Aug. 14, 2000 -- She's 36 and happily married, with one child and another on the way. She's got an upbeat approach to life. Even after six years of marriage, her relationship with her husband is as high-voltage as when they were dating, says Samantha (not her real name).
There's a problem, though. Like 12 million adult Americans, she's asthmatic. When her energy level rises, sexually speaking, Samantha's lungs sometimes fail and her passion plummets. She can end up literally hanging over the side of the bed hacking up phlegm -- not very romantic.
"It's a bummer," Samantha says, and you know she's understating a chronic medical condition that has caused her countless hours of grief.
Physicians who treat patients with asthma -- an inflammatory condition of the airways -- tend to focus on the disease itself, adjusting and changing medications to reduce or eliminate the wheezing and breathlessness that can occur. Until recently, a physician would not be likely to ask a patient like Samantha about her sex life.
But the results of a new study suggest that physicians would be wise to begin asking asthmatic patients about their sexual functioning. The study found that two-thirds of the 353 people with asthma surveyed said their sexual activity was affected by the disease. One in five said the disease has forced them into abstinence.
Talking about the patient's sex life during an exam to evaluate the asthma could be life-saving. "Serious limitations in sexual functioning indicate that the asthma is not well-controlled," says Ilan Meyer, PhD, an assistant professor at Columbia University's Joseph L. Mailman School of Public Health, who led the study.
Meyer and a team of co-researchers at the university's Harlem Lung Center drew information from subjects whose symptoms were severe enough to send them to the emergency room. Each participant was asked to complete a quality-of-life questionnaire three weeks after visiting the ER.
Taken together, the answers paint a dramatic picture. Of the 80% who continued to have sex, 58% said asthma limited what they could do in bed. Meyer's team also found that people impaired sexually by their asthma tended to be depressed and to have little sense of control over their health, but it is unclear whether depression limited the sexual activity or the limited activity wrought by asthma led to depression.
Meyer's preliminary findings were reported in May at the 96th International Conference of the American Thoracic Society in Toronto.
What Triggers the Bedroom Attacks?
Increased physical activity during sex may cause the airways to become inflamed, constrict, and even shut down. Chronic shortness of breath may be the reason other asthma patients simply avoid sex. The place where lovemaking typically occurs (the bedroom) may contain asthma triggers for some people, the research team says. "It may be the bedding itself or dust mites in the bedroom," Meyer says. "There's also been discussion of latex-induced asthma."
The latter refers to condoms. Studies of health care providers show that a small percentage have allergic reactions to latex gloves. The same trigger that sets off a skin reaction like hives could set off respiratory problems in others, says Meyer. But due to the lack of formal studies, it's impossible to say for sure.
What You Can Do
Meyer suggests that patients with asthma speak up about any concerns they have about their sex lives if their doctors don't ask. "It shouldn't be painful or embarrassing," he says. "We cannot say asthma is well controlled unless we know it is not impacting the patient's sex life."
If "sexercise" is causing a problem, bronchodilators should be used, if prescribed by a physician. These drugs relax the muscles in the large and small airways, increasing ventilation. They can be taken as pills, liquids, inhalants, or injections, and their optimal effect is felt in about an hour. However, overuse of bronchodilators is dangerous. Check with your physician about the optimal dose and when to take it. Inhaled medications may also be prescribed for daily use for long-term control of asthma.
If the problem is environmental, Meyer says, the agent triggering the attacks should be identified. Is it the sheets, blankets, and pillows? If so, switch to allergy-proof bedding. Talk to your physician or allergist to be sure you are not overlooking some common triggers.
Four Practical Tips
Besides adjusting medicines and environmental triggers, there are other measures you can take to preserve a healthy sex life.
- Let your partner take the lead, says Paul Selecky, MD, medical director of the pulmonary department at Hoag Memorial Hospital in Newport Beach, Calif., and clinical professor of medicine at UCLA. Selecky has been a pioneer in the movement to help people with asthma enjoy satisfying sex lives. Being sexually active, he tells his patients, may require a degree of passivity. Anything causing shortness of breath is to be minimized.
- Be open to various ways of making love. "People focus on genital activity, on intercourse, but there are other ways of pleasuring each other besides penis-in-vagina," he says. Less vigorous love making, if necessary, can still be pleasurable.
- Change the time of day when you make love. Try the late morning or early afternoon, if and when your schedule allows it, Selecky says. These are the times your lungs may be functioning the best. "Generally, the medication has worn off early in the morning, and near the end of the day you're physically tired," he says.
- Avoid anything that increases pressure on the lungs. This means that the missionary position, with the woman beneath the man during intercourse, may not be a good choice for people with asthma.
Samantha has been living with her asthma and coping successfully for six years. The adjustments haven't been easy, but she's made them. No more smoking. No more red wine, which can trigger her attacks. Regular use of the proper medications (she has three inhalers). Regular planning, too. A peak flow meter, which measures breathing capacity, enables Samantha to predict attacks a day or two before they occur.
It sounds like a lot of effort, but it's not too bad, she says. "Unless I'm really ill, I don't notice the difference."
Her husband has adjusted well to the measures she takes to stay healthy and ready for romance, she says. Above all else, he wants his wife to be healthy. Having a healthy and happy partner isn't the only dividend of patience and understanding. His health has improved, too, Samantha says. "He stopped smoking in the house, in the car, and anywhere near me!" That's better for his health, as well as hers and their child's.
Scott Winokur is a San Francisco Bay Area journalist who often writes about health and human behavior.
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