Practical Considerations

“Now there’s a million dollar idea! Someone ought to write a no nonsense instructional booklet for the men folk, one that we would automatically recognize and understand. One that would help us, step by step, through the harrowing experience of having a person we love at death’s door.”


My first column under this heading of Relationships and Intimacy was titled, It Never Entered My Mind. It recounted a conversation I had with a woman who told me of the very painful personal experience she had while attending the death of her beloved husband in a Midwest hospice. Apparently it struck a chord with some. I don’t get a lot of correspondence from people who read my columns, but every now and again the odd email or letter will show up and I am reassured that my efforts haven’t been for naught. I love when that happens.

Not long after that first column appeared I got an email from a fellow who may have seen that column. He didn’t reference it directly, but it would have been quite a coincidence had he not seen it. This fellow wanted some practical tips on how he might broach the subject of sex with his wife who had been recently diagnosed with ovarian cancer.power-tools

The man’s name was Alex. And what struck me most about his message was his manner. In typical male fashion, he got right to the point. He even laid out his questions in bullet points, again a very typical man thing to do. Even though he made no mention of his anxiety I could easily tell he was supremely worried that he might fail his wife in some way during her hour of need. His email reeked of the kind of performance anxiety I so often see in my sex therapy private practice. His wife’s disease process shook his confidence to the core.

Basically, he was looking for a “how to” guide. You know, like the kind of owner’s manual one would find included in the box of a new power tool. I thought to myself as I read his email. Now there’s a million dollar idea! Someone ought to write a no nonsense instructional booklet for the men folk, one that we would automatically recognize and understand. One that would help us, step by step, through the harrowing experience of having a person we love at death’s door.

IMPROPER OR UNSAFE use of this power tool can result in death or serious bodily injury.
This manual contains important information about product safety. Please read and understand this manual BEFORE operating the power tool. Please keep this manual available for other users and owners before they use the power tool. This manual should be stored in a safe place…

There would be lots and lots of diagrams and symbols and even a schematic or two. Of course, there’d be pages and pages of dos and don’ts as well.

NEVER touch moving parts.
NEVER operate without all guards in place.
ALWAYS use the right tool for the job.
NEVER use a power tool for applications other than those specified.
NEVER use a tool that is defective or operating abnormally.
ALWAYS use protective eye gear.

Alex’s message was a manly cry for help. And it was clear to me that even though he loved his wife dearly, he had some deep misgivings about his capacity as an effectual lover, even under the best of circumstances. And now that his wife had undergone radical gynecological surgery, well, he was even more adrift than ever.

intimacy02It didn’t help that Alex couldn’t or wouldn’t use even the medical terms for his wife’s “parts.” I couldn’t tell if he didn’t know the vocabulary or if he was just too embarrassed to type them out. When words failed him, he used that universal euphemism, “down there.”

I had my work cut out for me. I was tempted to do some remedial sex education. Hell, I could have included some diagrams and symbols and even a schematic or two. In the end I decided to forego an elaborate response that might have overwhelmed him. I decided to answer, as succinctly as I could, each of his questions.

“I don’t know what your wife wants or needs. But there is a mighty good way to find out. Ask her!”

“Discussing sexual concerns in a crisis is never going to be easy, especially if you guys don’t have a history of doing so.”

“Maybe that’s a question you and your wife could bring to her oncologist.”

“Yes, I can assure you that both the surgery and the chemo will affect your wife’s interest in sex. Don’t take it personal.”

I answered all the question he posed as best as I could. Then I added a personal note.

“Alex, my friend, may I suggest that before you approach your wife with this discussion, you might do a little homework by yourself. Maybe if you knew your mind about what it is you are looking for in your intimate relationship with your wife at this time in your marriage, at least one of you would have a leg up on the upcoming conversation.”hands m:f

I directed him to my book, The Amateur’s Guide To Death And Dying; Enhancing The End Of Life, not because I wrote the blasted thing, but because it contains an entire chapter on sex and intimacy concerns for sick, elder, and dying people and their intimate partners. It’s a s close to a “how to” guide as I’ve ever seen. To prep my readers for Chapter 6, the sex and intimacy chapter, I invite them, at the end of Chapter 5, to consider — Some Questions about Sexuality and Intimacy.

I posed 5 simple questions to help my readers focus their attention on their own sexuality and intimacy needs.

  1. How important is sexuality in your life?
  2. Is there’s a difference between sexuality and intimacy?
  3. Do you have a range of options in which to experience your sexuality? If yes, what are some of them?
  4. How well are you able to communicate your needs for sex and/or intimacy to your partner(s)? Are there any specific issues that get in the way of asking for what you need?
  5. What are your biggest concerns about your sexuality as it relates to your disease, aging and/or dying process, or the disease, aging and/or that of your intimate partner?

I had great confidence that if Alex took my advice and answered these questions honestly, he would be ready to approach his wife to find out what she wanted and needed from their intimate life together post diagnosis and surgery. I suggested that, once he had answered the five questions, he could offer her the opportunity to do the same. Once they had both answered the questions they could set up a time to discuss their answers.

While this approach wouldn’t make the experience any less daunting, at least they would have a roadmap to get them where they needed and wanted to go.

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