We die as we have lived, and if sexuality and intimacy has been a part of your life, then it stands to reason it will also be an important part at the end of your life. There may be a reluctance to discuss intimacy during a time when we are faced with our own mortality – despite sadness, exhaustion, or other symptoms, there is still opportunity to establish deep intimacy and connection.
💖 Of note, although not everyone will face these challenges, there is a need for sensitivity to cultural beliefs around sexuality, possible past infidelity, trauma, abuse, or assault. Consideration needs to include whether a person is capable of giving consent for sexual activity (i.e. due to meds, disease process). Seeking help from a social worker/counsellor to navigate through feelings that potentially interfere with intimacy, may be helpful.
💖 With the illness of a partner, the couple face the fact that their time as a couple is limited, disconnection does not need to happen with the diagnosis and progression of an illness.
💖 Healthcare providers may feel if an issue is important, the patient will bring it up. However, research reveals if topics aren’t addressed as appropriate to speak about by medical providers, the patient will likely avoid the topic.
💖 Medical providers addressing possible sexual issues as part of the course of a disease may give patients the confidence to discuss any issues they may be having. Importantly, if sexuality and intimacy are addressed during the palliative and end of life stages, these issues will be less likely to be unresolved during future bereavement.
💖 Health professionals can address side effects of treatment or disease that cause impotence or lack of orgasm, by suggesting and prescribing hormone treatments or drugs like Viagra. As Dr. Adrian Tookman, Medical Director at the Marie Curie Hospice in the UK notes: “A drug like Tamoxifen, which is used to treat breast cancer, can lead to anorgasmia” (inability to achieve orgasm). “When I explain that, it helps people understand the changes are nothing to do with them personally and that it’s not because of their relationship.”
💖 Intimacy can be defined in different ways, including:
PHYSICAL (e.g. touch, massages, music)
MENTAL (e.g. shared values & interests, meaningful conversation)
EMOTIONAL (e.g. caring for other’s feelings, affirming)
SPIRITUAL (e.g. respect for the other’s beliefs, shared purpose)
💖 Research indicates that hearing is the last sense to go; feel free to whisper I love you, I’m here for you, I’ll miss you, in your loved one’s ear. Similarly, the sense of touch has been thought to be felt long after apparent unconsciousness. Check with your loved one what their preferences are (some people don’t like their feet being touched, for example) and offer reassuring touch.
💖 Openness and understanding that accompanies intimacy allows for the opportunity to reminisce about how people became part of each others’ lives. “And in the end, the love you take is equal to the love you make.” (The Beatles, The End, Abbey Road, 1969.)
💖 Encouragingly, ‘Cuddle beds’ (two hospital beds pushed together) have been purposely built in two Australian Hospitals (April 2019) to facilitate physical closeness and connection at end of life. The beds have been used by families, couples, parents and grandparents with their children and grandchildren.
Variation on the Word Sleep by Margaret Atwood (Selected Poems II: 1976-1986)
I would like to watch you sleeping, which may not happen.
I would like to watch you, sleeping. I would like to sleep
with you, to enter your sleep as its smooth dark wave slides over my head
and walk with you through that lucent wavering forest of bluegreen leaves
with its watery sun & three moons towards a cave where you must descend,
towards your worst fear
I would like to give you the silver branch, the small white flower, the one word that will protect you
from the grief at the center of your dream, from the grief at the center.
I would like to follow you up the long stairway again & become the boat
that would row you back carefully, a flame in two cupped hands
to where your body lies beside me, and you enter it as easily as breathing in
I would like to be the air that inhabits you for a moment only.
I would like to be that unnoticed & that necessary.
💖 Life-limiting illness and the time at end of life invites us to notice the opportunities for connection and intimacy, that we may have been too busy to notice before the diagnosis.
💖 In grief and bereavement, be aware of your vulnerability and take the time you need before embarking on a new relationship. Intimacy requires trust and emotional connection, which is more difficult to establish in a vulnerable state like bereavement.
You may wish to find more info at these references:
– virtualhospice.ca (Offers articles, research, and recommendations on a wide range of topics, e.g. Dr. Anne Katz research around sexuality and intimacy.)
– joanprice.com (An advocate for ageless sexuality, described as “the wrinkly sex kitten”, includes blogs about self-pleasure.)
“Why are we still afraid of talking about sex at end of life?” mariecurie.org.uk/intimacy-terminal-illness
By Matt Bowskill, January 15, 2019.
“At Life’s End, the Gift of Intimacy” wbur.org/cognoscenti/palliative-care-dying
By Ashwini C. Bapat, May 14, 2019.
“His Beautiful Death” moderloss.com.
By Mira Simone Etlin-Stein, a Toronto writer, Instagram: @newmoonmira, February 12, 2020.