Dear Dr. Mahler:I am having difficulty having sex with my wife. I am 57 years old, and have been married for 25 years. My doctor says that I have moderate COPD with a touch of emphysema. My COPD medications are Spiriva in the morning, and ProAir as rescue inhaler which I use 1 -2 times a day. Both help me breathe easier. I work four 12-hour days as a foreman at a gun factory, and am tired a lot of the time.It is hard to write about this, but our sex life isn’t what it used to be. I want to have sex on the weekends, but my breathing gets difficult when I get excited and my junk isn’t always ready. My doctor seems very young, and I am not comfortable talking to her about this problem. The commercials on television are interesting, but I have not tried any ED medications. Do you have any suggestions?Bill from Warren, CT
Your question – about difficulty having sex by someone who has COPD – is generally not discussed during medical training, and there is little written in the respiratory journals about your problem.
Erectile dysfunction (ED) is defined as the inability to get or keep an erection firm enough to have sexual intercourse. Although occasional ED is not uncommon, the frequency of this problem increases with age. The Massachusetts Male Aging Study (Journal of Urology, year 1994, volume 151, pages 54-61) showed that at age 40 about 40% of men have this problem, while the rate increases to 70% in men in their 70s. In the National Health and Social Life Survey (Journal of the American Medical Association, year 1999, volume 281, pages 537-544) there was a decrease in sexual desire with increasing age. Also, sexual problems were more likely in men who had poor physical and emotional health.
For someone who has COPD, sexual problems may be due to ED, breathing difficulty (shortness of breath) with sexual activity, or both. ED is more frequent and more severe in those with COPD than men of similar age but without COPD. Other medical conditions (called comorbidities) such as heart disease, high blood pressure, diabetes, depression, alcohol use, and physical inactivity may also contribute to ED. Certain medications used to treat high blood pressure and to treat depression as well as previous surgery for cancers of the prostate, bladder, and colon (that alter nerve pathways and blood flow) may also affect erectile function. These are important considerations that you should discuss with your doctor.
It is important to remember that ED can be treated depending on the underlying cause. Treatments range from counseling and lifestyle changes to drugs and surgery. If you suffer from ED, it is important to talk to your doctor so that he/she can help identify the cause of your ED and figure out the most appropriate therapy.
If COPD is contributing to your sexual problem, here are some strategies that can make your breathing easier for when you are having sex.
Be as fit and as active as possible to improve your stamina. A pulmonary rehabilitation program may be quite helpful in getting you started on exercise.
Plan to have sex when you and your partner feel the most energetic. This could be in the morning, in the middle of the day, or at night. Whatever works best for you and your partner.
Use a fan to provide a flow of air on the face to relieve any shortness of breath.
Take albuterol inhaler about 15 minutes before sex just like you would before exercise.
Consider using oxygen during sexual activity. It has been suggested that if you use oxygen when walking, then you will probably need to use oxygen during sex.
Try different positions to find out what works best for you and your partner. Try to avoid positions that put pressure on your chest which will make breathing more difficult.
Take a break during sex if your breathing becomes too difficult. Remember, your breathing increases during sex just like with physical activities.
Enjoyable sex is not only about giving and having organisms, but about intimacy.
Dr. Robert Sandhaus from National Jewish Health Center in Denver has said, “Sometimes that means coming to organism and sometimes not.”
Finally, it is important to share your feelings and thoughts with your wife and with your doctor. If you are uncomfortable talking to your primary care doctor for whatever reason, ask for a referral to a specialist who has more knowledge and experience with sexual problems in those with COPD. The
availability of ED medications starting in 1998 has made talking about sexual problems much easier.
Please let me know how things go for you.
Donald A. Mahler, M.D.
Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.