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SEX,
FATIGUE AND DEPRESSION
by
Stanley Ducharme, Ph.D.
For
men and women with spinal cord injury, difficulties with
sexual functioning are often linked to neurological problems.
Erectile problems, difficulty in ejaculation, insufficient
lubrication for women and an inability to achieve orgasm
often are associated with level and completeness of the
spinal cord injury. Although neurological issues may in
fact be important factors, these may not always be the only
reason for poor sexual functioning. The problem may be far
less complicated. All too often, fatigue and depression
are common causes of sexual distress for both men and women.
Yet, we don’t often associate these conditions with
sexual health.
Fatigue
is probably epidemic among people with spinal cord injury
and their partners. Activities of daily living, longer daily
schedules, work/school related pressures and family/home
obligations take a tremendous amount of time, energy and
effort. In addition, societal expectations to postpone or
even skip sleep have increased in recent years. As if this
were not sufficient, there is also the erroneous belief
that we need less sleep as we grow older. As a result, many
of us go through our days feeling tired. We never seem to
feel fully rested and refreshed.
Many
people, especially men, feel that they should be able to
function sexually at any time. Many people feel that sexual
functioning has little to do with how they are feeling or
how tired they are. Nothing could be further from the truth.
As we grow older, fatigue becomes an increasingly important
issue in how our bodies will function. Over age 30, physiologic,
neurological and hormonal deterioration are facts of life.
This deterioration tends to increase more rapidly as the
individual becomes older. The sexual responses become slower
and often require more stimulation than in early life.
Coupled
with fatigue, these gradual physical and hormonal declines
can push a man or woman with spinal cord injury over the
edge in terms of sexual abilities. Fatigue can intensify
sexual dysfunction regardless of other etiology. It can
exacerbate both the effects of the aging process and the
spinal cord injury. Thus, neurological factors can appear
more sexually disabling and more pronounced than they actually
are. When fatigued, the man who typically can achieve an
erection may not be able to do so. The woman who can have
multiple orgasms may find it difficult to become aroused.
In many ways when fatigued, our sexual abilities become
less predictable.
A
man or woman who made love twice or three times on a weekend
at age 25, may find themselves in a very different situation
at age 50. Sometimes, the mental desire may be there, but
the body just won’t cooperate. Having sex following
dinner and a video on a Friday night may be problematic
after a tiring and busy week. Keeping up with a younger
partner, trying to meet unrealistic sexual expectations
or trying to prolong youth in an unrealistic manner can
produce fatigue and sexual frustration. Fatigue such as
this is incompatible with good sexual performance.
Depression
can be another factor influencing our sexual performance.
Although recent studies have shown that depression is no
more prevalent in people with SCI than in the general population
(1), it can reduce sexual drive and blunt sexual interest.
Depression can reduce energy levels and make it more difficult
to achieve optimal physical and sexual functioning. Becoming
sexually aroused is difficult if the individual is feeling
depressed. Fully enjoying sex may be impossible under these
conditions.
Further
complicating the effects of depression is the fact that
many of the newer anti-depressants also have profound side
effects that can negatively impact sexual abilities. Commonly
used anti-depressants such as Prozac, Zoloft, Wellbutrin,
Pacal and others can influence sexual abilities in a number
of ways. This family of medications, known also as SSRI’s,
can reduce sexual interest, decrease the ability to achieve
erections, reduce vaginal lubrication, prohibit male ejaculation
and diminish the capacity for orgasm in both men and women.
As with fatigue, depression and anti-depressant medications
can intensify the neurological disruptions that affect sexual
performance.
When
fatigue and depression are present, a number of considerations
may be worthwhile. Although it may limit spontaneity, enjoy
sexual activities when you are well rested and refreshed.
Many doctors, in fact, believe that sexual activities in
the morning can be more satisfying. Nighttime oxygenation
of the genitals and nocturnal erections often mean better
sexual functioning earlier in the day. Later in the day,
try a short nap before making love. If making love in the
evening, try having sex before eating a heavy meal or before
drinking alcohol. Maximize the effects of Viagra by taking
on an empty stomach when well rested.
Be
realistic about your abilities and communicate these to
your partner. Even for men, it’s OK not to be in the
mood for sex or to realize that you are too tired at the
present time. If you are not in the mood for sex don’t
try to fake it. Be sensitive, honest and clear about your
needs and desires. Communicating these to your partner can
reduce performance anxiety and lessen the chance that your
sexual encounter will end in disappointment and frustration.
Often
fatigue and depression go hand and hand. There is no reason
to feel shame or embarrassment if you find yourself depressed.
Such feelings are commonplace in today’s society. Untreated,
depression however, can be self-defeating and potentially
dangerous. Typically, counseling and medications either
alone or in combination with one another are the most common
and effective treatments of depression. These treatments
can significantly improve appetite and sleep, restore energy
and ultimately renew sexual interest.
Although
anti-depressants medications can affect sexual performance,
your medical doctor can suggest changes in medications or
dosages to reduce unwanted side effects. For more information
on depression and spinal cord injury, the reader is encouraged
to check out “Depression: What You Should Know, A Guide
for People with Spinal Cord Injury” available through
the PVA Consortium for Spinal Cord Medicine at 1-888-860-7244
or by visiting the PVA website at www.pva.org.
(1)
Titch, Radnitz and Bauman, Depression and Spinal Cord Injury:
A Monozygotic Twin Study, Journal of Spinal Cord Medicine,
Vol. 22, No. 4, Winter, 1999, 284-287.
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