Sexuality is an enormous part of our character. It lies at the heart of our most intimate relationships, providing not just pleasure but a deep connection with some of the most important people in our lives. We’ve become fairly good at acknowledging and talking about the vital role of sex in a well-rounded life, at least most of the time. But when it comes to sexuality in the final stages of life, when one of the partners is consciously facing death, even the frankest of us will find it difficult to discuss the situation openly. But that kind of nervousness about approaching the subject is doing a disservice to patients who are terminally ill – and doctors ought to do more to raise the issue in a clear and honest way.
After all, end of life care aims to give patients a fulfilling, dignified way of approaching death, one that leaves their last days as satisfying as possible.For reasons of fatigue, pain, and lack of privacy, it’s difficult for terminally ill patients to maintain an active sex life. But cutting sex out of the last weeks of a patient’s life isn’t just depriving them of an enjoyable experience – it’s potentially damaging their relationship with their partner, one that is often already under strain as the disease takes its course. Partners often find that they take on the role of carer rather than lover towards the end of the patient’s life, and that can be distressing – it’s surely preferable that both maintain as normal a relationship as possible, right to the end. It’s the damage that the loss of sexuality does to quality of life for the terminally illthatmakes itso important for doctors to have an open conversation about the subject, even if they feel uncomfortable doing so.
And when that conversation does happen, it can make a real difference. Take the problem of privacy, for example. Patients are rarely left totally alone in their last days. While a carer need not be physically presentat all times, providing palliative care is a job that requires regular ‘popping in’ – and anyone would feel uncomfortable trying to be sexual when someone could walk into the room at any minute. Making it clear that patients and their partners can close the door when they need to, and respecting that a closed door shows a desire for privacy, can go a long way towards solving this problem.
Or think about pain. Often the pain itself is not the problem – though any discussion of the palliative regime should provide space for patients to be both free of pain and lucid enough to engage in sexual activity, if they wish. The real difficulty is that partners are often worried about being sexual with the patient because they’re worried that the patient will get hurt. This can be resolved by having a frank discussion with the doctor – often it’s perfectly possible to have painless sex even in your last days, especially when advice is taken on alternative positions which are well-suited for such situations. And remember that physical intimacy can take a variety of forms – some patients and their partners may like to kiss or touch each other, or simply lie in the same bed together.
These aren’t problems that could be or need to be treated with new medical technology, or some extra piece of knowledge we don’t already have. At the heart of the difficulty is the reticence of all of us about sex in our final days. Doctors must make more of an effort to be open with patients, so that solutions can be found for any worries they might have. Of course, many won’t feel comfortable being actively sexual anyway, and there’s nothing wrong with that. But for those who do still want to continue their sex lives, and are being held back by difficulties which can be easily managed, it’s essential that they can have that discussion.