Breathlessness is often a major feature of pulmonary aspergillosis and we provide instructions on how to regain control over breathlessness on another page of ths website. Sadly breathlessness leaves many of its patients highly anxious about any exertion that may bring on the sensation of losing control again. This is a problem as exercise is a very good way to help relieve breathlessness and is one way we manage living with it.
Not surprisingly this can also have a major impact on the enjoyment of sex as sex often involves significant exertion! Thankfully the British Lung Foundation offer detailed support to help people concerned with enjoying a full sex life while having a chronic lung condition and we replicate their work here:
Sex is an important part of life for many people, and this doesn’t have to change because you or your partner has a lung condition. It’s normal to worry about getting tired or out of breath. However, both you and your partner should take responsibility for your sexual relationship, so it’s important to talk to each other about your concerns and wishes and remain open-minded.
How much energy will I need?
Sexual activity, including intercourse, oral sex and masturbation, requires energy. As with all physical activity, you will need to use your heart, lungs and muscles.
You might need to breathe more frequently and your heart rate and blood pressure might go up for a short time. This is the same for everyone. They return to normal levels quickly, so don’t worry if this happens. The energy you use during orgasm is similar to the energy needed to climb stairs or take a brisk walk.
Remember that some changes in your sex life are just part of getting older and not because of your lung condition. Slower erections and delayed orgasms are normal in middle age and later life.
There are a number of ways to be intimate with your partner that are less physically demanding, including hugging and touching.
When is the best time to have sex?
Have sex when you feel rested and your breathing feels comfortable. This is likely to be when your medication is most effective and your energy levels are not too low, so you may need to plan ahead. However, don’t change your normal habits if this is stressful for you or your partner.
Be comfortable and relaxed. If you are too cold or too hot, you won’t be relaxed. If you’re feeling stressed or tired, having sex could intensify these feelings. All of this could make your breathing more difficult.
It’s also advisable to avoid sexual activity after a heavy meal or drinking alcohol. Your breathing might be more strained if you have a full stomach and feel bloated. Alcohol can decrease your sexual function and make it more difficult for men to get an erection. This could make you or your partner more anxious.
How can I prepare for having sex?
You might want to try coughing up phlegm before you have sex, or avoid having sex in the morning when many people cough up more phlegm.
If you use an inhaler to open up your airways, called a bronchodilator, try taking one or two puffs before starting sexual activity as this may relieve shortness of breath and wheezing during sex.
Some people also find that oxygen increases stamina. If you use oxygen at home, using it before sexual activity might help to prevent you from getting short of breath.
How will my treatment affect my sex life?
Some medications can cause a decline in your sex drive or sexual function. If this is a problem for you, talk to your GP, respiratory nurse or health care professional for advice.
Using a steroid inhaler or taking steroids through a nebuliser can cause oral thrush, a type of infection in the mouth. This might make you feel less inclined to have sex or be intimate. It’s a good idea to speak to your GP, respiratory nurse or health care professional if you get a lot of thrush infections.
Some medications, such as antibiotics, might also increase the risk of genital thrush. It’s important to make sure thrush infections are properly treated, and avoid having sex until the infection has cleared up.
If you use oxygen at home, you might find that you feel self-conscious or uncomfortable using it during sexual activity. However, it is perfectly safe to have sex while using oxygen, so talk to your partner about your concerns.
Oxygen can be delivered through a tube attached to a face mask, but if you need to use oxygen while having sex you might feel more comfortable using a nasal cannula (two very small plastic tubes that are placed into each nostril, enabling you to breathe the oxygen in through your nose).
If you have been advised to use a different setting of oxygen for activity, make sure you use the oxygen at this level during sexual activity too.
Many people who use non-invasive ventilation (NIV) overnight to help them to breathe find that it affects sexual activity. However, it is perfectly safe to have sex and to be intimate while on NIV, so there is no reason why you can’t use your ventilator during sexual activity if it is suitable for you and your partner.
What if I get short of breath during sex?
All types of physical activity, including sex, can cause you to become slightly out of breath. This is nothing to be worried about, and your breathing will return to normal. Trying to relax will help.
If you become very short of breath during sex, try pausing to take some slow, deep breaths. Your GP, respiratory nurse or health care professional should be able to advise you about breathing techniques to manage your breathlessness. These often have the added benefit of helping you to relax.
As with any activity, taking regular and frequent rests can also be helpful. For example, try changing positions or taking turns with sexual activity. You should also stop to take your reliever inhaler if you need to.
It’s important to keep your diaphragm free and avoid weighing down on your chest. You might find it more comfortable to use positions that need less energy to maintain. Here are some suggestions for both heterosexual and same-sex couples:
Try both partners lying on their sides, either facing each other (example 1) or with one partner behind the other (example 2).
If you prefer one partner being on top, it might be better for the partner who has a lung condition to take the lower position, as it tends to require less activity. It’s important that the person on top doesn’t press down on their partner’s chest (example 3).
You could try one partner kneeling on the floor, bending over with their chest resting on the bed (example 4).
One partner sitting on the edge of the bed with their feet on the floor, with the other kneeling on the floor in front, might be comfortable (example 5).
Finally, remember that holding each other, hugging, kissing and caressing can also be fulfilling expressions of love and affection, and require less energy (example 6).
All forms of intimacy should be enjoyable and fun, so having a sense of humour and being able to laugh with your partner will help. Talking about any difficulties either you or your partner is experiencing is also important. Be prepared to try different ways to express your affection and tell each other what feels good.