PH and your sex life

This section discusses in more detail how having PH can affect sexual activity and provides advice and tips on how to maintain a fulfilling sex life.

Small changes, big results

Having a fulfilling and meaningful relationship really does start with good communication. Good sex requires sensitivity on both sides. In the context of the physical part of relationships it is helpful to take the time to tell your partner what it is that arouses you. Listen to what they like too. Making small changes can make a significant difference to the quality and frequency of your lovemaking.

Breathlessness and fatigue

Breathlessness and fatigue are the most common symptoms of PH and can obviously have a big effect on sex. Sex is an energetic activity. During sex your heart rate and breathing will typically increase and it may take some time for normal levels to return. This process can be exaggerated for people with PH, who may become much more breathless during sexual activity and take much longer to recover afterwards.

One of the biggest problems for people with PH is fatigue. Sometimes fatigue during sex can be more of an issue than breathlessness. Energy levels can become quickly depleted with only a little exercise. What we often consider as traditional sex acts, such as intercourse, might prove very difficult or impossible. But remember that this does not mean that satisfying sex is no longer possible; it just means that you may need to change your approach a little.

If you don’t find sex either satisfying or fulfilling – but more like running a marathon – you may start to ask yourself, ‘why am I bothering at all?’ It can be hard to view sex as an enjoyable act when it just leaves you feeling utterly exhausted.

It’s all in the timing

One solution is to have sex at a time when your breathing and energy levels are at their best – perhaps in the morning or early afternoon. Also consider finding time for sex shortly after taking your medication. This will be when the positive effects of your treatments are more pronounced. If you use oxygen, you may find taking it just before, or using it during sex, is beneficial. Don’t be afraid to let your partner know the times you are feeling at your best.

Know your limits

However well you choose the time and place, and whatever position you adopt, there may be times when you feel very short of breath or very tired during sex. It could be on a particularly hot day or you may have forgotten to take your medication – or perhaps enthusiasm just gets the better of you. Either way, it’s important that you know what your limits are and stick to them.

You should also let your partner know you need to stop so that you can catch your breath. Pausing for a moment shouldn’t spoil the moment – but don’t be hurried into continuing until you’re sure you’re ready. Remember, your partner may not be able to tell whether you are gasping with pleasure or because you cannot breathe properly. Often simply slowing down will allow you to recover enough to continue. If in doubt, take a breather.

You PH treatment and sex

It’s not only the symptoms of PH that may have an effect on your sex life.; your treatments may have an impact too. If you are taking a prostaglandin, e.g. Epoprostenol (Flolan) and have to wear a pump and a catheter, you will have to be careful and choose positions where the pump and so on will not be in the way. If you need oxygen during sex, you will have to take into consideration the tubing and position of the oxygen cylinder or concentrator.

Some treatments may cause side effects such as nausea, headaches, palpitations and a general feeling of being unwell. These side effects may not be present all the time, but if you get them, the last thing on your mind may be sex. Talk to your PH specialist if the side effects of your treatments are becoming very troublesome and are affecting your quality of life. They may be able to give you a different treatment.

Sexual positions

Some sexual positions may be difficult or uncomfortable for people with PH. It is important that you avoid using sexual positions that put weight on the chest. Being able to breathe freely during sex is obviously very important, especially for people with PH, who become more breathless during sexual activity. The ‘missionary position’ is a poor choice unless necessary steps are taken to support the weight of the person on top.

The following position suggestions are for heterosexual couples but the same principles can be applied to same-sex couples. The idea is to ensure that the person with PH has no pressure on their chest and can breathe freely during sex, so the following positions may be more appropriate:

Of course, the best and most enjoyable way to find out what suits you both is to experiment – as much as possible! And don’t forget you don’t have to stay in the same position all the time; you can change whenever you like. Changing positions frequently has the added advantage of avoiding undue stress being placed on any one area of your body.

Assistive aids

Did you know that your bedroom is probably already full of useful ‘’props’’ that can make lovemaking more comfortable and relaxed for both you and your partner? The more comfortable you are, the less energy you have to use to fully enjoy sex – and the less likely you are to become very breathless.

Pillows, towels or even rolled-up duvets can be used for support during sex. They can be placed to make penetration easier and reduce the weight burden of intercourse. You could even try warming the towels first to make it even more sensual!

Be imaginative

Having sex doesn’t have to be all about conventional penetrative sex. There are many sexual acts that you can enjoy, which can both satisfy your sexual appetite and strengthen an emotional bond between you and your partner. If penetrative sex makes you too breathless, using sexual aids such as a vibrator or other ‘toys’ can be a good way to enjoy sexual acts together.

Know your limits

However well you choose the time and place, and whatever position you adopt, there may be times when you feel very short of breath or very tired during sex. It could be on a particularly hot day or you may have forgotten to take your medication – or perhaps enthusiasm just gets the better of you. Either way, it’s important that you know what your limits are and stick to them.

You should also let your partner know you need to stop so that you can catch your breath. Pausing for a moment shouldn’t spoil the moment – and don’t be hurried into continuing until you’re sure you’re ready. Remember, your partner may not be able to tell whether you are gasping with pleasure or because you cannot breathe properly. Often simply slowing down will allow you to recover enough to continue. If in doubt, take a breather.

Sexual health

Although having PH may affect your ability to have sex, it’s important to remember that having PH offers absolutely no protection from pregnancy and sexually transmitted infections. Just like everyone else, it is crucial that you take your own sexual health seriously. The sexual health section of the NHS Choices website (www.nhs.uk) can guide you through many of these issues.

Pregnancy can be dangerous for women with PH.  Not only does pregnancy put an enormous pressure on the body, but some of the treatments for PH can be harmful to a developing baby.

Contraception can be a difficult and embarrassing subject to raise, especially with a new partner, but it should be discussed as soon as possible. Contraception should be thought about carefully in people with PH. Some PH treatments can make some types of contraception much less effective and certain types of oral contraceptive could even make your PH worse.

You can find out more about contraception and PH by clicking here.

We have emphasised that having PH need not mean the end of your sex life. However, whether you are heterosexual, gay, bisexual or transgender, PH does not reduce your responsibility to take your own sexual health seriously. If you have concerns about your sexual health, the responsible approach would be to get it checked out. Going to your local sexual health clinic (sometimes it’s called genitourinary medicine, or GUM, clinic) is the right thing to do. They offer confidential assessments and treatments that are not shared with your other healthcare providers such as your GP or PH centre.