People reaching the end of their lives often still have sexual needs and desires. Sometimes it’s difficult to fulfill them, but adjustments can be made. Here are some common obstacles:

Lack of privacy. Many terminally ill patients are in nursing homes, hospitals, or inpatient hospice centers. They may share the room with another patient and have doctors and family members coming in and out of the room at all hours.

Some facilities allow time in a private room for intimacy. Or, they might provide a “do not disturb” sign for the door, which must be respected by all staff members and visitors. Partners may be allowed to lie down with the patient.

If patients are at home, their beds may be moved to a more public area, such as a living room, where it is easier for health aides and family members to visit. In this case, patients and partners may need to enforce their private time.

Pain, fatigue. Sex may be painful for some patients. Or, they may just be too tired for sex. Their partner might feel fatigued from the stresses of caregiving as well. Making adjustments can help. For example, if pain or flexibility is a problem, trying different positions or sexual activities, or using pillows as supports, may make sex more comfortable. If fatigue is an issue, intimacy might be planned for when a patient is feeling his or her best, such as when certain medications are most effective.

Couples may need to revise their expectations. Perhaps they can’t have intercourse like before, but they may still gain satisfaction from touching, massage, or just holding one another. Some partners take part in the patient’s physical care and activities like bathing can provide opportunities for intimacy.

Body changes. It’s not uncommon for patients to feel self-conscious about changes in their bodies. They may have surgical scars and fear that their partner will no longer find them attractive. They may have catheters or a colostomy pouch to manage. Often, healthcare personnel can provide tips for these issues, such as changing the lighting or wearing a shirt.

Depression. Patients and partners alike may become depressed, leading to strain in their relationship and sexual difficulties. Talking openly about their feelings is one way to work through depression. Couples may also benefit from counseling by a therapist trained in end-of-life care.

Sexual dysfunction. Illness or its treatment can lead to sexual dysfunction. Medications may also have sexual side effects. Many sexual dysfunctions can be treated, so it’s important for patients to discuss any problems with their doctor. Changing or eliminating a particular medication may help.

Communication, among patients and their partners and with healthcare providers, is important. Some healthcare providers don’t perceive sexuality as important to people at the end of their lives. The patient and/or partner may need to speak up to make sure sexuality is addressed.