Chronic Illness and Sexual Functioning: Understanding the Most Common Challenges
When most people think about chronic illness, they think of medical appointments, medications, and managing day-to-day symptoms like pain and fatigue. What often goes unspoken, but is just as real, is the impact chronic illness can have on sexual functioning and intimacy.
I know this not only as a certified sex therapist and licensed marriage and family therapist, but also as someone who personally lives with chronic illness. I understand the exhaustion, the unpredictability, and the grief of living in a body that doesn’t always cooperate. And I also know the shame and silence that can surround sexual struggles when illness enters the picture.
Through my virtual practice, I work with individuals and couples across Tennessee, Texas, Louisiana, Oklahoma, and Colorado, helping them navigate the complicated intersection of health, sexuality, and intimacy.
In this blog, I want to share some of the most common chronic health conditions that impact sexual functioning, why this happens, and how sex therapy can help.
How Chronic Illness Affects Sexual Health
Chronic illness doesn’t only affect physical health, it touches every part of life, including relationships and sexuality. Some of the most common ways I see it affect clients include:
Lowered desire from fatigue, pain, or hormonal changes.
Difficulty with arousal or orgasm caused by medication side effects or nervous system changes.
Avoidance of intimacy out of fear of pain, embarrassment, or performance struggles.
Body image concerns tied to weight changes, scars, or medical devices.
Emotional distress such as anxiety, depression, or grief that dampens desire for connection.
None of these struggles are signs of being “broken.” They are natural responses to living with illness in a world that often doesn’t talk about sexuality honestly.
Chronic Conditions Most Commonly Linked to Sexual Difficulties
While any chronic illness can affect intimacy, research and my clinical experience show that some conditions are especially likely to create sexual health challenges.
1. Diabetes
Diabetes can lead to nerve damage and reduced blood flow, which may cause erectile dysfunction in men and vaginal dryness or decreased arousal in women. Blood sugar fluctuations can also leave people feeling exhausted and less interested in sex.
2. Heart Disease
Cardiovascular conditions can limit blood flow, making arousal and orgasm more difficult. Some clients also fear that sexual activity could trigger cardiac symptoms, which increases anxiety around intimacy.
3. Chronic Pain Conditions (Fibromyalgia, Arthritis, Endometriosis)
Living with ongoing pain can make sex physically uncomfortable. Even the anticipation of pain can create avoidance. In conditions like endometriosis, pelvic pain may directly interfere with sexual activity.
4. Autoimmune Disorders (Lupus, Multiple Sclerosis, Rheumatoid Arthritis)
Autoimmune conditions often cause fatigue, pain, and flare-ups that make intimacy unpredictable. Neurological conditions like MS can also directly impact sexual functioning through nerve involvement.
5. Cancer and Cancer Treatments
Cancer itself and treatments like chemotherapy, radiation, or surgery often change how the body looks, feels, and functions. This can create both physical barriers to sexual activity and emotional struggles with self-image.
6. Depression and Anxiety
While not always thought of as chronic illnesses, mental health conditions often persist over time and deeply affect sexuality. Depression can lower desire, while anxiety can make performance and arousal more difficult. Medications for both can also contribute to sexual side effects.
7. Chronic Fatigue Syndrome / ME (Myalgic Encephalomyelitis)
Extreme fatigue, post-exertional malaise, and pain can make intimacy feel impossible. Many clients with CFS/ME struggle to reconcile their longing for connection with their body’s limitations.
Where Sex Therapy Fits In
As both a therapist and someone who knows the lived reality of chronic illness, I hold space for the grief, frustration, and shame that often surround intimacy struggles. In therapy, we work together to:
Redefine intimacy so that connection goes beyond performance or intercourse.
Develop adaptive strategies, such as planning intimacy around energy levels, using supportive pillows, or incorporating medical aids.
Address body image struggles and reclaim a sense of worth and desirability.
Strengthen communication skills so partners can talk openly about needs, limits, and fears.
Process grief and adjustment, acknowledging how illness has changed life and finding new ways to build closeness.
One of my specialties is helping individuals and couples who feel “stuck” in this intersection of health and sexuality. You don’t have to choose between caring for your health and having a meaningful sexual connection- you can have both, with the right support.
Why Telehealth Makes a Difference
For many people living with chronic illness, getting to an office appointment can feel overwhelming. That’s why I provide online sex therapy throughout Tennessee, Texas, Louisiana, Oklahoma, and Colorado. Virtual sessions allow you to access care from your home, without the added stress of travel or physical strain.
You Are Not Alone
If chronic illness has affected your sexual functioning, I want you to know: you are not broken, and you are not alone. I understand this both personally and professionally. Your body may have limitations, but your capacity for intimacy, connection, and pleasure remains it may just look different in the light of your illness.
Therapy offers a compassionate, judgment-free space to rediscover what intimacy can look like for you and your partner. With the right tools and support, it is absolutely possible to reclaim sexual connection, even in the midst of chronic illness.
If you’re ready to begin this journey, I’d be honored to walk with you.