“I am 42 years old and was injured in a motor vehicle accident four years ago. My injury is at C7 and my wife was trained to be my caregiver during my rehabilitation. I find that lately, we are having sex less frequently and my wife has told me that she does not mind helping me with my catheter and toilet routine but she does not like sex anymore and that she sees sex just as a chore now. Please help me. We used to have such great sex!”

What you describe here is, unfortunately, a common occurrence. In the rehabilitation period it is recommended, with good reason, that the caregiver and lover should not, if at all possible, be the same person.

For most adults, pre-injury life is routine, familiar and comfortable. When your lover becomes your caregiver, significantly more tasks are added to their daily activities. Like many other aspects of life after an injury has occured, changes in views and established routines are undoubtedly necessary. Below standard caregiving may become a problem to the disabled person who finds it difficult to chastise, reprimand or discipline the lover-caregiver.

Although the couple is affected by the same injury, the problems reported tend to be self oriented. Surely then, the key to a healthy post-injury relationship centres on open communication, learning about the facts of life, post injury and a willingness to adjust one’s views in many areas?

Work together as a team to maintain equality in the relationship. This equality will help prevent lover-caregivers from becoming resentful of, or overwhelmed by, responsibilities and daily duties. Significant and meaningful contributions must come from both partners regarding everyday tasks such as parenting, various household chores and managing the household accounts .

The finances of a newly disabled person can seldom accommodate the expense of a caregiver and the spouse or lover often volunteers to be the caregiver.

Lover-caregivers start finding it difficult to perform oral stimulation or receive penetration from a penis that is now associated with urine, bladder accidents, catheters and sexual intimacy becomes a chore instead of a pleasant experience. This seems to be the stage that your wife has reached and you need to take some action to remedy the problem. If your present financial status allows it, you should contact the rehabilitation unit where you received your treatment. They will be able to put you in contact with an agency that supplies qualified and trained caregivers.

If money is a little tight at the moment, a reliable domestic worker could also be trained to perform the tasks.

If for some reason it is not possible to employ a caregiver, you and your wife need to come to an agreement whereby the tasks concerning care giving and the activities around sexual intercourse are kept apart. When you both are feeling in the mood for love, she must be able to see herself as a romantic partner and not as a caregiver. Keeping the two roles as distinct and separate as possible will help you both to avoid confusing and blurring the roles in your minds.

If possible, allocate a specific room, or area of a room, to intimacy – where no care giving tasks are ever performed. Ensure that both bladder and bowel have been voided prior to intimacy. Keep towels and cleaning materials handy then, if a bowel or bladder accident does occur, clean up and carry on.

Humour can also play a major role in improving your sexual relationship. The main purpose is to enjoy your intimacy and not to stress about it.