing or confusing – even without a clear diagnosis. Many people seek support because symptoms, treatment experiences, or fatigue make intimacy difficult to navigate. We work with your lived experience, not with labels.

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What if medication affects my desire or orgasm?

This can happen. It is important not to change or stop medication on your own. Medical consultation is recommended if symptoms are new or burdensome. In therapy, we can look at ways to reduce pressure, find suitable moments for intimacy, adjust expectations, and communicate about this in your relationship.

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Is online sex therapy helpful for this topic?

For many people, yes – especially with chronic illness, where energy and mobility may be limited. Online sessions allow very practical work on communication, boundaries, pacing, anxiety or shame, and everyday strategies you can try between sessions. In-person sessions in Berlin are possible if desired.